State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the U.S. spent more on health care than any other country in the world—$4.1 trillion, representing 19.7% of the Gross Domestic Product (GDP). States are trying to better understand their role in health care spending and to think creatively about strategies to address health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers) and transform this data to useful information on health care costs and trends. This paper describes the use of APCDs by states and recent efforts that have provided opportunities and challenges for states interested in this unique opportunity to inform health policy. While challenges exist, there is new funding for state APCD improvements in the No Surprises Act and potential new federal interest will help states enhance their APCD capacity to better understand their markets, educate consumers and create actionable market information.

Background: Relapsing-onset multiple sclerosis (MS) typically starts in early- to mid-adulthood, yet the trajectory of disease activity over the subsequent lifetime remains poorly defined. Previous studies have not quantified the age-specific portion of decreases in annualized relapse rates (ARR). Objective: The aim of this article is to determine, under a range of disease-related assumptions, the age-specific component of decreases in ARR over time among adults with relapsing-onset MS. Methods: We used a simulation modeling approach to examine a range of assumptions about changes in ARR due to age versus disability status. Scenarios included variations in initial ARR and rate of worsening on the Expanded Disability Status Scale. Model parameters were developed through analysis of MS patients in British Columbia, Canada, and literature review. Results: We found a substantial age-specific decrease in ARR in all simulated scenarios, independent of disability worsening. Under a range of clinically plausible assumptions, 88%–97% of the decrease was attributed to age and 3%–13% to disability. The age-specific decrease ranged from 22% to 37% per 5 years for a wide range of initial ARR (0.33–1.0). Conclusion: Decreases in ARR were due mostly to age rather than disability status. To facilitate informed decision making in MS, it is important to quantify the dynamic relationship between relapses and age.

Background:Relapsing-onset multiple sclerosis (MS) typically starts in early- to mid-adulthood, yet the trajectory of disease activity over the subsequent lifetime remains poorly defined. Previous ...

State policy makers are under increasing pressure to address the prohibitive cost of health care given the lack of action at the federal level. In 2020, the U.S. spent more on health care than any other country in the world-$4.1 trillion, representing 19.7% of the Gross Domestic Product (GDP). States are trying to better understand their role in health care spending and to think creatively about strategies to address health care cost growth. One way they are doing this is through the development and use of state-based all-payer claims databases (APCDs). APCDs are health data organizations that hold transactional information from public (Medicare and Medicaid) and private health insurers (commercial plans and some self-insured employers) and transform this data to useful information on health care costs and trends. This paper describes the use of APCDs by states and recent efforts that have provided opportunities and challenges for states interested in this unique opportunity to inform health policy. While challenges exist, there is new funding for state APCD improvements in the No Surprises Act and potential new federal interest will help states enhance their APCD capacity to better understand their markets, educate consumers and create actionable market information. Keywords APCDs, Medicare, Medicaid, health care costs In 2020, the U.S. spent more on health care than any other country in the world-$4.1 trillion, representing 19.7% of the Gross Domestic Product (GDP) (CMS 2021). The persistent rise in health care spending and lack of federal action has significant impact for states and state policymakers. First, increases in health care spending levies pressure on states which must balance their budgets each year. State spending on the Medicaid program alone accounted for almost one-fifth (17.8%) of state budgets in the 2021 fiscal year (NASBO 2021). States also finance health care for state employees, state prison health care services, and a myriad of safety net programs. Second, patient concerns about excessive costs, including both increases in health