By Rahwa Yehdego, Policy Research Associate, Georgia Watch
An All-Payer Claims Database (APCD) is a powerful tool for increasing transparency in healthcare costs that 19 other states have adopted. Georgia Watch, Georgians for a Healthy Future, lawmakers and other advocates helped ensure the passage of Georgia’s Surprise Billing Consumer Protection Act in 2021 which included the creation of an APCD in Georgia. Launched in January of this year,this database will help inform the surprise billing resolution process which you can learn more about in Georgia Watch’s blog on surprise billing Additionally, it will help to inform policymakers and advocates about health status and disease burden in Georgia as they develop public policy to improve equity in healthcare across the state.
What is an APCD?
An APCD is a centralized place for de-identified claims data from both public payers (Medicare, Medicaid, state employee benefit plans) and private payers (commercial or employer sponsored) across a state. The data includes information on the variability in costs for various healthcare services. One of the main goals of an APCD is to identify any unnecessary healthcare spending and to help reduce the price variation for procedures within a state.
What does an APCD accomplish?
APCDs help to promote cost transparency, improve overall healthcare quality, and provide a better understanding of services and population health trends. Other states have gained crucial insights on their healthcare systems after implementing an APCD. For example, in Virginia their database identified that roughly 14% of emergency department visits could have been treated at a lower cost in a primary care provider’s (PCP) office1. This would have saved an estimated $100.5 million for both consumers and healthcare providers if the patients were seen by a PCP first1. APCDs can be a great resource for identifying and addressing the most pressing health issues in a state and guide efforts to reduce health disparities.
How does Georgia’s APCD impact you?
Georgia’s new APCD can help consumers make informed decisions about their healthcare options to ensure they are paying fair amounts and receiving quality care. It specifically equips consumers considering elective procedures (ex. knee or hip replacements) with average cost information to help guide their decision-making. It also helps providers determine the best treatment options for Georgians facing common health problems or considering additional diagnostic testing. The legislature identified 10 specific goals for Georgia’s APCD which you can read about here. To learn more about your healthcare rights and resources in Georgia, please visit our Healthcare Access page.
References
- Potentially Avoidable ED Visits in 2020. vhi.org. https://vhi.org/Media/flyers/Potentially%20Avoidable%20ED%20Visits.pdf. Published May 2, 2022. Accessed April 19, 2023.
