Utah's All-Payer Claims Database Fails to Deliver

The Salt Lake Tribune reports that simply having an All-Payer Claims Database (APCD), without the support in place to actually use the data, will not provide consumers with useful and actionable information about which doctors, clinics and hospitals deliver the best care for the best price. Utah’s APCD, a repository of all medical and pharmacy insurance claims filed statewide, has failed to deliver this critical information.

Utah’s database was conceived in 2008 by a legislative health reform task force as means to arm consumers with the information they need to take charge of their health. It was intended to expose how much value patients receive from their insurance, how much they pay for tests and surgeries, and help them comparison-shop for coverage and medical care.

But State Department of Health employees charged with building and overseeing the database have moved on to other positions in state government. The New Jersey-based vendor hired to mine the data, Care Advantage, went out of business last month. And promised reports comparing health centers on certain quality measures have yet to materialize.

Many point to the lack of funding as the major reason for the database's failure. Utah’s database was held out as an example of what can be done on the cheap. While most states spent millions to get their versions running, Utah budgeted $800,000. At last count, the database contained more than 65 million insurance claims dating back to Jan. 1, 2007.

But until the health department hires a replacement for Care Advantage, there’s no way to extract data. The department isn’t staffed or equipped to run complicated queries, such as tracking "episodes of care," or patient outcomes from diagnosis through treatment and any follow-up.