Using all payer claims data to analyze geographic access patterns in primary care

Dates: 2013-2014

State: New Hampshire

Client(s): NH DHHS

Services: Health Care & Public Health Planning, Applied Research & Evaluation, Health Systems Transformation

Technical Expertise: Health Disparities, Population Health, Primary Care, Rural Health, State and Local Public Health

In order to effectively evaluate the accessibility of health care services, states need comprehensive data on utilization patterns amongst the population, as well as methods to analyze and apply the data.

Many states are now collecting all-payer claims data (APCD) that combine billing information from Medicaid, Medicare, and private insurers, including large self-insured companies. JSI has developed a method to tap the power of these new data sources to examine geographic patterns in health care access in New Hampshire using the state’s new APCD.

This initial project, conducted with the NH State Primary Care Office (PCO), focused on showing where patients in the state go for the bulk of their primary care services, though the method can be used to examine access patterns in a wide range of key health care services. The maps that JSI developed provide a picture of utilization patterns by zip code, showing how far people travel, and how likely people are to choose a particular destination zip code for their primary care. A similar effort is underway with the Massachusetts PCO to study Medicaid access patterns.

The NH project was initially designed to validate the recently revised primary care service area (PCSA) definitions, developed based solely on Medicare billing data. From our initial analysis, we found the data shows many similarities to these definitions, however it also showed some key differences in some parts of the state where general usage patterns vary from the PCSA designations. It also shows that residents of some areas of the state travel greater distances than in other regions.

Using the new APCD information in this way, JSI sees the potential to allow states to conduct a wide variety of access and service area analyses. For example, one can to compare private insurance patterns with Medicare and Medicaid patient patterns, or to evaluate the accessibility of specialized services across the state.


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