Washington Health Alliance releases first-ever report on health care costs and equity


SEATTLE — The Washington Health Alliance this week released its first-ever report looking at the total cost of care across Washington state through an equity lens in an effort to drive the conversation toward removing barriers to high-quality, affordable and equitable health care.  

Relying on its All-Payer Claim database, covering 4.5 million Washington residents, the Alliance paired its extensive health care cost data with the Neighborhood Atlas, also known as Area Deprivation Index or ADI, a tool validated by the University of Wisconsin School of Medicine and Public Health. Merging the data with this tool allows the Alliance to show for the first time how socioeconomic advantage has a direct impact on the cost, utilization, and overall impact of health care in our state.  

“In order to address health care equity, we need to look not just at the quality of care our communities receive, but also the cost of providing that care. Without a concerted effort to address the costs, we continue to have a system where socioeconomic barriers keep residents from receiving appropriate care and perpetuates poor health outcomes,” said Drew Oliveira, MD, MHA, the Alliance’s executive director. 

“With this report, we show for the first time how where someone lives can impact the cost of caring for them. We do not intend to just highlight the trends uncovered in the report, but to actively engage with our members, and other health care stakeholders, to identify how we close these care gaps to ensure the health and wellness of all Washington residents,” Oliveira added.  

A recording of an hour-long webinar discussing the results is available on the Alliance’s Youtube page. (Link) 

While there were many findings from pairing the data with this tool, some impactful trends were immediately clear across the ADI reported levels of advantage and disadvantage:  

  • As the deprivation score rises, the risk score also rises. Despite this, the percentage of people without any claims at all goes up. (Risk score reflects the relative health or illness burden of a group, accounting for age, gender, and each patient’s use of health care services.) 
  • For commercially insured residents, as ADI rises, the spending rises for hospital-based care, but declines for professional care. 
  • While the average cost rises dramatically, these costs can be highly variable and difficult to predict for areas more disadvantaged. 
  • The illness burden (based on risk scoring) rises for commercially insured in all cost categories with the risk scores rising most substantially among patients who had ‘Facility Inpatient’ care. 
  • The share of people with commercial insurance who don’t appear to be using it rises with ADI from 5.8% to 13.3%. 
  • About one-third of patients with commercial insurance do not seem to be associated with a primary care provider, which has a demonstrated impact on the quality of care received.  

Following the webinar on Tuesday to discuss the results of the report, the Alliance convened nearly two-dozen leaders in health care, representing health care providers, health plans, employers and union trusts and pharmaceutical companies, to drive the conversation on market change necessary to move the needle toward a more equitable health care system in Washington state.  

This latest release builds on work released in March of this year when the Alliance paired its leading health care quality analysis with the same ADI tool. For more on that analysis, please visit our report highlight: Quality Measures by Area Deprivation Index 

The Alliance will continue to work in lockstep with its more than 185 member organizations and stakeholders toward affordability, quality and equity in health care with the goal of ensuring every Washingtonian lives a healthy life.  

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