HCAI reports progress on California Health Care Payments Database; adds public reports and opens regulated data‑release process

The Department of Health Care Access and Information (HCAI) told the Healthcare Affordability Board on March 12 that California’s Health Care Payments Database (HPD) has reached several implementation milestones and is now producing public reports while standing up a regulated data‑release program for qualified researchers.

HCAI Deputy Director and CIO Michael Valle said the HPD now ingests three payer sources: Medi‑Cal (Department of Health Care Services), Medicare fee‑for‑service (CMS), and commercial plans (mandatory submitters defined as plans covering 40,000 or more lives, plus all Covered California plans). Valle noted the HPD currently covers roughly 32.6 million covered lives across payer types and contains detailed claims records useful for utilization, price and prescription drug analysis.

Why it matters: the HPD is intended to give policymakers and researchers a detailed, multi‑payer view of healthcare spending and utilization in California. Board staff and outside researchers will use the HPD to evaluate cost drivers, monitor the effects of any sector targets, and analyze equity impacts.

Recent public releases and analytics: doctor Chris Krawczyk, Chief Analytics Officer, described public visualizations and reports already available on HCAI’s website: the HPD Snapshot and Measures dashboards (first and second‑generation releases), a fee‑for‑service prescription drug cost visualization for the commercial market, a services visualization that counts common procedures by setting, and a newly published out‑of‑pocket costs for chronic conditions report (released the week of the meeting). Krawczyk demonstrated the drug and out‑of‑pocket visualizations during the meeting, showing how a small share of prescriptions account for a large share of pharmacy spending and how county‑level median out‑of‑pocket burdens vary.

Data quality and gaps: Dionne Evanstein, Chief Data Programs Officer, said HPD data completeness is high for operational billing fields (procedure codes, dates, dates of service, national drug codes) but lower for optional demographic items such as race/ethnicity in commercial files. She warned that provider roster fields (NPI, address, entity type) sometimes contain inconsistencies across submitters, requiring enterprise data‑quality work and NPIs to be matched to federal NPIs (NPPES) for cleanup.

Non‑claims payments and timelines: Evanstein said HCAI is moving to adopt rules to collect non‑claims payment data (monthly capitation files, annual non‑claims payments and pharmacy rebates) using a standardized layout developed in coordination with national partners. If OAL approves the regulation, HCAI expects to begin testing in fall 2025 and accept production non‑claims submissions in fall 2026.

Data‑release program launched: HCAI also announced the HPD data‑release regulations were adopted in November 2024 and the program launched December 17, 2024. The office has received multiple data‑release requests and held an informational webinar in January 2025; HCAI expects its data‑release committee to review the first request in its May 2025 meeting. The data‑release pathway enables non‑public, identifiable or de‑identified HPD extracts to be shared with approved researchers and government partners under regulatory safeguards.

Examples of current analytic work: Margaretta Brand (OCA) described an HPD‑based behavioral‑health spending analysis that uses a Millbank/Friedman methodology to classify claims as mental‑health or substance‑use disorder spending by care setting, and which will feed OCA’s deliberations on how to set a behavioral‑health investment benchmark.

Public comments and next steps: public commenters praised the HPD for transparency and urged sustained state funding; HCAI reminded the board that the HPD’s initial implementation funding expires in June 2025 and invited support for ongoing appropriation. HCAI said the HPD team will continue to refine data quality, expand reporting (2022–2023 data updates were scheduled for release in the second quarter of 2025) and partner with OCA on cost‑driver work and equity measures.

Ending: HCAI said the HPD is now productive for public reporting and research and will broaden its value when non‑claims payment files are added and voluntary ERISA/ self‑insured submissions increase through outreach.