Healthcare Payments Data (HPD) Services Report
Introduction
The Healthcare Payments Data (HPD) Services Report consists of two dashboards that allow users to explore the types of healthcare services provided to Californians each year.
Each dashboard presents data on the individual services, which correspond to the procedure codes obtained from single service lines on claims or encounters. The services can range from a consultation with a specialist to a routine mammogram to anesthesia administration during surgery. The combination of filtering options, visualization displays, and the collection of measures can answer a range of specific questions such as:
- How is the utilization rate for service categories, such as tests or procedures, changing over time?
- What types of services are most commonly used by Californians?
- How much does the utilization rate for Evaluation and Management Services specific to behavioral health in Medi-Cal compare to the commercial market? To Medicare?
- What types of imaging services (e.g., CT scan, MRI, ultrasound, X-ray) are most common? How does this vary by region, payer, etc.?
The HPD Services Report utilizes the Restructured Berenson-Eggers Type of Service (BETOS) Classification System (RBCS) to classify healthcare services into meaningful categories and subcategories. (See Technical Note for definitions.)
- The Services – Overview visualization lists the services at the most aggregate level, consisting of the eight main RBCS categories: Anesthesia, Durable Medical Equipment, Evaluation and Management, Imaging, Procedure, Test, Treatment, and Other. Users can view one of three metrics for these categories: The total number of occurrences, the number of people who received the service at least once, or the utilization rate of the service category per 1,000 members per year. Selecting a specific service category will highlight differences in utilization over time, by geographic region, and across age, sex, or payer type. Payer types are commercial (largely fully insured), Medi-Cal (combines managed care and fee-for-service (FFS)), and Medicare (combines Medicare Advantage and FFS).
- The Services – Drill-Down visualization presents the data at a more granular view, displaying the eight aggregate RBCS service categories in their relevant subcategories. The subcategories of interest can be selected using the drop-down menus. Users may display the information by total number of occurrences, the number of people who received the service at least once, and the utilization rate per 1,000 members per year in a table format that may also be filtered and organized by year, age range, sex, Covered California region, and payer type. Finally, the County Granularity filter allows users to view Los Angeles County’s data for the entire county or by one or more of its Service Planning Areas (SPAs).
Key Findings
- From 2018 through 2023, the service rate per 1,000 members of each of the service categories excluding Other was higher for Medicare compared to Commercial and Medi-Cal.
- Evaluation and Management services (including but not limited to Hospital Inpatient Services, Emergency Department Services, Office/Outpatient Services, Care Management/Coordination, Home Services, etc.) had the highest service rate as a category compared to all other categories in all years. In 2023, there were approximately 6,200 services related to Evaluation and Management for every 1,000 enrolled members in the state.
Feedback
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Glossary
Population
The data displayed in the HPD Services Report includes all records of medical services that are available within California’s All-Payer Claims Database (APCD) from 2018-2023. Services that are reported with a valid procedure code are grouped accordingly into relevant RBCS service categories and subcategories.
Metrics
- Total Services: The total number of services received by members during the reporting year. If multiple services in a category are reported for the same member on the same day, those are counted as one service.
- Member Count: The total number of unique individuals who received at least one service during the reporting year.
- Service Rate per 1,000 Members: Calculated by dividing the total number of services during the reporting year by the sum of monthly member enrollments and then multiplying the result by 12,000. This methodology adjusts for differences in population or situations where a member was enrolled in an insurance plan for only a part of a reporting year.
Data Elements
- Reporting Year: Based on the year of the first service date on which a member received the service; January 1 – December 31.
- Age Band: Based on the member’s age at the end of the reporting year in which they received the service. Member records without a valid age are excluded from reporting.
- Sex: Based on the member’s sex at the end of the reporting year in which they received the service. Member records with a missing or invalid reported sex are excluded from reporting.
- County/Service Planning Area (SPA): Based on the member’s ZIP code of residence during the reporting year in which they received the service. For members within the highly populous Los Angeles (LA) County, the data can also be displayed by the eight LA Service Planning Areas (SPAs), which are also based on the member’s ZIP code of residence. Members records with a missing, invalid or non-California ZIP code are excluded from reporting.
- Covered California Region: Based on the member’s county of residence during the reporting year in which they received the service.
- Service Category/Subcategory: Groupings of services at a broader (category) and more granular (subcategory) level. The HPD Services Report utilizes the Restructured BETOS Classification System (RBCS) from the Centers for Medicare and Medicaid Services (CMS) to group HCPCS procedure codes found on each service line into these more consistent and meaningful classifications.
Payer types
Payers are the companies, programs, and organizations that oversee insurance plans and reimburse healthcare providers. Services are assigned to payer types according to the payer information reported on each medical claim service line. Individuals are assigned to payer types based on the primary medical insurance coverage reported on their monthly member enrollment. Three main types of payers make up the majority of the insurance market.
- Medicare: A federal health insurance program funded by the Centers for Medicare & Medicaid Services under the Social Security Amendments of 1965 that provides healthcare benefits to those aged 65 years and over or to disabled beneficiaries of any age. Includes Traditional FFS Medicare and Medicare Advantage managed care.
- Medi-Cal: A public health insurance program that provides free or low-cost medical services and healthcare benefits to low-income individuals, financed from state and federal funds; California’s version of Medicaid. Includes FFS Medi-Cal and managed care Medi-Cal.
- Commercial: Insurance products for which the coverage premium is paid by a private party, such as an employer, individual, or other entity. The HPD currently includes very limited data for the Employee Retirement Income Security Act (ERISA) self-funded health plans.
How HCAI Created This Product
- The HPD Services Report is based on Healthcare Common Procedure Coding System (HCPCS) codes. The report uses the Restructured BETOS Classification System (RBCS) from the Centers for Medicare and Medicaid Services to group HCPCS procedure codes found on each service line into meaningful categories and subcategories. The RBCS categories represent a more aggregate level, while the RBCS subcategories split each main category into more granular groupings. Service utilization rates are represented as the number of occurrences per 1,000 members during a reporting year.
- The HPD Services Report follows California Health and Human Services Agency’s Data De-Identification Guidelines. Data from any group with less than 30 individuals are removed from the analyses and suppressed in the visualizations. This will result in some error in the reported rates, especially in counties with small populations or measures that generally have lower rates. Note that totals in the dashboard only include values from unsuppressed records, and that values of zero are unsuppressed in both the data and the dashboards. Use caution when interpreting results for counties with less than 30,000 residents.
- In addition to the exclusions mentioned in the above section for each data element, only claims that were paid as primary were included in the HPD Services report. Orphaned claims, subsequent adjustments to original claims that were never reported to the APCD, were also excluded from the HPD Services Report.
- The HPD Program is currently refining its approach to resolving the unique identity of individuals across insurers and over time. As this approach is improved beyond industry standards, the HPD Program expects to identify more linkages – cases in which two or more records are determined to belong to a single individual. Therefore, member counts may decrease when new linkages are incorporated and accounted for.
- Additional information on how HCAI created this product is available in the data’s Technical Note.
Additional Information
Topic: Cost Transparency / Healthcare Utilization
Source Link: Cost Transparency – Healthcare Payments Database
Citation: HCAI – Healthcare Payments Database – Healthcare Payments Data (HPD) Healthcare Services, 2025
Temporal Coverage: 2018-2023
Spatial/Geographic Coverage: Statewide, County
Frequency: Annually