Transparent pricing is essential for a competitive and efficient market, yet it remains elusive in the health care industry. Without clear pricing data, employers and state agencies struggle to design benefit plans that balance cost and quality, while Texans often face unpredictable, high medical expenses. The Texas Legislature has a unique opportunity to address this challenge by fully funding the Texas All-Payor Claims Database (TX-APCD)—a vital tool for improving health care value across the state.
Health Care Price Transparency: Next Steps
Why the TX-APCD Matters
In 2021, the Texas Legislature passed critical legislation mandating price transparency in the health care industry. The next step in this ongoing effort is ensuring full funding for the TX-APCD, which was established by House Bill 2090 (87R) and is housed within The University of Texas Health Science Center at Houston (UTHealth Houston) and its School of Public Health’s Center for Health Care Data.
This database aggregates de-identified claims data from public and private insurers, encompassing medical, pharmacy, and dental claims, as well as provider and eligibility files. It will include claims information for approximately 60% of all insured Texans, covering nearly all medical claims regulated by the state. With robust data collection, the TX-APCD can serve as a game-changing resource for improving health care pricing transparency, helping all stakeholders make informed decisions.
Identifying High-Value Care
A key benefit of the TX-APCD is its ability to help researchers, employers, and policymakers identify high-value providers and health plans—those that deliver high-quality care at lower prices. By analyzing claims data alongside patient outcomes, researchers can evaluate which providers consistently offer the best care at the most competitive costs. This will empower employers to design better benefit plans that prioritize high-value care, reducing overall health care expenses while maintaining or improving quality.
Helping State Budget Writers and Appropriators
Building on the Legislature’s past efforts to reinforce the fiscal strength of the Employee Retirement System and Teacher Retirement System, fully funding the TX-APCD will provide Texas state officials with a powerful tool for evaluating health benefit plans for state employees and teachers. Lawmakers and budget writers will be able to assess the impact of proposed plan changes, ensuring that taxpayer dollars are used efficiently to provide high-quality care. Additionally, the database can help state agencies detect fraudulent or wasteful billing practices, ultimately driving down costs and improving system integrity.
Addressing the Burden of Uncertain Medical Costs
Texans face real consequences due to the lack of price transparency in health care. A recent Texas 2036 poll found that 41% of Texas voters had a family member who postponed or skipped medical treatment due to uncertainty over costs. Among mothers, this number rises to 52%. Benefit plans can play a role in providing their employees and enrollees with more certainty about prices, but they need to embrace innovative new benefit designs that are powered by access to historical claims data. By providing researchers with access to claims data to help design these new benefit plan types, the TX-APCD can help reduce uncertainty for families, allowing them to make informed choices about their health care without fear of unexpected expenses.
A Critical Step Forward
Texas has made important strides in restoring competition to the health care market. Fully funding the TX-APCD is the next critical step. With transparent, accessible data, employers can design better health plans, researchers can identify high-value care, and appropriators can make smarter budget decisions. Ultimately, this initiative will lead to a healthier, more prosperous Texas, where families, employers, and policymakers can work together to improve health care outcomes and affordability for all.