How APCDs Can Support Insurance Regulation

Prepared for the Robert Wood Johnson Foundation

From Utah and Oregon to Maine and Massachusetts, state insurance departments across the country are exploring how All Payer Claims Databases (APCDs) can be used to support and enhance insurance regulation.  APCDs are large and developing data assets that promise states new capacity for monitoring and regulating a rapidly changing healthcare landscape.  Interviews with insurance departments and APCD leaders from 11 states reveal areas where APCDs can be used to support insurance regulation, as well as areas where the National Association of Insurance Commissioners (NAIC) and state insurance regulators can support APCDs in accomplishing their mission.

In a report for the Robert Wood Johnson Foundation, “Enhancing the Value of Coverage Through Transparency: How APCDs Can Support Insurance Regulation,” Manatt Health explains what APCDs are, where they are active, how they are organized and funded, and what data they collect.  The report also addresses the three challenges that APCDs must meet if they are to reach their full potential in nurturing a data-driven approach to improving healthcare: enhancing data quality, establishing national data standards, and defining state-based priorities for using APCD data.

In addition, the report examines five use cases relevant to insurance regulators on a state-by-state basis.  Each case illustrates what can work with the right focus and what may be less productive, with the caveat that use cases vary significantly by state.  Finally, the report offers three recommendations for building on what already are productive relationships in many states:

  1. The NAIC should support national APCD data recommendations.
  2. Insurance departments should promote state-specific use cases.
  3. Insurance departments should build long-term alliances with APCDs.

Click here to read the full report.

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