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All Payer All Claims Reporting Program



Overview

The Oregon All Payer All Claims Reporting Program (APAC) has been integral to Oregon's health system transformation since it was established in 2009. It contains administrative health care data on topics such as insurance coverage, health service cost and utilization for Oregon's insured populations. APAC provides access to timely and reliable data essential to assess the cost of health care, improve quality, reduce costs and promote transparency.

The purposes of APAC are described in statute (ORS 442.373) and include:

  • Allowing health care policymakers to make informed choices
  • Improving the quality and affordability of health care and health care coverage
  • Comparing the costs and effectiveness of treatment settings and approaches
  • Providing information to consumers and purchasers of health care

Request Data

See APAC Data Request page

Submit Data

See APAC Mandatory reporter/Data submitter page

Contact Us

APAC.Admin@dhsoha.state.or.us


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About APAC

APAC receives administrative data on most Oregon residents. Administrative data are collected by insurers for purposes related to issuing coverage and making payments.

As an example, for 2018, APAC contains data representing 92% of Oregon residents despite lacking some self-insured data. Those not in APAC are uninsured, are covered by Federal programs such as Tricare or Veterans Affairs or are covered by self-insured plans not reporting to APAC. In 2018, APAC contains:

  • ~100% of fully-insured (1,837,000 members)
  • 36% - 61% of self-insured (318,000 - 534,000 members)*
  • 96% of Medicaid OHP/CCO and FFS (1,219,000 members)
  • ~100% of Medicare (966,000 members)

APAC receives medical claims, dental claims, pharmacy claims, payment amounts, member demographics, billed premiums and provider information. Data are received from insurance companies, third party administrators and pharmacy benefits managers identified as mandatory reporters.

APAC Overview
Provides an overview of the APAC database, including its purpose, what data are collected, how data are used, and the data request process.

How are APAC data used?

  • APAC has been used by OHA, other state agencies, researchers and organizations working to improve health care. A few examples include: 
    • OHA has used the information to review rates paid to coordinated care organizations. 
    • APAC data are one source used to compare Medicaid payments to commercial and Medicaid costs. The Department of Consumer and Business Services did a similar comparison for workers' compensation payments.
    • Oregon State University used APAC data to determine the economic impact of having athletic trainers in high schools. The study found health benefits beyond specific sports applications. Published in Injury Epidemiology 2019.
  • To see more examples of APAC data use, see our APAC Use Case document.

Frequently Asked Questions 
Answers questions about APAC data collection, management, access and use.
Insurance Claims 101

Change in Vendors

OHA recently concluded a competitive procurement process and has selected Human Services Research Institute (HSRI) as the new vendor to collect and maintain APAC data. The transition will occur in late 2020 with HSRI's first data collection occurring in January 2021. This transition will:
  • Save money. The five year total cost, including the cost of implementing the new solution, saves almost $200,000 per year.
  • Improve transparency. Any data enhancement specific to HSRI or Oregon will be fully transparent on the method of calculating the field, while data elements based on third party algorithms, such as HEDIS and AHRQ measures, will maintain their current level of transparency.
  • Help researchers. Moving from a business perspective focused on present-day data to a research perspective that supports longitudinal studies will enhance the use of APAC data to track regional cost and utilization trends over time.

High-Level Vendor Transition Schedule

(last updated 5/7/2021)

Activity
Subactivity
Status/Date
System Design 

Complete
System Security 
Complete
Data Submission 

 Complete
Data Access/Use 
 
 Data Dictionary available
Complete
 Data Elements Workbook for Limited data sets (APAC-3) forms available
Complete
 Data Migration completed; 2020 Q4 data (submitted January 31, 2021) available in production analytic viewsComplete

For Data Requesters

For information about how to use APAC data, the data request process, and applications, visit our APAC Data Request Page.

For Data Submitters

For information about how to submit APAC data, the data submission process, and submission requirements, visit our APAC Data Submission Page.

APAC

Current and new data submitters can find information about submission specifications, schedules, and waivers on the APAC Data Submission Page.

Primary Care Alternative Payment Methods - Contract Reporting

Please refer to the Primary Care Payments page for more information.

Reports

Leading Indicators for Oregon's Health Care Transformation

This report presents quarterly data from Oregon's All-Payer All Claims Reporting Program.

Leading Indicators Report, September 5, 2015
Leading Indicators Report, April 30, 2015

Payment Arrangement File

October 2020 Data Brief – How Oregon's Insurance Carriers and Coordinated Care Organizations Paid for Health Care in 2018

Additional Resources

Oregon Revised Statute (ORS 442.372, 442.373, & 442.993)
Statute that mandates reporting of health care claims data.

Oregon Administrative Rules for APAC (OAR 409-025)



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