All-Payer Claims Database (APCD)
Recapping the 2017-2018 California Legislative Session (Part 2): Incremental Steps Made in Scrutinizing Market Changes and High Health Care Costs
Sammy Chang, Health Policy Researcher January 29, 2019
As California begins its 2019-2020 legislative cycle, we look back at the 2017-2018 bills that will affect California health care costs and markets. Previously, we mentioned that last session’s health care bills coalesced around four themes: targeting high costs of prescription drugs, attempting to implement single payer, regulating competition, and limiting high health costs. In Part 1 of our review, we covered how the legislature banned pharmacy gag clauses and limited out of pocket expenses but failed to implement single payer. This time, we’ll look at 2017-2018 bills that sought …
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Beyond Price Shopping: How Stakeholders Utilize All-Payer Claims Databases to Address Rising Health Care Costs
Tiffany Wang, Student Fellow and Megan O'Leary, Student Fellow January 22, 2019
Since 2005, Americans have identified the availability and cost of health care as one of their top concerns. Health care costs have risen due to various factors, such as reliance on fee-for-service payment systems, lack of patient engagement, and lack of coordination and management. In recent years, state legislatures have focused on increasing price transparency in the hopes that it will drive down health care costs by encouraging consumer price shopping. One means of promoting price transparency is through the use of database tools, such as state-mandated all-payer claims databases …
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AB 1810: California’s Rough Road to an APCD Becomes Smoother
Sammy Chang, Health Policy Researcher November 27, 2018
California’s AB 1810, among its many provisions, authorizes the creation of an all-payer claims database (“APCD”) via a one-time $60 million appropriation to California’s Office of Statewide Health Planning and Development (“OSHPD”).[1] An APCD is a database that collects medical, pharmacy, and dental claims and administrative data from public and private payers. An APCD is the best way to provide price transparency, as they allow comparison of the costs of medical procedures across different health facilities. For more information, see the Source’s issue brief on All-Payer Claims Databases and California …
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California Legislative Beat: Transformative Healthcare Bills of 2018 (Pt. 2)
Sammy Chang, Health Policy Researcher July 23, 2018
Year two of California’s 2017-2018 legislative session continues to be an active one with the introduction of new innovative healthcare bills. As lawmakers work diligently, this month’s California Legislative Beat continues to look at some 2018 bills that can potentially change the California healthcare landscape. AB 2499: This bill would increase the medical loss ratio (MLR) by 5%, from 85% to 90% for a health plan or health insurer in the large group market, and from 80% to 85% for a health plan or health insurer in the individual market. …
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The Source Executive Editor Jaime King Testifies at Congressional Hearing on Price Transparency
Amy Y. Gu, Managing Editor July 17, 2018
The Source’s Executor Editor Jaime S. King is testifying on July 17th at the House Energy & Commerce Committee’s Subcommittee on Oversight and Investigations hearing: “Examining State Efforts to Improve Transparency of Health Care Costs for Consumers.” Professor King proposes five changes at the federal level to address barriers to transparency in healthcare and maximize the potential of existing state initiatives: 1) address ERISA preemption challenges, 2) encourage consumer price shopping initiatives, 3) create a public interest exemption to trade secrets, 4) mandate interoperability of electronic medical records systems, and 5) …
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Reference Pricing: When Transparency Is Not Enough
Katie Gudiksen, Senior Health Policy Researcher June 12, 2018
In most markets, consumers can compare prices and shop for the items they want. For example, to buy a new pair of shoes, a consumer can typically drive to a shopping mall and choose from a number of stores. Each store typically carries a number of different styles and brands. The consumer might choose to pay $500 for a designer pair of heels or $25 for an inexpensive pair of tennis shoes. The consumer can also shop online and have the shoes shipped to his or her home. Regardless of …
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California Legislative Beat: Noteworthy 2017 Bills Still Pending That Should be Passed
Sammy Chang, Health Policy Researcher May 24, 2018
As year two of the California legislative session goes into full swing, a couple of bills introduced in 2017 are still active and waiting to be passed. This month’s post will look at four active 2017 bills that should be considered for passage. SB 199: This bill authorizes the creation of an advisory committee to research and develop recommendations on the creation of a database to be titled California Health Care Cost, Quality, and Equity Atlas. This bill is the first step to creating a statewide database that would collect …
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California Proposes Legislation to Establish An All-Payer Claims Database – 5 Questions and Answers to Understand AB 2502
Sammy Chang, Health Policy Researcher April 19, 2018
What is AB 2502 About?To better understand healthcare costs and promote price transparency, AB 2502 proposes the establishment of an all-payer claims database (APCD) in California. In general, all-payer claims databases collect health insurance claims from all payers, which inform policymakers on how to better control healthcare costs. The bill’s intent is to understand “how to reduce health care costs while improving quality and reducing disparities”, and to encourage “health care service plans, health insurers, and providers to develop innovative approaches, services, and programs that may have the potential to deliver health …
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Are APCDs the Solution to Price Transparency in Healthcare?
Katie Gudiksen, Senior Health Policy Researcher April 16, 2018
As health care costs continue to rise, voters have identified “health care” as the top issue for the 2018 elections. In response, in March 2018, a group of bipartisan Senators asked thirty stakeholders for feedback as they develop legislation to increase price transparency in the healthcare market in order to increase competition and drive down prices for healthcare services. A lack of price transparency for health care prevents patients from shopping for medical care the way they can for other services, thereby driving up costs. There are no consistent or …
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Academic Articles & Reports Roundup: October 2017
Sammy Chang, Health Policy Researcher November 1, 2017
Happy November! In this Roundup, we cover five articles from October. The topics this month include: (1) pharma-tribal cooperation and the patent system, (2) Medicare subpopulations with the highest preventable spending, (3) privacy protections in All-Payer Claims Database legislation, (4) medical spending on autism spectrum disorder, and (5) a game theory model to understand hospital competition. Pharma-Tribal Cooperation Undermines the Patent System The Association for Accessible Medicine paper Patent-Assignment Transactions Between Brand-Name Drug Companies and Native American Tribes Will Undermine A Healthy Patent System and Harm Patients arises from Allergen’s …
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