All-Payer Claims Databases (APCDs) are large-scale databases that systematically collect medical claims, pharmacy claims, and eligibility and provider files from private and public payers. APCDs include data from all settings of care and permit the systemic analysis of health care delivery.  There are over 20 APCDs throughout the United States, mostly as state-level entities though some are at a metropolitan geographic level.

WHIO systematically collects and integrates medical claims, pharmacy claims, and eligibility and provider files from private and public payers. These records cover commercial health insurance, Medicare Advantage plans, and the Wisconsin Medicaid program. There are three distinct advantages of these data: (1) represent the single most comprehensive view of health care in Wisconsin, containing claims for about 75 percent of Wisconsinites; (2) include health care claims managed by virtually all of the state’s private and public payers; and (3) cover the spectrum of care delivery, including inpatient, outpatient, long-term care, clinician services, pharmacy and more. The data also identifies the place of service where the patient was seen, such as a hospital, a doctor’s office, an urgent care clinic or an ambulatory surgery center. Data collection for the WHIO is performed by technical partner SymphonyCare. WHIO provides oversight and management of the data collection effort.

WHIO offers several data products along with related support, training, and consulting services.  Products include:

1. The Standard Integrated Data (SID) files, a “just the facts” integration of records into a single relational set of data tables centered around a unique and persistent (though de-identified) patient ID.
2. The Enhanced Data (ED) files, which build on WHIO’s foundation of comprehensive claims and eligibility records to produce a single relational set of tables that include episodes of care; patient risk adjustment; and normalized pricing.
3.  Applied Insights, a secure web portal to pre-built Tableau reports.
4.  Provider Portfolio, a single-table asset to complement your own provider data.

Service and pharmacy fill dates go back to January 1, 2017, with ongoing quarterly updates to WHIO’s data collection that are completed approximately 8 weeks after the close of a calendar quarter.  Over 450 million (and counting) records cover 75% (and growing) of Wisconsin citizens, with details retained at the individual claim line level.

Not every last healthcare service provided in Wisconsin is represented in WHIO’s data, though the vast majority is.  Examples of services not included:

• Services by plans that don’t cover general medical care, e.g., accident-only;
• Workers’ compensation;
• S. Department of Veterans Affairs;
• The Indian Health Service;
• Tricare;
• Uninsured care or any care paid 100% by the patient.

As of fall 2021, only two commercial health plans do not contribute records to WHIO.  All others are participants, as is the Wisconsin Medicaid program.

Protecting individual privacy is of paramount importance at WHIO. Before any information leaves the data vault at WHIO’s technical partner, patient names, dates of birth, and addresses are converted into a unique and persistent WHIO patient ID that cannot be decoded or reversed. The WHIO does not collect -- in any form -- genetic information, telephone numbers, email addresses, photographs or notes from conversations between patients and caregivers.

While WHIO is chartered in Wisconsin statutes, no public funding is provided to support operations.  Unlike many state APCDs, WHIO is a voluntary effort of its contributing health plans and is supported by fees for the licensing and use of its data.

Prices vary by scope of data and level of effort required to respond to your needs.  WHIO’s pricing structure features a base fee to support ongoing operations, plus charges related to your specific use case.  Contact us at info@whio.org to discuss your project – we’re ready to help.  To get started, please include the following when you contact us:

• A description of your use case – what do you plan to do with data in your project?
• Any relevant data specifications – specific diagnosis code ranges, or patient demographics, or patient or provider geography or service area, or a limited service date span.
• Whether you are seeking data for your own analysis, or instead need the expert insight and consultation that WHIO can provide you.
• A general time frame for your project – by when do you need us to deliver?