NAHDO's members are laying the foundation for health care improvement, health system and payment reforms, and consumer engagement through publicly available and shared health care data bases. This month, we feature how one state is moving the needle through data.
Joe Thompson, MD, MPH, is president and CEO of the Arkansas Center for Health Improvement and served for 10 years as Arkansas's inaugural surgeon general under Governors Mike Huckabee (R) and Mike Beebe (D).
The United States’ health care system continues to be the most expensive and, by most indicators, one of the least effective health care systems in the world. We spend more than any other country on pharmaceuticals, hospitalizations, and physician visits, and yet by most available statistics across economically developed countries, we get less bang for our buck. According to the World Health Organization, average life expectancy in the United States in 2015 was shorter than in 30 other countries.
Understanding the reasons for this dichotomy is the source of much political debate and many profit-driven decisions. Only by examining who is paid for what, and when and where services are provided and to whom, will we be able to optimize the value of the U.S. health care dollar.
Nationwide, the 20 states that have all-payer claims databases have started to create a window of transparency, with Arkansas having mandated data submission to its APCD from public and private payers via legislation in 2015. In the future, the Holy Grail may be the integration of claims payment history with electronic health records, but in the meantime there are opportunities to accelerate our knowledge and understanding using APCDs.
Pursuant to legislation passed in 2017, Arkansas is adding components to our APCD to help enable this vision to become reality, with several new data elements due to be integrated this year.
Death and birth certificate data
Health care claims enable a profile of cross-sector care delivery, but frequently, deaths that may or may not have been preventable occur outside of the clinical care setting, and thus there is no claim to identify or provide an explanation for the event. Additionally, if an individual ceases to have claims, it is not immediately apparent if the reason was due to death. Incorporating the state’s death certificate data, linked through a hashed, unique identifier, will enhance users’ understanding of currently unexplainable events within the APCD.
Although less frequent, out-of-hospital births also will be captured through incorporation of the state’s birth certificate data, and parent-child linkages will enable family profiles during critical periods for postnatal and postpartum care.
Hospital discharge and emergency department data for the uninsured
Another blind spot for APCDs is care and treatment provided to individuals who lack insurance and thus generate no claims. By incorporating hospital discharge and emergency department data for the uninsured into Arkansas’s APCD, it will become possible to assess services provided to patients without health care coverage and to track the varying experiences of individuals as they gain or lose coverage over time.
Cancer registry data
While sentinel events for stroke, heart attack, and trauma are fairly easily recognized in the APCD, information about a diagnosis of cancer, including type and stage, is frequently problematic. Incorporating data from the state’s cancer registry will enable a better understanding and more granular assessments of cancer diagnoses and subsequent treatment and outcomes. Long-term opportunities may emerge to use cancer registry data, treatment paths reflected in the claims, and mortality outcomes from death certificate data to improve cancer screening, diagnosis and treatment strategies.
Medical marijuana registry data
Finally, marijuana has been authorized by many states as a therapy, despite prohibitions at the federal level. Arkansas joined those states in 2016 through a voter-approved constitutional amendment allowing people with certain conditions to access medical marijuana. The APCD will flag individuals who have been determined by the state Health Department to be eligible to use medical marijuana and will link that information with health care claims data.
This will enable demographic, diagnosis, and utilization profiles prior to medical marijuana-qualifying patient status, as well as prospective assessments of changes in care patterns, medical and pharmacy utilization, and cost of care. As public and private funders begin to support research into this and other emerging therapies, additional elements in Arkansas’s APCD will make it an increasingly valuable data asset.
Follow Dr. Thompson on Twitter @JoeThompsonMD and @ACHI_net.