Why I get excited about APCDs (hint: also a memoir and album by Herbie Hancock)

July 31, 2015 / By Kristine Daynes

I love hearing about multi-source or all-payer claims databases (APCDs). I’m not a data scientist, but I know enough about analytics to appreciate the possibilities within an APCD. Each announcement of a new state APCD (or private data alliance) feeds the expectation that someone will discover something new and useful and that maybe, sometime soon, the information will change the healthcare system for better.

I get excited about the possibilities. (Jazz musician Herbie Hancock chose “Possibilities” as the title for his memoir. It’s a tribute to those who aren’t afraid to explore in music and in life.)

I got the same sense of anticipation last week when the State of Minnesota released a landmark report on health care. The report marks the first time state data from all public and private insurance payers has been used systematically to assess potentially preventable events.

The Minnesota All Payer Claims Database (MN APCD) contains claims for 4.3 million Minnesotans. The report assesses the frequency and impact of unnecessary, avoidable, or harmful healthcare services, measured as potentially preventable readmissions, hospitalizations, and ED visits.

The study illustrates the advantages of having a state APCD and how research based on APCD data can be conducted and reported for effectiveness.

• Researchers could confidently draw inferences from the data, because it comes from a very large and representative pool of individuals across the entire state and multiple payers.

• The data represents medical services across the spectrum of care, including pharmacy. This is important, since we know that what happens (or doesn’t happen) in settings outside the hospital figure significantly in whether patients eventually require hospital care.

• Longitudinal administrative data contains more than disease and cost information. It can be mined to incorporate socioeconomic markers and discover patterns of behavior.

• The report was made public and heavily publicized, allowing all Minnesotans to understand the issue and frame their own strategies.

• The data is risk adjusted to account for the increased health burden of individuals with acute conditions or complex needs.

• The analysis segmented patients to look at high risk groups—such as patients with complex health care needs and people on public healthcare programs—and understand their behaviors and outcomes compared with the population at large.

• Hospital readmissions and emergency care often cannot be avoided. Therefore, only potentially preventable services were measured to determine an expected level of utilization and compare it to actual readmissions and ED visits.

The study found that in 2012, Minnesotans had 1.3 million avoidable ED visits and hospitalizations, including readmissions, at an estimated cost of $1.9 billion. Emergency departments received the brunt of the problem. About two-thirds of all ED visits were potentially preventable. Among individuals on public healthcare programs, ED visits accounted for 97% of their avoidable care, suggesting poor access or health literacy to get timely care in a more appropriate setting.

An APCD and data analytics don’t create a better-connected health care system. But they do shine a light so that people aren’t functioning in the dark. They allow policy makers and state leaders to “identify system and community changes that will encourage patients to seek, and clinicians to deliver, the right care at the right time in the right setting,” as stated in the report.

The report authors’ goals hinge on data transparency, the right people at the right time getting the right information in order to deliver the right care. Because of privacy concerns, the Minnesota APCD data is available only for the state’s projects and not to outside researchers. That limits the type of report information that clinicians, hospitals, and commercial payers will receive from the state. However, a lot can be accomplished, even if only state leaders have a full view of the healthcare landscape.

The next milestone for the MN APCD will be demonstrating how healthcare organizations benefit from the analytics capabilities. That is what APCD enthusiasts like me are really waiting for. As an innovator like Herbie Hancock might say, it’s time to start inventing the possibilities.

The MN APCD is one of many reform initiatives throughout the state. For example, the RARE campaign (Reducing Avoidable Readmissions Effectively) combined statewide resources to reduce readmissions. The voluntary initiative helped hospitals to work with community partners to aggressively reduce potentially preventable readmissions. When the campaign officially closed in June 2014, hospitals collectively had reduced readmissions by 19 percent. Read more about this and other Minnesota programs.

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.

Learn more about 3M classification methodologies that identify potentially preventable events (PPEs).