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Alliance’s Total Cost of Care Report Receives Widespread Acclaim

The Washington Health Alliance’s new Total Cost of Care report has garnered significant attention, including coverage by the Everett Herald, AboutHealthTransparency.org, Healthcare Innovation, State of Reform, and hundreds of other news organizations across the country that carried the announcement. It has been called, ”exciting,” “courageous,” “amazing,” and “transformative.” The online tool provides unprecedented detail on how much money is spent on a county-by-county level and in independent regional organizations, called Accountable Communities of Health (ACHs) that work on local health care and social needs-related projects.

At the All-Alliance meeting on February 16th, billed as an opportunity “to discuss ideas for how we can use the Total Cost of Care results to improve the delivery of health care across Washington state,” moderator Alliance Executive Director Nancy Giunto, opened the webinar with the acknowledgement of the Alliance’s focus on collaboration. “We know that the best ideas come from those who will use the results and who know the marketplace in our state from a variety of perspectives.”

Jim Andrianos, founder of Calculated Risk, Inc., presented the report methodology. Andrianos has consulted on many Alliance projects and reports over the years and staffs the Health Economics Committee, where much of the development work for Total Cost of Care occurred. Andrianos described how the results are reported on a per member per month (PMPM) basis and by using risk adjustment and setting the state average as a benchmark, allows for more equitable comparison of costs across geographic areas.

Mark Pregler, Alliance Director of Data Management and Analytics, who led the Alliance’s Total Cost of Care effort, reviewed the many aspects of the extensive online interface, that allows users to look at the data in a wide variety of ways:

  • geographically on a state map to compare average county and ACH PMPMs and risk scores;
  • by setting, inpatient, outpatient, professional services, prescription drugs, and ancillary;
  • by services, including surgical, maternity, preventive, emergency, urgent care, and home health care;
  • a side-by-side comparison of Medicaid and commercial results; and
  • a year-over-year comparison.

After the presentations, Giunto put the Alliance’s collaboration focus front and center with a call for audience input, “We want to hear from you. What are the questions this information raises for you and what thoughts do you have for extending the work?” In response, the Alliance heard many suggestions, including:

  • providing these results to local government officials and economic development agencies;
  • using this information to inform policy reform initiatives;
  • adding cost driver information, such as service use rates and price levels, to explain spending differences;
  • comparing the data by diagnosis trends of major health conditions to help identify best practices and promote high value care paths;
  • incorporating information on healthcare provider and facility locations to see how health may be affected for those who have less access;
  • figuring out how to including race and ethnicity data into the analysis.

The Alliance is considering all of the recommendations and is currently working on the next release of this report with results on the medical group and clinic level. If you have suggestions, please forward them to Mark Pregler.

Published: March 1, 2022

About Washington Health Alliance

The Washington Health Alliance is a place where stakeholders work collaboratively to transform Washington state’s health care system for the better. The Alliance brings together organizations that share a commitment to drive change in our health care system by offering a forum for critical conversation and aligned efforts by stakeholders: purchasers, providers, health plans, consumers and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on measures of health care quality and value. The Alliance is a nonpartisan 501(c)(3) nonprofit with more than 185 member organizations. A cornerstone of the Alliance's work is the Community Checkup, a report to the public comparing the performance of medical groups, hospitals and health plans and offering a community-level view on important measures of health care quality (www.wacommunitycheckup.org).

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