Issue Brief: Recommendations for Collecting Non-Claims-Based Payments from States

April 2024 – For many years, statewide all-payer claims databases (APCDs) have collected a full array of healthcare claims from insurance providers – including commercial, Medicaid, and Medicare – offering health coverage to a state’s residents. The claims reported to an APCD typically detail the list of services provided and the billed amounts for each service – tests, exams, ultrasounds, prescriptions, and more.

Recently, however, claims submitted to APCDs have been reflecting a shift in how healthcare systems approach billing and payments – moving toward new payment models that focus more on patient outcomes rather than on simply the volume of services provided. These alternative payment models – or non-claims-based payments – are an increasingly significant part of healthcare spending, and many states are working hard to ensure that non-claims data are integrated with their claims data so that they can better understand and improve the healthcare being delivered.

This Onpoint issue brief offers an overview of the leading frameworks used to categorize non-claims payments, existing efforts from states to collect this data, examples of how the data can be used in analytics, and recommendations for the collection of non-claims data. Read the full issue brief here...