Nevada's All-Payers Claims Database: An Explainer

Healthcare costs in the United States have risen dramatically, yet outcomes remain poor, prompting states to explore data-driven solutions like All-Payers Claims Databases (APCDs). To gain transparency into the cost of care drivers, assess population health needs, and evaluate health system reform policies that have the greatest likelihood of success, states have implemented large data repositories called All-Payers Claims Databases (APCDs) and use this data to inform data-driven, evidence-based policy decisions.‍ APCDs collect medical, pharmacy, and dental claims data from public and private insurers to improve healthcare transparency, evaluate pricing, and support policy decisions. Nevada’s APCD, established through Senate Bill 40 in 2021, mandates data reporting to the state’s Patient Protection Commission, the Department of Health and Human Services (DHHS), and the Attorney General’s Office.

Nevada’s APCD implementation aligns with national trends, leveraging federal funding and lessons from other states. This policy brief examines drivers for successful implementation, including effective governance, secure data stewardship, and sustainable funding. At its best, the database can be used by policymakers to guide reforms, ensure price transparency, and improve healthcare quality. Future considerations could include expanding data access, addressing gaps in data collection due to excluded payers, and ensuring long-term financial and operational support for the APCD.

Key Findings:

• Purpose of APCDs: To improve healthcare cost transparency, track pricing, evaluate reforms, and produce population health data.
• Nevada’s APCD Legislation: Created by Senate Bill 40 in 2021, requiring insurers to report claims data for state oversight and policy use.
• Data Scope & Limitations: Payers excluded from APCDs represent about 60 percent of the population nationally, like self-insured private funders and third-party administrators operating ESIRA-regulated health plans.
• Policy Considerations:
  • Secure sustainable funding
  • Leverage expertise in Nevada's higher education system for data analytics and policy development
  • Establish governance structures that allow for diverse stakeholder input
  • Ensure data security is in place and data limitations are clear
  • Maintain nonpartisan oversight
  • Maximize the database’s policy impact by developing use cases and making the data publicly available

An ADA-accessible version of this report is available upon request.