Health Care Payments Data Program – Public Reporting

Public Reporting Principles#

To support effective public reporting, HCAI worked with the HPD Advisory Committee to develop Public Reporting Principles to guide HCAI in reporting results based on HPD data. These principles are listed below.

1. Protect Patient and Consumer Privacy
   • Protect patient-level data from reidentification with prohibitions on publishing direct identifiers.
   • Follow guidelines such as CalHHS data-deidentification and HIPAA safe harbor
2. Inform Policy and Practice
   • Generate information that is accurate, meaningful, relevant, actionable, and as comprehensive as possible.
   • Consider the needs of diverse audiences, and design public information products that meet those needs.
   • Consider ways to mitigate the risk of anticompetitive behavior when publicly reporting data.
3. Engage Stakeholders in the Process
   • Incorporate stakeholder perspectives into priority-setting for public reporting.
   • When appropriate, preview the results with affected stakeholders prior to publication.
4. Adopt Methods that Ensure Credibility
   • Use only methods that can be supported by the data and techniques that produce reliable and stable results over time, acknowledging the limitations of data collected for other purposes (primarily billing).
   • Use best practices when creating comparisons, including factors such as appropriate sample sizes, meaningful variation, risk adjustment, and statistical validity.
5. Align with Existing Efforts
   • When available and appropriate, use nationally accepted, standardized measures.
   • Consider measurement efforts underway in California and nationally.
   • Coordinate with other relevant state agencies.
6. Provide Information to Support User Understanding
   • Include information about data sources, methodology, and limitations with public information products.
   • To the extent possible, use language understandable to diverse audiences.

FAQ#

1. What data does the HPD System collect and publicly report?

HPD collects claim and encounter data from the Department of Health Care Services (DHCS) for Medi-Cal members; the Centers for Medicare & Medicaid Services (CMS) for Medicare fee-for-service members; and payers (health plans and insurers) for those with employer-based, individual, or Medicare Advantage coverage. HPD adopted a threshold of 40,000 covered lives for mandatory submission of claim and encounter data from commercial and Medicare Advantage payers; health plans and insurers with fewer lives are exempt from mandatory submission.

The HPD Program adopted a national standard created by the APCD Council, the APCD Common Data Layout ^TM (APCD-CDL^TM), for commercial submitters and for Medi-Cal claim and encounter data. The files include medical and pharmacy utilization, member enrollment, and provider data. The variety and volume of data the HPD System collects will increase over time, as will the complexity of supported analyses. See the HPD Program Upcoming Activities.

2. How complete is the data in the public reports?

HPD collects healthcare data for over 30 million Californians each year.

The HPD public reports contain data from January 2018 to December 2021 and include fully adjudicated claims for services rendered. When new years of data are added, previous years’ data will be updated to include any newly processed records for those prior years. The 2018 to 2021 data was part of an initial “historical file” collected at the start of the HPD Program. While the HPD has collected 2022 calendar year data and is in the process of collecting 2023 data, the only data publicly available currently is from 2018 to 2021. As the HPD has more complete years of data available, they will be added to published public reports on a regular basis.

HCAI is evaluating the completeness of data on, and analytic methods for studying, patient demographics such as for race and ethnicity, so that these important dimensions of health equity can be appropriately examined in future HPD reporting. HCAI will include a review of data completeness in a 2024 report to the California Legislature. 

In total, fewer than 300,000 covered lives are not included in the HPD public reports compared to what was expected to be reported by mandatory submitters. See the HPD Snapshot technical note for more information.

3. What populations are not included in the data?

Some payers, such as, self-insured employers subject to ERISA, the prison system, active military, Veterans Affairs, TRICARE, the Indian Health Service, and Taft-Hartley trusts are not required to report HPD data to HCAI. Some voluntarily submitted data for self-insured employers is currently incorporated in the HPD database. HCAI is evaluating the completeness of data from voluntary submitters and will include a review of data completeness in a 2024 report to the California Legislature. Learn about HCAI’s effort to encourage voluntary submission.

Because HPD collects utilization and payment data associated with health care coverage, services that are not covered by health benefits or that are paid out-of-pocket (“self-pay”) are not in HPD.

4. What does it mean that the data is reported “as submitted”?

The HPD reports the data submitted by payers to HCAI. While HPD will enhance the data by adding groupers, calculated fields, and flags that aid analysis, HPD will not change the data submitted by payers. Therefore, the HPD reports and datasets may include errors and omissions that were contained in the original submitted data. HPD works regularly with payers to improve data quality and completeness over time.

5. What future enhancements or additions are planned for HPD public reporting?

HCAI anticipates continuing to advance the accessibility and usefulness of HPD public reports as the database becomes more comprehensive and complete and HCAI builds its capacity over time. The HPD Advisory Committee is responsible for advising HCAI on principles and priorities for public reporting.

HCAI plans to release additional visualizations, including healthcare measures on chronic conditions and utilization.

To receive updates on the latest releases, subscribe to the HPD mailing list.

6. How is HPD data accessed?

The public can access HPD data through the publicly available information HCAI produces from the database, including data products and analytic reports. . In addition, HCAI will establish a process through which data requestors can apply for access to more detailed, non-public data.

HCAI, with the advice of the Advisory Committee and the Data Release Committee, will develop criteria, policies, and procedures for access and release to non-public data, including data aggregation and the protection of individual confidentiality, privacy, and security. Individual patient-level data is exempt from the disclosure requirements of the California Public Records Act.