Report provides detailed spending for patients across Washington state
SEATTLE, WA — What does it cost to provide health care to Washington state’s patients?
Answers to that question are provided in the Washington Health Alliance’s latest Total Cost of Care Highlight looking at the cost to provide medical services to patients with results reported by their by attributed primary care medical group and clinic location.
“This tool provides a much-needed starting point for working to improve health care affordability,” said Greg Marchand, Washington Health Alliance board member and Director of Global Benefits at Boeing. “The Alliance is a trusted source of reporting and insight, and this information is a key resource for purchasers to clearly understand and manage their company’s health care costs.”
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.
“Physicians across the state have been looking for this level of detail for some time and the fact that this is now publicly available is a big step forward,” said Dr. Pete Rutherford, Chief Executive Officer of Confluence Health. “I’m very excited to see the next steps of this analysis, so the Alliance can explain the drivers of what is contributing to these costs, and the variability across the state and then we can start to take steps to reduce it.”
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 most expensive patients account for approximately 13% of Washington state’s health care costs. This report captures the full spectrum, including patients 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.
The members of the Alliance’s Board of Directors, Health Economics Committee, and Quality Improvement Committee participated in the development of this release of the Total Cost of Care report. “We’re grateful to the physicians across the state for supporting transparency and moving Washington state to the front of the discussion on reducing health care costs,” said Pam MacEwan, Chief Executive Officer of the Washington Health Benefit Exchange.
About the Washington Health Alliance
The Washington Health Alliance (Alliance) is a 501(c)(3) nonprofit, nonpartisan organization working collaboratively to transform Washington state’s health care system for the better. The Alliance brings together more than 185 committed member organizations to improve health and health care by offering a forum for critical conversation and aligned efforts by health plans, employers, union trusts, hospitals and hospital systems, health care professionals, start-up companies, consultants, consumers, and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on health care, quality, pricing, and overall spending. The Alliance publishes its reports at WACommunityCheckup.org and provides guidance for consumers at OwnYourHealthWA.org so that individuals can make informed health care decisions.
Date: July 7, 2022
Contact: Denise Giambalvo