Oregon Health Authority, Health Policy and Analysis
Oregon Health Authority (OHA) is at the forefront of lowering and containing costs, improving quality, and increasing access to health care in order to improve the lifelong health of Oregonians. The OHA mission is helping people and communities achieve optimum physical, mental and social well-being through partnership, prevention and access to quality, affordable health care. Health Analytics provides leadership, balanced information, and data analysis to support policy development.
Organization Contact
Karen Hampton
Karen.R.Hampton@state.or.us
All Payer All Claims Program
The Oregon All Payer All Claims Database (APAC) is a large database that houses administrative health care data for Oregon's insured populations. It includes medical and pharmacy claims, enrollment data, premium information, and provider information for Oregonians who are insured through commercial insurance, Medicaid, and Medicare. Data files are received on a rolling 12 month basis from the date incurred. Established in 2009, APAC has data for analysis 2011- to the current completed year.
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The Oregon State Legislature established the All Payer All Claims Reporting Program (APAC) in 2009. An integral component of the state's ongoing health care improvement efforts, APAC provides access to timely and reliable data essential to improve quality, reduce costs, and promote transparency.
The purpose of the APAC program as described in statute (ORS 442.466) includes:
* Allowing health care policymakers to make informed choices
* Improving the quality and affordability of health care and health care coverage
* Assisting OHA in furthering health policies expressed by the Legislature
* Comparing the costs and effectiveness of treatment settings and approaches
* Providing information to consumers and purchasers of health care
Annually from 2011 to 2016, APAC collected 78-98 million claims, which represents 3.4-3.9 million people (87%-97% of the Oregon population). APAC includes medical and pharmacy claims and payments, member demographics and enrollment, billed premiums and provider information reported by payers. Mandatory reporters to APAC include commercial insurers and third-party administrators with 5,000 or more covered lives, Medicare Advantage, Medicare Part D, pharmacy benefit management organizations, dual eligible special needs plans, Medicaid Coordinated Care Organizations (CCO), Oregon health insurance exchange, PEBB and OEBB plans. APAC data is currently reported by 90 mandatory reporters, as well as OHA (for Medicaid/OHP) and Medicare.
Some claims are not reported to APAC. Accident, vision, dental, disability, hospital indemnity, long-term care, Medicare supplemental, disease specific, stop-loss, student health, corrections or worker compensation plans are excluded. Data from self-insured plans exempt from state insurance regulation are also excluded, as are certain substance use disorder claims.
APAC data are subject to the federal Health Insurance Portability and Accountability Act (HIPAA), so data release is restricted to protect confidentiality. Data are routinely used by OHA, the Department of Consumer and Business Services, researchers and others seeking to improve health care operations. See more information on use in the APAC Use Cases.
Data is received in a rolling twelve month schedule from data incurred. Data is available for analysis within six months of the last data file. For example, 2017 data is received through October 31, 2018 and will be available by March 2019.
The purpose of the APAC program as described in statute (ORS 442.466) includes:
* Allowing health care policymakers to make informed choices
* Improving the quality and affordability of health care and health care coverage
* Assisting OHA in furthering health policies expressed by the Legislature
* Comparing the costs and effectiveness of treatment settings and approaches
* Providing information to consumers and purchasers of health care
Annually from 2011 to 2016, APAC collected 78-98 million claims, which represents 3.4-3.9 million people (87%-97% of the Oregon population). APAC includes medical and pharmacy claims and payments, member demographics and enrollment, billed premiums and provider information reported by payers. Mandatory reporters to APAC include commercial insurers and third-party administrators with 5,000 or more covered lives, Medicare Advantage, Medicare Part D, pharmacy benefit management organizations, dual eligible special needs plans, Medicaid Coordinated Care Organizations (CCO), Oregon health insurance exchange, PEBB and OEBB plans. APAC data is currently reported by 90 mandatory reporters, as well as OHA (for Medicaid/OHP) and Medicare.
Some claims are not reported to APAC. Accident, vision, dental, disability, hospital indemnity, long-term care, Medicare supplemental, disease specific, stop-loss, student health, corrections or worker compensation plans are excluded. Data from self-insured plans exempt from state insurance regulation are also excluded, as are certain substance use disorder claims.
APAC data are subject to the federal Health Insurance Portability and Accountability Act (HIPAA), so data release is restricted to protect confidentiality. Data are routinely used by OHA, the Department of Consumer and Business Services, researchers and others seeking to improve health care operations. See more information on use in the APAC Use Cases.
Data is received in a rolling twelve month schedule from data incurred. Data is available for analysis within six months of the last data file. For example, 2017 data is received through October 31, 2018 and will be available by March 2019.
Steps Required to Obtain Data
1. Requests for all types of APAC data begin with completing the APAC-2 form and submitting it to apac.admin@state.or.us. See forms at https://www.oregon.gov/oha/HPA/ANALYTICS/APAC%20Page%20Docs/APAC-2.pdf.
2. Requests for Public Use Files will receive a data use agreement and invoice. Once the agreement is signed and returned, and payment is received, the electronic file will be transmitted.
3. For limited/custom data sets, after review by the Program to determine if the proposed use falls within statutory limitations, the applicant will be asked to complete the APAC-3 form and a Data Elements Workbook.
4. Limited/custom data files require a description of the project and methodology, information on secure storage, individuals accessing the data and information on use of each field for minimum necessary review by a research analyst. The Data Elements Workbook identifies which fields must have the use explained prior to approval. An IRB waiver or approval may be required.
5. The limited/custom data request is assigned to a research analyst for evaluation. The research analyst may request clarification or additional information from the data requestor.
6. After approval by the research analyst, the data request is posted online for comments for two weeks, then reviewed by the Data Review Committee.
7. If approved by the Data Review Committee, a data use agreement and invoice are sent to the data requestor.
8. When the signed data use agreement and payment are received, the data file will be prepared and transmitted.
2. Requests for Public Use Files will receive a data use agreement and invoice. Once the agreement is signed and returned, and payment is received, the electronic file will be transmitted.
3. For limited/custom data sets, after review by the Program to determine if the proposed use falls within statutory limitations, the applicant will be asked to complete the APAC-3 form and a Data Elements Workbook.
4. Limited/custom data files require a description of the project and methodology, information on secure storage, individuals accessing the data and information on use of each field for minimum necessary review by a research analyst. The Data Elements Workbook identifies which fields must have the use explained prior to approval. An IRB waiver or approval may be required.
5. The limited/custom data request is assigned to a research analyst for evaluation. The research analyst may request clarification or additional information from the data requestor.
6. After approval by the research analyst, the data request is posted online for comments for two weeks, then reviewed by the Data Review Committee.
7. If approved by the Data Review Committee, a data use agreement and invoice are sent to the data requestor.
8. When the signed data use agreement and payment are received, the data file will be prepared and transmitted.
On average, how long does it take to access the data?
Public use file 1 - 2 months; Limited data file 2 - 4 months
Category
Claims & Transactions
Originating Data Source
Payer
Intended End User
Academia
Business
General Public
Government
Data Type
Raw
Data Format
Public use file is tab delimited; Limited/custom files are pipe-delimited
Additional Processing Required
No
Is the data identifiable?
No
Real or Synthetic Data
Real
Data is Updated
Quarterly data updates; annual release of data files
Free of Charge?
No
Costs outlined in APAC-2 form
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