Alliance Releases Total Cost of Care for Medical Groups and Clinics

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Alliance Releases Total Cost of Care for Medical Groups and Clinics

I am delighted to report that the Washington Health Alliance is continuing its efforts to understand where Washington state is spending its health care dollars. Today we released our Total Cost of Care Report.

Using medical claims and enrollment data from its voluntary All-Payer Claims Database from multiple payers, the Alliance combined the cost of all health care services and patient payments, such as co-payments, co-insurance, and deductibles. The total is reported on a per patient per month basis (PPPM) and broken down into five major categories and dozens of services.

  • Facility Inpatient—such as surgery, maternity, skilled nursing facility (SNF) and other care that includes an overnight hospital stay.
  • Facility Outpatient—services provided on an outpatient basis such as day surgery, radiology, cardiovascular, emergency medicine, and pharmacy.
  • Professional—a wide range of treatments including physical therapy, occupational therapy, radiology, emergency medicine, preventive care, specialty drug treatments, and urgent care.
  • Prescription Drugs—medicines dispensed at retail pharmacies.
  • Ancillary—includes ambulance, home health care, and specific supplies such as durable medical equipment, glasses and contacts, and prosthetics.

As we all know, health care cost can vary significantly between patients, with some utilizing little more than preventive care and others managing multiple or complex health conditions that can be very expensive. While small in number, the Alliance found that the most expensive patients account for approximately 13% of Washington state’s health care costs. This new release captures the full spectrum, including patients that are considered high-cost, but people who did not receive any health care services during the reporting period are not included.

Using risk adjustment that considers each patient’s use of health care services, including diagnoses and prescriptions, the Alliance set the state average as the benchmark and reports the illness burden for each physician group population and services, allowing for an apples-to-apples comparison.

This would not have been possible without the involvement of the Alliance’s Board of Directors, Health Economics Committee, and Quality Improvement Committee who all participated in the development of this release over many months and the support of clinical leaders across the state.

Details on the ways you can use the Total Cost of Care report will be coming soon. Watch for an invitation to two webinars – one focused on purchaser use cases and one on provider use cases. Sessions are open to all Alliance members regardless of your stakeholder group.

All the best,


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