Introduction to Indiana's All-Payer Claims Data Base (APCD)
Indiana's All-Payer Claims Data Base (APCD) is a comprehensive state database comprising medical claims, pharmacy claims, eligibility information, and provider files from various health plans and insurers. The initiative aims to enhance healthcare policy-making, cost comparison, consumer information, and overall quality and affordability of patient care. Governor Holcomb's Next Level 2020 agenda spearheaded the establishment and development of the APCD in Indiana. The design includes secure data collection portals, analytics, and reporting tools. Health payers and insurers with a significant member base in Indiana are mandated to participate.
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All All- -Payer Claims Data Base Payer Claims Data Base (APCD) (APCD) Introductory meeting with the Insurance Institute of Indiana March 15, 2023 Presented by: IDOI - Jonathan Handsborough MBA, MBB-6 Onpoint - Gina Robertson BA 1
Agenda Agenda Introduction Purpose of APCD Design of APCD Required and Voluntary Submitters Data Security Timeline Questions and Answers 2
Introduction Introduction IN APCD will be a comprehensive state data base that will include medical claims, pharmacy claims, eligibility, and provider files submitted by health plans, health insurers or their delegated submitters. Over twenty states have already created or are implementing APCDs. 3
Governor Holcombs Next Level 2020 Governor Holcomb s Next Level 2020 Agenda Item Agenda Item Senate Enrolled Act 5 2020 Established Indiana s All-Payer Claims Data Base and kickstarted its development with issuing a Request for Information. House Enrolled Act 1402 2021 Refined the submission requirements, expounded upon the expectations and capabilities of the Data Base, and created the Advisory Board. 4
Purpose of APCD Purpose of APCD Identify healthcare needs and inform healthcare policy Compare costs between various treatment settings and approaches Provide information to consumers and purchasers of healthcare Improve the quality and affordability of patient healthcare and healthcare coverage 5
Design of APCD Design of APCD Submitter Registration Portal Submitter Data Collection / Submission Portal Secure Claims, Enrollment, and Provider Data Base Analytics and Reporting Consumer-facing Website 6
Required Submitters Required Submitters Health payers, health insurers, or non-ERISA self- insured plans with 3,000 or more Indiana members are required to register and report. Health Payers are defined per IC 27-1-44.5-21 and include: Medicare, Medicaid or Managed Care Organizations, Health Maintenance Organizations (HMO), Pharmacy Benefit Managers (PBMs), Multiple Employer and Welfare Arrangements (MEWAs). This also includes self-insured employer sponsored health or pharmacy plans if the employer is not subject to ERISA. 1 (Indiana Code 27-1-44.5-2) 7
Required Submitters (continued) Required Submitters (continued) Health payers or health insurers administering benefits on behalf of another organization (e.g. administering benefits for a non-ERISA self-insured plan) should include all covered lives from those organizations in their threshold calculation. 8
Voluntary Submitters Voluntary Submitters Health payers, health insurers, or non-ERISA self-insured plans with fewer than 3,000 Indiana covered lives are exempt from reporting requirements but may voluntarily participate. Those entities must still register with the data base. Required submitters that decrease membership below 3,000 Indiana covered residents throughout the year must continue reporting for the calendar year and may elect to voluntarily continue to participate the following year. ERISA self-insured plans (regardless of number of covered lives) are encouraged to voluntarily register and voluntarily participate. 9
Coordination Coordination of Data of Data Submissions Submissions Plans that contract with other entities to administer plan benefits (aka: carve-outs) will be responsible for ensuring their members are reported. The plan may either: Obtain the necessary data from the contracted entity and submit the data through the submission portal Ensure that the contracted entity submits the data directly to the system The plan will identify each contracted entity through the registration process. If the contracted entity submits claims data, they also must register with the portal. 10
Onpoint Health Onpoint Health Data Data Onpoint will serve as the administrator for Indiana s All- Payer Claims Data Base. Over 40 years ago, Onpoint opened its doors to help others digest and interpret health data. Their team developed the first-of-its-kind multi-payer claims data base for large employers in Maine in 1995. Over the last 28 years, Onpoint has built over 50% of APCDs nationwide.2 2Onpoint Health Data: Onpoint Health Data | (onpointhealthdata.org/about) 11
Data Data Submission Submission Portal Portal Eligibility, Medical, Pharmacy, and Provider data are collected. Files must be securely sent using PGP-encryption. Support will be readily available throughout the implementation and beyond by IDOI and the Onpoint team. 12
Data Data Submission Guidelines Submission Guidelines Submitters will be expected to use a Data Submission Companion Guide with the APCD-CDL v2.1 specifications. The companion guide will be provided to all submitters in the coming weeks. Submitters will be required to provide the following data monthly: Medical Pharmacy Eligibility Provider Submissions must cover full months of data Partial months should not be reported 13
Data Data Submission Portal Overview Submission Portal Overview 14
Data Security Data Security HIPAA principle of least access for internal and external users Multi-factor authentication is enforced on all external endpoints that serve PHI data Encryption and password policies, including complexity and automatic expiration/renewal requirements are mandated Devices are encrypted using Bit locker HITRUST Certified 15
Secure Data Base Secure Data Base (Secure claims, enrollment, (Secure claims, enrollment, and provider and provider data base) data base) AWS Cloud-based storage used to store data Data residency requirements are strictly followed Stored across multiple data centers for redundancy Elastic load balancers used for high availability 16
Timeline: Data Submission Timeline: Data Submission Date Date Details Details 6/30/2023 Successful submission of encrypted test file due via Onpoint CDM 8/31/2023 Historical and calendar year catch-up data (covering the 1/1/2020 7/31/2023 reporting period) due 9/30/2023 First month of regularly scheduled production data (covering the August 2023 reporting period) due 17
Timeline: Submitter Onboarding Timeline: Submitter Onboarding Date Date Details Details 3/20/2023 Submitter registration opens for Indiana APCD data submitters 3/22/2023 Webinar: Webinar: Training on APCD implementation, the APCD- CDL , and submitter registration 3/29/2023 Webinar: Webinar: Training on PGP encryption and the SFTP submission process 4/5/2023 Onpoint CDM opens for registered IN-APCD data submitters 4/11/2023 Webinar: Webinar: Training on Onpoint CDM and data variances 4/25/2023 Webinar: Webinar: Overview of Onpoint CDM and data submission best practices 4/28/2023 Submitter registration due for the IN-APCD 6/30/2023 Successful submission of encrypted test file due via Onpoint CDM Ongoing One-on-one submitter support meetings 18
Contact Us Contact Us IDOI APCD Team: apcd@idoi.in.gov| 317-232-3619 (Anticipated Live Date: Wednesday March 22) Jonathan Handsborough - Executive Director IN APCD: jhandsborough@idoi.in.gov IN APCD Administrator Onpoint Health Data in-support@onpointhealthdata.org| 207-623-2555 19
Questions? Questions? 20
References References Indiana Code 27-1-44.5: All Payer Claims Database | (iga.in.gov) Governor Holcomb: 2020 Next Level Agenda | (in.gov/gov/next-level- agenda) APCD Council: APCD Council | (www.apcdcouncil.org) Agency for Healthcare Research and Quality: All-Payer Claims Databases | Agency for Healthcare Research and Quality (ahrq.gov) Onpoint Health Data: Onpoint Health Data | (onpointhealthdata.org) Thank you! 21
