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Washington Moves Closer to A Single All-Payer Claims Database

I am delighted to report that the legislation to move us closer to a single statewide All-Payer Claims Database (APCD) has successfully moved through both houses of the Washington legislature. It passed the House 91 to 5 on April 16th and passed the Senate 44 to 1 on April 26th. It is currently awaiting Governor Inslee’s signature.

It has been a long road to get here, with many unexpected twists and turns, including an unsuccessful bid for leading the current WA-APCD in 2016. And through it all, the Alliance was fortunate to have the knowledge and support of board members and leaders of our Government Affairs Committee including Past Alliance Board Chair and Senior Deputy to King County Executive Fred Jarrett, Washington Roundtable President Steve Mullin and Former King County Executive Director and Housing and Urban Development Deputy Director Ron Sims. I have told them and will share with you that the Alliance could not ask for better champions. A heartfelt thank you goes out to them, all of our board members, the indefatigable Amy Brackenbury (our lobbyist), and bill sponsors Representatives Eileen Cody, Paul Harris, Nicole Macri, Michelle Caldier, June Robinson, Laurie Jinkins, Gael Tarleton, Timm Ormsby, Vandana Slatter, and Senators Karen Keiser, Ann Rivers, David Frockt, and Mark Mullet, without whom none of this would have been possible.

The current contract with Oregon Health & Science University to serve as the lead organization for the WA-APCD will terminate on June 30, 2019. The bill allows for transfer of the state APCD from the Office of Financial Management to the Washington State Health Care Authority (HCA) by January 1, 2020. These state agencies must develop a transition plan for that to occur by July 1, 2019.

Compared to the previous APCD legislation, there are some significant changes in this bill that are favorable to the Alliance. For example, the competitive procurement process emphasizes the importance of the lead organization’s role in engaging stakeholders to develop reports “especially among groups of health care providers, carriers, and self-insured purchasers.” The HCA may not select a lead organization that is a health plan, a hospital, a provider, a third party administrator or an entity with a controlling interest in any of these types of organizations.

In other changes, this bill allows the lead organization to have access to proprietary financial information when following data request and use protocols, claims line elements the Alliance receives today from many strong data submitters. The database’s financial sustainability may “be reasonable and customary to other state databases,” rather than self-sustaining, as previously required. It also provides for school employee benefits programs to supply data to the database, an estimated increase of 300,000 to 400,000 lives. HCA is responsible for ensuring the effectiveness of the database in meeting agencies’ programs through the creation of a new state agency coordinating structure. To see the full text of the bill click here.

As you know, the Alliance has a long history of providing credible and robust analysis from our voluntary APCD, in existence from 2007. Since then, we have brought together hundreds of purchasers, providers, payers, and consumers, who have invested millions of dollars to improve our health care system. And we are heartened that this legislation may enable us to eliminate the additional expense and reduce the administrative burden of a second database for data submitters and for the providers and hospitals that validate the data.

We expect to be responding to the procurement process when it is issued by the HCA and hope that the Alliance will be considered for the role of the state’s lead organization. We are encouraged by the progress and look forward to partnering with the state to move to a single, sustainable APCD, to speed the improvement of quality and affordability of health care for citizens in our state.

I feel fortunate to be guiding the Alliance at this exciting time. The work we do and our reputation in the community is based on our members’ support and willingness to take on these incredibly complex and difficult challenges, wherever they arise.  Without you, we, literally, would not be here.

As always, I appreciate and thank you for your continued support,

Nancy

Published: May 2, 2019

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).

One Response to “Washington Moves Closer to A Single All-Payer Claims Database”

  1. nadezhda vasileva

    How about dental services? This is completely out of any regulation or protection (from my personal experience): They take a lot of money for dishonest neglectful services. I lost thousands the dollars, and was not able to recover even a penny, and am still losing my teeth. Thank you

    Reply
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