3 Essential Questions to Ask of Your APCD Provider

3 Essential Questions to Ask of Your APCD Provider

Uncover the Fundamental Truths Your APCD Should Deliver

By Morgan Atkins and Daniel Dreaden

Not all APCD (all-payer claims data) is created equally. Depending on the data aggregator and clearinghouse used, the APCD offered by any given analytics company can vary significantly.

When choosing a partner to provide your APCD, it can be difficult to discern what’s most important. Many incentives offered may sound nice to have, but could also be distractions to keep you from noticing more critical features that are lacking. As you consider your options, keep these three questions in mind:

  • Does this APCD provide patient cohort tracking?
  • Will you be able to access submit and remit data?
  • Is there transparency into what is being modeled and how?

Let's discuss in more detail each of these questions and why it’s critical to have these clearly answered before signing on with an APCD provider.

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1. Does your APCD provide patient cohort tracking?

A patient cohort is a group of patients experiencing similar diagnoses who may be monitored over a period of time. For truly valuable insight into the patient journey, you need to be able to follow a patient cohort as they move through the system in search of care. Following this trail of intelligence, you’ll be able to track patient choices for similar care (acute, primary care, etc.) and see how those choices change throughout a care journey. Tracking patient choice is important because it allows you to:

  • Track patient groups as they go from point-to-point within the healthcare system
  • Quickly pinpoint leakage and path divergences at specific sites
  • See when a patient splits their care between multiple providers
  • More effectively track physician referrals and utilization patterns

This level of insight can better position your facility to dig into reasons for patient shifts and respond appropriately—possibly improving or providing resources that would keep patients aligned with your hospital throughout their care journey.

Stratasan’s APCD includes the full continuum of care to the cohort level. This level of insight allows planners and marketers to gain a better understanding of patient choices and how to provide the right resources for their needs.

 

2. Will you be able to access submit and remit data?

Similar to what is seen in state data, APCD submit data shows claims sent to payers. It includes procedure and facility charges. APCD remit data shows claims actually paid down to the code-level.

Exact payers are associated with every claim, so with remit data, it’s possible to see which plans are more closely affiliated with providers of interest. You’ll be able to track whether you’re getting paid similar amounts for the same procedures, relative to what your competitors are being paid. Remit data offers a transparent view into payment models and reimbursement rates in your market and will help you with your pricing strategy.

Aware of the value remit data offers, Stratasan’s APCD provides both submit and remit data, as we believe that both should be used to discover insights about your market.

 

3. What is Being Modeled, and How?

Does your prospective APCD partner let you see behind the curtain—sharing the full story of their data collection process? Making decisions off of false or mis-modeled data can lead to inaccurate reporting of primary clinic performance or costly investments in the wrong leads.

Look for a partner who will provide access to real data, not projected, modeled, or mis-modeled data. If your planning process calls for future modeling or projections, look for a partner who employs a transparent approach rather than the typical “black-box” methods, where undefined formulas and algorithms are applied to create estimations about future growth, a method used by many vendors in the market.

Stratasan’s APCD includes data for real claims which have been processed. With our transparent method, you’ll have a complete understanding of how conclusions were drawn, giving you more control and insight to help make the best strategic decisions.

 

The Takeaway

It’s important to note that no all-payer claims data can meet every need or answer every question, though analytics vendors often promise that their data can. APCD is often promoted as the answer, even when it’s not the ideal dataset for the question at hand. It's important to be critical and ask the hard questions of your potential APCD providers. Find out what they have and don’t have to offer.

As a baseline, patient cohort tracking, remit data, and modeling transparency should be must have insights offered by your APCD provider of choice.

At Stratasan, we share with our partners the number of claims included in our APCD, the percent of coverage, type of claims, and recency of our data. Using Stratasan’s APCD within our tools, users can query to claim level detail. We receive updates to our data set on a monthly basis with very little lag from the end of the month to receipt of the data, allowing us to offer the most current market data available.

For more information about Stratasan’s APCD and how you can leverage it for strategic growth, schedule a discovery call with one of our experts today.

Article by Morgan Atkins, Director of Innovation, and Daniel Dreaden, Senior Health Analyst for Stratasan

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