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The American Journal of Managed Care May 2019
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Producing Comparable Cost and Quality Results From All-Payer Claims Databases
Maria de Jesus Diaz-Perez, PhD; Rita Hanover, PhD; Emilie Sites, MPH; Doug Rupp, BS; Jim Courtemanche, MS; and Emily Levi, MPH
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Producing Comparable Cost and Quality Results From All-Payer Claims Databases

Maria de Jesus Diaz-Perez, PhD; Rita Hanover, PhD; Emilie Sites, MPH; Doug Rupp, BS; Jim Courtemanche, MS; and Emily Levi, MPH
This paper describes a replicable process for standardizing disparate databases and methods to calculate cost and quality measures within and across states.

Objectives: To describe how all-payer claims databases (APCDs) can be used for multistate analysis, evaluating the feasibility of overcoming the common barrier of a lack of standardization across data sets to produce comparable cost and quality results for 4 states. This study is part of a larger project to better understand the cost and quality of healthcare services across delivery organizations.

Study Design: Descriptive account of the process followed to produce healthcare quality and cost measures across and within 4 regional APCDs.

Methods: Partners from Colorado, Massachusetts, Oregon, and Utah standardized the calculations for a set of cost and quality measures using 2014 commercial claims data collected in each state. This work required a detailed understanding of the data sets, collaborative relationships with each other and local partners, and broad standardization. Partners standardized rules for including payers, data set elements, measure specifications, SAS code, and adjustments for population differences in age and gender.

Results: This study resulted in the development of a Uniform Data Structure file format that can be scaled across populations, measures, and research dimensions to provide a consistent method to produce comparable findings.

Conclusions: This study demonstrates the feasibility of using state-based claims data sets and standardized processes to develop comparable healthcare performance measures that inform state, regional, and organizational healthcare policy.

Am J Manag Care. 2019;25(5):e138-e144
Takeaway Points

This study’s results demonstrate the feasibility of assessing healthcare performance within and across states using rich data sources.
  • State-level claims data sets can be standardized to support the development and measurement of comparable metrics to assess performance within and across states.
  • The development of the Uniform Data Structure file format led to the success of the project and can be scaled across populations, measures, and research dimensions.
  • Building relationships among contributors, administrators, and users can increase the likelihood that all-payer claims databases can be leveraged to improve value in healthcare.
In the absence of robust clinical registries, administrative claims represent an important source of information about healthcare delivery in the United States; this is especially true for commercially insured populations for whom public databases are unavailable.1 Claims data sets are relatively inexpensive to develop and span across time and healthcare settings.2

All-payer claims databases (APCDs) systematically collect healthcare claims data, such as medical, pharmacy, eligibility, and provider data, from several payer sources.3 Through a variety of use cases, these data sets promote transparency and, therefore, help to inform policy development, quality improvement, public health, healthcare services research, and consumer choice.4,5 With liberalized data use policies, APCDs could support a variety of stakeholder efforts to obtain a clearer picture of healthcare cost, quality, and utilization across states or regions.3

Although APCDs and multipayer claims databases (which we refer to collectively as APCDs) are rich healthcare data sources, the opportunity to leverage them for cross-state analysis has only been realized through multistate collaborations.6 Furthermore, regional APCDs provide more than just data; the organizations that administer databases bring connections with local stakeholders, including health plans, providers, employers, state policy makers, and consumers, who provide context to the data and offer a forum in which to test assumptions and generate hypotheses. Combining these rich data sources with those insights is likely to increase the value of research conducted using APCDs. Using the APCDs to engage key stakeholders in the analytical process may also increase their interest in the findings and pave the way from dissemination to action.7

As researchers explore the use of APCDs for multistate analysis, the lack of standardization across those data sets frequently emerges as a potential barrier.5 In this paper, we report a method that can be used to overcome this lack of standardization.

The Network for Regional Healthcare Improvement and 4 of its Regional Health Improvement Collaborative (RHIC) members in Colorado, Massachusetts, Oregon, and Utah partnered with the National Bureau of Economic Research (NBER) and Harvard University in the Comparative Health System Performance Initiative Study funded by the Agency for Healthcare Research and Quality (AHRQ).8 AHRQ funded 3 Centers of Excellence to study how healthcare systems promote evidence-based practices in delivering care. The work described in this paper is an output of Project 2, a subset of projects being facilitated through the NBER Center of Excellence. The goal of Project 2 is to better understand the cost and quality of healthcare services across delivery organizations.

In support of Project 2’s aims, this paper describes the steps used by the 4 state partners to develop standardized data sets, produce comparable cost and quality measurement, and share a path forward for others. The methods described test the feasibility of this approach by producing comparable data sets that can be used in more comprehensive future studies. To our knowledge, this is the first time that regional APCDs have been used to comparatively study quality measures across states.5


This paper provides an account of the process followed to produce descriptive healthcare quality and cost measures across and within states using commercial claims data from regional APCDs.

Data Sources

Commercial APCD data were used from Colorado, Massachusetts, Oregon, and Utah for calendar year 2014. APCDs consist of submissions from payers of member eligibility, healthcare service claims, and provider information for a population of members (Table 1).

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