All-Payer Claims Database
Compiling claims information from all payers can help states and their partners assess performance across systems and payers. It can give policymakers and other stakeholders actionable information to drive quality improvement and cost savings.
*Full name: Create an all-payer claims database.
*Relevance to the ACA:
Information from an all-payer claims database can help states implement key aspects of the ACA successfully and assess the effect of the reforms. While developing a database is not required by the law, it may be advisable. For example, all-payer claims data may help:
Exchanges make informed decisions about whether a health plan ought to be allowed to participate (see §1311).
States determine whether a health insurers’ proposed premium increases are reasonable (see §1003).
Sections of the ACA that may help states build all-payer claims database include:
§3021 – Mandate of new Center for Medicare and Medicaid Innovation (CMMI) allows it to “test and evaluate systems of all-payer payment reform.” If linked with payment reform, state development of an all-payer claims database might be eligible for funding through CMMI.
§10332 – Medicare claims data to be available to states (and other entities) developing databases.less