Healthcare Payments Data Program: Voluntary Submitters

Healthcare Payments Data Program (HPD) Overview

The HPD is California’s all payer claims database (APCD), a resource that compiles data on health care services in California to increase transparency and inform policy. An overview of the HPD Program is available on HCAI’s website addressing topics including timeline, types of data and format, stakeholder engagement, privacy and security, and access to HPD data. Resources for data submitters are also available.

HPD Program Goals

The HPD Program has developed the following goals, based on the legislative intent outlined in the authorizing statute.

  • Provide public benefit for Californians and the state while protecting consumer privacy.
  • Increase transparency about health care costs, utilization, quality, and equity.
  • Inform policy decisions on topics including the provision of quality health care, improving public health, reducing disparities, advancing health coverage, reducing health care costs, and oversight of the health care system and health care companies.
  • Support the development of approaches, services and programs that deliver health care that is cost effective, responsive to the needs of enrollees, and recognizes the diversity of California and impacts of social determinants of health.
  • Improve data transparency to achieve a sustainable health care system and more equitable access to affordable and quality health care for all.
  • Learn about and seek to improve public health, social determinants of health, and the health care system, not about the individual patients.

Voluntary Submission to the HPD

Many health benefit programs are increasingly concerned about the continued escalation of health care costs and are interested in more effective use of data and transparency to drive the development of solutions. An estimated 4-5 million Californians are covered by ERISA self-funded employers and other purchasers, which are not mandatory submitters under the HPD Program. These purchasers may choose to contribute their data to the HPD. The more comprehensive the HPD is in reflecting the entire population of California, the more accurate the analytic findings will be and the greater the likelihood of achieving both purchaser goals and HPD program goals – including transparency, informed policy decisions, improved health care, and equitable access to affordable and high-quality care.

Purchasers can request their ASO plan(s) that their data be submitted to HPD. Click below to request assistance connecting with your ASO.

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What Can Employers Learn from HPD Data?

The HPD  Program has launched with the release of its first public report – the HPD Snapshot. The HPD Snapshot provides information about what data is available in the HPD System, including the number of Californians represented, types of health care coverage (e.g., commercial, Medi-Cal, Medicare), and most common procedures and prescription drugs.  

  • This initial visualization allows users to view, at a glance, the most common services provided in the state, including the procedure category. Users can filter by type of service (e.g., inpatient, outpatient, home health), and by reporting year. 
  • The report also displays the top drug prescriptions, along with the total number of prescriptions. The visualization includes filters for drug class (e.g., cardiovascular agents), whether the drug is brand or generic, and reporting year.

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.    

HPD Public Reporting

Voluntary Submission Frequently Asked Questions

1. Are ERISA self-funded employers and other purchasers required to submit data to the HPD?

No. As currently written the Health and Safety Code authorizing the implementation of the HPD Program does not include entities subject to ERISA as mandatory submitters to the HPD Program. In March 2016, the U.S. Supreme Court ruled that states cannot require self-insured employer plans regulated under the federal Employment Retirement Income Security Act of 1974 (ERISA) to submit data to a state APCD. The decision, Gobeille v. Liberty Mutual, resulted from a lawsuit by a self-insured employer that challenged Vermont’s right to require the employer’s third-party administrator to submit claim data to the state APCD. The Supreme Court found that ERISA preempted Vermont’s ability to compel the submission of claim data for self-insured employers and other purchasers, such as Taft-Hartley trusts (collectively bargained labor-management agreements).

2. Aren’t CalPERS and other public purchasers also self-funded? Are they required to submit data?

The Gobille v. Liberty Mutual decision does not apply to governmental plans that cover public employees because such plans are exempt from ERISA. Accordingly, the California Health and Safety Code authorizing the implementation of the HPD Program, identifies self-insured health benefit programs for state employees and other public workers (including state, county, and municipal employees and retirees; and public-school teachers and retirees) as mandatory submitters to the HPD System if they meet the threshold for size. HCAI has set a threshold of 40,000 covered lives to define mandatory submitters, so public purchasers with fewer than 40,000 self-funded members and dependents fall below that threshold and are not required to submit their data.

3. Are ERISA self-funded employers and other purchasers allowed to submit data to the HPD system?

Yes. California law gives HCAI the authority, at its discretion, to accept data voluntarily submitted to the HPD System, including data from ERISA self-insured plans. Also, HCAI believes HIPAA covered entities can disclose protected health information (PHI) to HCAI without patient authorization based on exceptions in HIPAA enabling covered entities to disclose PHI for public health activities as described in 45 C.F.R. 164.512(b), or for health oversight activities authorized by law under 45 C.F.R. §164.512(d).

California law states that the HPD program “performs public health activities” and that the information collected for HPD is “necessary to carry out projects with public health purposes.”  Specifically, the HPD’s purpose is to collect PHI “to inform state policy decisions regarding the provision of quality health care, improving public health, reducing disparities, advancing health coverage, reducing health care costs, [and] oversight of the health care system and health care companies.”    

Please be aware that the above information is not intended to convey or constitute legal advice.  Please consult your legal counsel about your specific circumstances.

4. How can an ERISA self-funded employer or other purchaser submit data to the HPD system?

The purchaser’s TPA/ASO (third party administrator/administrative services only) partner(s) can submit the data on your behalf, with your authorization. The TPA/ASO may be contacted directly to make this request, or purchasers may complete the HPD Request Assistance Form for more information on how to facilitate data submission through the TPA/ASO. The HPD Regulations outline the process to become a voluntary submitter.

Request assistance connecting with your ASO.

5. How do ASO plans generally obtain authorization from clients to submit data to HPD?

Some plans engage their clients proactively on about contributing data to HPD (and other state APCDs) by explaining the opportunity and providing an opt-in authorization as part of new client onboarding and/or annual renewal processes. Other plans rely on requests from their clients to trigger the authorization and opt-in process and respond to those requests individually as they arise.

Purchasers can request their ASO plan(s) that their data be submitted to HPD. Request assistance connecting with your ASO.

6. How will the HPD program ensure data privacy, confidentiality, and security

With the establishment of the HPD program, HCAI is implementing further specific privacy and security protocols to safeguard the health care data of Californians. Chapter 8.5 (commencing with Section 127671) of Part 2 of Division 107 of the Health and Safety Code establishes strong privacy and security standards for the HPD System.

To read more about how the HPD program will ensure data privacy, confidentiality, and security, please see the HPD FAQs.

7. Who can access HPD data? 

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

Resources

Contact

Contact HPD at hpd@hcai.ca.gov  for additional HPD questions or inquiries.   

To receive regular informational updates about the program, subscribe to the HPD mailing list.