At long last Virginia has a consolidated medical claims database that insurers and employers can access to help improve health outcomes. The state’s All-Payer Claims Database consolidates “hundreds of millions” of paid claims from 2011 to 2015 into a single database. As Bob Burke writes in Virginia Business magazine:
Self-insured businesses can study the outcome of the health care their employees are getting and figure out what works and what doesn’t work. Accountable care organizations — which can be groups of doctors, hospitals or other health-care providers — can measure the health outcomes for the population they are treating.
Hospital departments at the regional and state level can evaluate the needs of specific population groups, and insurers can evaluate the effectiveness of treatments and the costs.
Other potential uses of the database: Finding out how many name-brand drugs are being prescribed versus generic drugs; revealing how often physicians are prescribing opioid pain killers and which parts of the state have higher rates of opioid abuse.
The creation of a unified database of medical claims has been years in the making. It hasn’t been easy getting buy-in from all the state’s major insurers as well as the state agency that administers Medicaid. (Apparently missing from the database is Medicare.) All-payer databases began catching on about a dozen years ago, according to Burke. About 30 states either have established the databases or have expressed a “strong interest” in doing so.
There aren’t many positive stories coming out of the health care policy arena, but this is one of them. Virginia insurers, hospitals, physicians and public health administrators have an opportunity to utilize big data to improve health outcomes in the state… and just in the nick of time, as I’ll get to in my next post.
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