1. All Payer Claims Database Creation PCC Certification Phase: Initiation
June 27, 2019
Terry Reusser, DOH CIO
Lori Zigich, APCD Business Lead
Rosanna Dill, Project Manager
1190 S. St. Francis Drive • Santa Fe, NM • Phone: • Fax: • nmhealth.org

2. Project Overview
Joint DOH/HSD State Innovation Model (SIM) grant began communications with stakeholders, created a Health Information Technology (HIT) plan and a plan for an All Payer Claims Database (APCD)
2015 Health Information Systems (HIS) Act requires DOH to provide public access to healthcare cost and quality data. HIS Act advisory committee created. Provides DOH with the authority for an APCD
Continued funding will be sought in State Fiscal Year (SFY21) for Implementation

3. Current Challenges DOH currently has the following cost information:
DOH collects annual Hospital Inpatient Discharge Dataset (HIDD) and Emergency Department Dataset (ED) including hospital charges, however Hospital charges alone do not reflect the true cost of healthcare
HIS act website publishes Medicaid data for nine common procedures, but Medicaid is not the only payer for New Mexicans having procedures.
For the APCD to be useful, additional data sources are needed to model the overall cost of health care in NM.

4. All Payer Claims Database (APCD)
“Repository of healthcare claims data that combines data from multiple payers, including Medicare, Medicaid, private insurers, dental insurers, children’s health insurance, self-insured employer plans, and pharmacy plans”
An APCD would be a critical addition to available NM health data, particularly in the areas of outpatient visit, pharmacy and cost data
The major long-term benefit of an APCD for NM would be to help understand and improve the health care system in order to improve the health of the NM population
“All-payer claims databases (APCDs) systemically collect administrative data, including medical, pharmacy, and dental claims, eligibility files, and provider (physician and facility) files. These claims are created when an insured patient recieves [sic] care or fills a prescription, and include a record of what was provided, who provided it, how much was charged, and how much was paid. Data are submitted directly to a central point, often a state agency or its vendor.” [ Retrieved May 15, 2019]

5. Project Approach
The NM APCD project will avail itself of the recommendations in the NMAPCD final report, as developed with the APCD council and other prior work.
The project will require a great deal of research and coordination to build a roadmap for a sustainable, successful APCD build and deployment.
For an NM APCD to be successful, many stakeholders need to be engaged, both as providers and consumers of APCD data. A stakeholder management entity will be contracted as part of the project to help manage this effort
DOH will review the efforts of other states that have implemented APCD’s, (Colorado, Utah and others) to learn from their successes and mishaps.
The project will continue to use NAHDO and APCD Council resources for best practices for implementing an APCD here in NM.

6. Resources for APCD implementation
APCD Council – a workgroup led by National Association of Health Data Organizations (NAHDO) and University of New Hampshire.
Numerous resources for APCD implementation (including an extensive handbook)
Facilitates communication between states with APCDs.
Facilitated the development of the NM APCD Plan
Other states with APCDs
Vendors who specialize in APCDs
Several vendors exist that work with different states
Individual states do not have to “reinvent the wheel”

7. Project Goals
Collect all claims paid by all insurance providers (Medicare, Medicaid, and commercial), providing a complete picture of healthcare costs
Join collaboration of 14 other states currently operating an APCD and 15 others interested in pursuing implementation
Satisfy legislative requirements to provide public accessible healthcare cost and quality information
Inform public, healthcare professionals and policy makers on efforts around healthcare costs, quality, access, barriers to care, utilization patterns, and policy decisions
Using analytics/informatics target healthcare resources to provide services that reduce healthcare costs and improve the health of the New Mexico population

8. Possible Uses of NM APCD
The NM APCD will be a tool for measuring health care delivery effectiveness and health care quality in New Mexico, ultimately improving the health of the New Mexico population. It could provide data in such areas as:
Substance Use Disorder: screening and brief intervention utilization
Suicide: depression prevalence and antidepressant use
Overdoses: Methamphetamine OD – outpatient treatment utilization, and Opioid OD – connect diagnosis to PMP data ,
Heart issues: Hypertension – prevalence and treatment, and heart disease – use of medications for secondary prevention
Rheumatoid arthritis: prevalence and treatment,
Primary care effectiveness: visits/population by county, and ratio of primary care visits to ED visits

9. Estimated Timeline Initiation phase – July 2019- Jan 2020
Onboard resources, review existing prior work and available literature, form an agency APCD working group
Planning phase – Feb 2020 – Aug 2020
Do market research, contact other states, engage stakeholders, Gather requirements, plan communications, develop data governance structure, do alternatives analysis, request additional computer enhancement funding into state fiscal year 2022
Implementation- Aug Aug 2021
Issue RFP, Award vendor, develop contract and deliverables, design, develop, implement APCD using best- practice project methodology,
Closeout – Aug Sep 2021

10. Estimated Project Budget
Project Deliverable
Budget
Due Date
Project Management (3 years)
$327,651
8/1/2019
IV&V (3 years)
$83,333
1/1/2020
Stakeholder Engagement (Contract)
$50,000
10/1/2019
Epidemiologist (3 years)
$231,192
Equipment, Supplies, DoiT/GSD Travel etc.
$75,000
Other Contratual Agreements
$1,032,824
TBD
Total
$1,800,000

11. Certification Request (Initiation)
Project Deliverable
Budget
Due Date
Project Management (1 year)
$109,217
8/1/2019
IV&V (6 months)
$16,667
1/1/2020
Stakeholder Engagement (Contract)
$50,000
10/1/2019
Epidemiologist X 2 (3 years)
$77,064
Equipment, Supplies, DoiT/GSD Travel etc.
$75,000
Total
$327,948
Previously Certified: $0
Amount Requested:

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