Oregon All Payer All Claims Program Solution

Opportunity

With partners at NORC (University of Chicago), we supported the Oregon Health Authority (OHA) with a state-of-the-art technology solution. The solution performs frontend All Payer All Claims (APAC) data collection, data quality validation, aggregation, business processing, data optimization and secure data warehousing—all customized to OHA.

Approach

Data for health system transformation

Oregon’s APAC database is a large-scale database that systematically collects and stores medical, pharmacy and dental claims, subscriber billed premiums, member eligibility, and provider data from commercial health plans, licensed third-party administrators, pharmacy benefit managers, Medicaid and Medicare. The APAC also collects and stores annual information on alternative payment methodologies from certain health plans.

An enhanced APAC solution

Along with our subcontractor NORC, we provided our solution and technical expertise to perform all APAC data collection, aggregation, enhancement, and quality assurance functions – a combination of proven processes, procedures, health data expertise and IT infrastructure, all built as transparent, nonproprietary products.

This work involved:

• Migrating existing data from the current data vendor to a new proposed data management platform
• Securing and streamlining data collection and aggregation
• Processing and validating data extracted from health care claims and other related health care data systems
• Providing data access and reports to approved users
• Optimizing data for a public-facing APAC website
• Optimizing data for a public-facing APAC website

Key strategic objectives

Key objectives of the APAC solution include:

• Providing unbiased, factual data on health care costs for use in policy discussions
• Adding transparent data enhancements including flags, groupings and unique identifiers to aid efficient data analysis
• Collecting standardized data that can be analyzed across payers and lines of business
• Providing timely data, collected quarterly with minimal processing delay before availability for use
• Maintaining strict data release procedures with role-based access
• Meeting or exceeding all security requirements of the state

Impact

With timely, trusted information, Oregon relies on and shares data to improve the quality of health care, reduce costs, and promote transparency.