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Medical Care

Harnessing State APCDs for Healthcare Insights

2024-12-05

State All Payer Claims Databases play a crucial role in providing valuable insights into our healthcare system. These databases offer a wealth of information that can help policymakers, regulators, and various stakeholders make informed decisions. With the ability to monitor coverage, utilization, and costs across different payer groups and time periods, APCDs are a powerful tool for understanding and improving healthcare. As of now, at least twenty-one states have established APCD programs at different stages of maturity. As more states invest in APCDs, it is essential to learn from peer states and address local data needs. The federal government also has a significant role to play in enhancing the utility of APCDs and building state capacity for healthcare market oversight. This brief presents a blueprint and recommendations for establishing, supporting, and improving APCDs.

Unlock the Potential of APCDs for Better Healthcare

Monitoring Healthcare with APCDs

APCDs enable the monitoring of health care coverage, service utilization, health needs, and cost trends across Medicaid, Medicare, and commercially-insured populations. This comprehensive view allows for a better understanding of how the healthcare system is performing and where improvements are needed. For example, by analyzing data from APCDs, policymakers can identify areas where coverage gaps exist and take steps to address them. They can also track changes in service utilization over time and assess the impact of different policies on healthcare costs.Another aspect is the ability to monitor health condition prevalence and outcomes. APCDs provide valuable information on disparities in health conditions and help identify areas where interventions are needed to improve health equity. This data can be used to develop targeted strategies to address specific health issues and ensure that all populations have access to quality healthcare.

Identifying Health System Inequities

APCDs are instrumental in identifying inequities in health system access and use. By analyzing data on service utilization and coverage, policymakers can identify populations that may be facing barriers to accessing healthcare. This information can be used to develop targeted outreach and enrollment efforts to ensure that everyone has equal access to necessary services.In addition, APCDs can help identify disparities in health condition prevalence and outcomes. By comparing data across different payer groups and regions, policymakers can identify areas where certain populations are at a higher risk of developing certain conditions or experiencing poorer health outcomes. This information can be used to develop targeted interventions and improve health outcomes for these populations.

Supporting Regulatory Oversight

APCDs play a crucial role in supporting regulatory oversight of payers and providers. They provide valuable information on network adequacy, mental health parity, and the cost impact of industry consolidation. This data helps regulators ensure that payers and providers are meeting their obligations and that the healthcare system is operating efficiently.For example, by monitoring network adequacy, regulators can ensure that patients have access to a sufficient number of providers within their network. This helps prevent patients from having to travel long distances to receive necessary care and improves access to healthcare. APCDs also provide information on mental health parity, ensuring that patients with mental health conditions receive equal coverage and treatment as those with physical health conditions.

Identifying Health System Failures

APCDs are valuable in identifying health system failures such as coverage disruptions, excessive cost growth, service price variation, and preventable emergency department visits. This information helps policymakers and healthcare stakeholders develop appropriate policy responses to address these issues.For instance, by identifying coverage disruptions, policymakers can take steps to ensure that patients have continuous coverage and avoid gaps in care. Excessive cost growth can be addressed by analyzing cost trends and identifying areas where costs can be reduced without compromising quality. Service price variation can be monitored to ensure that patients are not being charged significantly different prices for the same services. Preventable emergency department visits can be reduced by addressing underlying health issues and improving access to primary care.

Providing Information for Decision Making

APCDs provide purchasers, payers, and consumers with health service cost and quality information to make informed health coverage purchasing and network design decisions. This data allows these stakeholders to compare costs and quality across different providers and plans and make choices that are in line with their needs and preferences.For example, purchasers can use APCD data to negotiate better contracts with providers based on cost and quality metrics. Payers can use this information to design more cost-effective networks and ensure that patients are receiving high-quality care. Consumers can use APCD data to make informed decisions about their health coverage and choose plans that offer the best value for their money.As APCDs spread nationally, it is essential that the federal government takes steps to enhance their utility and build state capacity. This includes establishing national APCD data standards, procuring a national claims data clearinghouse and centralized analytic infrastructure, providing structured financial support for State APCDs, and establishing APCDs in alignment with best practices. By doing so, the federal government can ensure that APCDs are used to their full potential and contribute to the improvement of healthcare across the country.Click here to read the full recommendations. The paper was authored by The Leukemia and Lymphoma Society and Manatt Health with support from Arnold Ventures and the input of state APCD agency leaders.i Manatt Health analysis of information provided by the APCD Council and via interviews with APCD Council co-chairs Norm Thurston and Jo Porter.

On Wednesday, the Supreme Court engaged in oral arguments regarding United States v. Skrmetti. This lawsuit pertains to Tennessee's bill, SB1, which prohibits gender-affirming care for minors. Alabama had passed a similar bill, SB184, in 2022 and it came into effect a year later following a ruling by the 11th Circuit Court.

Protestors' Voices and Conservative Stances

Outside the Supreme Court Building on Wednesday morning, protestors passionately shared how access to gender-affirming care had saved their lives and those of their transgender children. Meanwhile, at a dueling event, conservative activist and media personality Matt Walsh declared, "We are not going to rest until every child is protected and trans ideology is entirely wiped from the earth."Both SB1 and SB184 criminalize providing specific medical treatments to transgender minors while allowing the same treatments for other purposes. The Alabama law specifically targets treatments "for the purpose of attempting to alter the appearance of or affirm the minor's perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor's sex."In recent months, Republicans have repeatedly targeted transgender people and gender-affirming care in an attempt to gain political points. President-elect Donald Trump ran campaign ads suggesting Kamala Harris "is for they/them," and in September, Alabama Attorney General Steve Marshall filed an amicus brief arguing that employer healthcare plans should not be required to cover necessary gender-affirming care.South Carolina Congresswoman Nancy Mace has remained in the headlines by directly attacking Congresswoman-elect Sarah McBride, who will be the first openly transgender member of the House. Mace also introduced federal "bathroom bills," legislation that makes it illegal for transgender people to use the bathroom matching their identity. Alabama state representative Susan DuBose has promised to champion similar legislation during the upcoming session.

The Case for Applying Strict Scrutiny

Over more than two hours on Wednesday morning, U.S. Solicitor General Elizabeth Prelogar and ACLU attorney Chase Strangio made a compelling case for applying strict scrutiny to SB1. Prelogar pointed directly to the text of SB1, explaining why the court should view the law as sex-based discrimination. She said, "It says you can't have these medications to live or identify in a manner inconsistent with your sex. That is quintessentially imposing sex-based rules and expectations on adolescents in the state.""The legislature was quite upfront that part of the interest here is in ensuring that minors appreciate their sex and not become disdainful of their sex, or as Judge White put in dissent below, that they look and live like boys and girls," Prelogar continued.The liberal justices generally seemed to side with Prelogar's arguments, but the conservative justices were more skeptical. Justice Samuel Alito repeatedly referred to recent restrictions on gender-affirming care in European countries, despite those being less extensive than those in Tennessee and Alabama, and cited the Cass Review multiple times. An independent report commissioned by the UK's National Health Service, the Cass Review, questioned existing research on transgender healthcare and recommended further restrictions.However, the Cass Review has faced harsh criticism from other experts in the field. In one report, critics claimed the review "repeatedly misuses data and violates its own evidentiary standards by resting many conclusions on speculation." And earlier this year, two UK gender clinicians alleged that the lead author, Hilary Cass, was personally opposed to gender-affirming care and recommended people read the controversial anti-transgender book Irreversible Damage before she began working on the report.

Comparisons to Loving v. Virginia

During the oral arguments, Justice Ketanji Brown Jackson repeatedly compared the case to Loving v. Virginia, the 1967 Supreme Court case that struck down bans on interracial marriage. Jackson even told Prelogar at one point that she wondered "whether Virginia could have gotten away with what they did here by just making a classification argument the way that Tennessee is in this case."Justice Elena Kagan was also skeptical of Rice's arguments on behalf of Tennessee, calling it "a dodge to say that this is not based on sex—it's based on medical purpose—when the medical purpose is utterly and entirely about sex."During Rice's time speaking before the court, he repeatedly discussed "detransitioners," people who identified with a different gender and then changed their minds, and questioned the benefits of transitioning. "And the question of how many minors have to have their bodies irreparably harmed for unproven benefits is one that is best left," he began saying at one point.Justice Sonia Sotomayor quickly interrupted, saying, "I'm sorry, counselor. Every medical treatment has a risk. There is always going to be a percentage of the population under any medical treatment that's going to suffer a harm."Like Rice, Chief Justice John Roberts seemed inclined to believe that legislative bodies, rather than the courts, should make decisions about the proper regulation of gender-affirming care.Jackson pointed out that she believes the court must adjudicate potential unconstitutional legislation, stating, "I understood that it was bedrock in the equal protection framework that there was a constitutional issue in any situation in which the legislature is drawing lines on the basis of a suspect classification."The Supreme Court is expected to issue a ruling on United States v. Skrmetti by some time next summer. Legal experts generally concluded after listening to the oral arguments that there is likely a majority on the court in favor of upholding the Tennessee law.

The healthcare sector is on a remarkable journey of transformation, using contact opportunities to reshape the entire healthcare landscape across the nation. This transformation is driving healthcare organizations to form crucial partnerships, aiming to support the implementation of advanced technical services such as IT. By doing so, they continue to modernize the healthcare environment.

Discover the Trends at the 2024 Healthcare Summit

On December 11th, at the Potomac Officers Club's 2024 Healthcare Summit, gain a profound understanding of the trends that are transforming the healthcare industry. This event will bring together healthcare professionals, industry luminaries, and thought leaders who will speak about the future of healthcare as the industry strives to advance operations and patient care. With the event just around the corner, secure your ticket now and be a part of this significant gathering!

CIO-SP4 - Transforming Healthcare with IT Services

The National Institutes of Health is all set to launch the fourth phase of an IT services acquisition contract. This contract is designed to meet the federal government agencies' health data technology requirements. With a potential value of $50 billion through the CIO-SP4 contract, the NIH will focus on advancing ten key IT-associated task areas. These include providing IT services for biomedical, health sciences, and healthcare research, offering chief information officer support, delving into digital media, exploring outsourcing options, ensuring IT operations and maintenance, providing integration services, enhancing infrastructure services and protection assurance, establishing digital governance, implementing enterprise resource planning, and developing software. The NIH has extended the CIO-SP3 contract until April to ensure the continuity of services during the initial award of the CIO-SP4.

By focusing on these ten key areas, the NIH aims to bring about significant advancements in healthcare through the power of IT. This contract will not only enhance the efficiency and effectiveness of healthcare operations but also pave the way for innovative research and improved patient care.

For example, in biomedical research, the IT services will enable researchers to access and analyze vast amounts of data more efficiently, leading to faster discoveries and better treatments. Chief information officer support will ensure that the IT infrastructure is well-managed and aligned with the healthcare organization's goals. Digital media will help in disseminating health information more effectively to patients and the public.

NIAID Professional, Scientific & Technical Support Services - Fueling Research

The Department of Health and Human Services is in search of professional, scientific, and technical services to support the National Institute of Allergy and Infectious Diseases' upcoming research priorities. Under a potential $3 billion contract, HHS aims to provide support in significant research efforts such as transitional research, clinical research, vaccine research, general laboratory research, veterinary research, and scientific research.

Government contractors will offer their services in various fields like microbiology, molecular biology, biochemistry, infectious diseases, immunology, bioinformatics, and vaccine research. These services will help in improving the understanding of immune responses and in producing new vaccine targets for HIV and AIDS. This will have a profound impact on the fight against infectious diseases and the improvement of public health.

For instance, in microbiology research, the contracted services will enable scientists to study the behavior and characteristics of microorganisms more closely, leading to better insights into infectious diseases. In bioinformatics, the analysis of large datasets will help in identifying patterns and trends that can aid in the development of new vaccines and treatments.

ACF's Contracting Support - Meeting Mission Needs

The Administration for Children and Families within HHS is seeking to provide contracting support to fulfill its mission needs. Through the ACF's specialized contracting and procurement directorate under government contracting services, the agency will leverage contracting assistance for numerous partners including the Immediate Office of the Assistant Secretary, the Office of Human Services and Emergency Preparedness and Response, and the Office of Legislative Affairs and Budget.

Current forecasts estimate contract spending to exceed $250,000, with expectations updated periodically throughout the year. This contracting support will play a crucial role in ensuring the smooth functioning of the ACF and its various programs. It will help in acquiring the necessary resources and services to meet the needs of children and families.

For example, in the Office of Human Services and Emergency Preparedness and Response, the contracted services will be essential in providing timely and effective support during emergencies and crises. In the Office of Legislative Affairs and Budget, the contracting support will assist in formulating and implementing policies and budgets that are beneficial to children and families.

To gain more insight into the healthcare contracting landscape, view this informational packet prepared by the Potomac Officers Club and save your seat at the 2024 Healthcare Summit on December 11th! These are just a few of the various healthcare contracting opportunities available, and there are many more waiting to be explored. Stay tuned for more updates and opportunities in the healthcare contracting world.