Public insurance claim database will give a better look at health care access in Georgia

Early next year, the public will have access to a new tool that makes the cost of health care more transparent — it’s a statewide database of insurance claims. 

Georgia will join about half of all states that already have an all-payer claims database, or an APCD. The database and visualizations to come were developed with support from the Georgia Tech Research Institute. 

By making this data publicly available, the state legislature hopes to encourage “data-driven, evidence-based improvements in access, quality, and cost of health care,” according to language in the law that put the APCD in motion. 

All-payer claims databases use de-identified insurance claims data to make average costs public, for things like ambulances, labor and delivery, dentistry, and medicine for chronic diseases. 

It will be the largest single source of aggregate health care data in the state, said Jon Duke with Georgia Tech’s Center for Health Analytics and Informatics. Once public, the data can be categorized by age, rural or urban residency, insurance type and service provided. 

“The goal would be: Let me look at my county, let me look in my area," Duke said. "Compared to other areas, let me try to get a better understanding of the health in that environment from what is available in claims.”

Unlike public health data, the APCD will be updated every few months, rather than annually. 

“We want this to be a tool and a resource to finally shed light and understanding to the average Georgia citizen about what health care is, and how they can access it,” said Megan Denham, senior research associate at the Georgia Tech Research Institute. 

To start, Georgia’s APCD will include insurance claim data from millions of residents to represent about 50% of the population, according to the researchers at Georgia’s Tech. About 75% of residents will be represented in the data by 2025. Data collected through the Georgia APCD will be available through a public dashboard online and public use files. 

Only insurance providers that cover more than 1,000 beneficiaries are required to submit data to the APCD. It’s a voluntary process for some smaller companies and employer-sponsored coverage providers. 

Also left out of the data, of course, are people without insurance. That makes it hard to really understand health care disparities. People without insurance are more likely to forgo preventative care, which can result in higher rates of chronic diseases and mental health issues. 

“So far, that's one of the challenges that has evaded most of the states,” Denham said about tracking health outcomes for the uninsured. 

About 250,000 people in Georgia live in a coverage gap, because they have an income higher than what’s accepted for Medicaid coverage but not enough to qualify for subsidies for ACA insurance plans. Thousands more are also uninsured but may be eligible for coverage under the ACA.