With new lens of equity, Alliance releases 2023 Community Checkup

Since 2008, the Washington Health Alliance has been reporting on the quality of care in our state, and we continue to endeavor to add impactful insights into the Community Checkup to better help purchasers, health plans, and providers understand where they can collectively begin to tackle health care challenges.

This year we introduce new components to understand how the neighborhood you live in can impact your health and to highlight the importance of having a primary care provider.

The Alliance remains committed to transparency and trusted, credible reporting on health care quality, cost, and value. Our reporting relies on a voluntary All-Payer Claims Database, covering more than 4 million Washington residents, well over 50% of the state’s population having commercial insurance or Medicaid coverage. These claims, from Jan. 1 through Dec. 31, 2021, show results from all the Accountable Communities of Health (ACH), more than 1,900 clinics, 300 medical groups, 100 hospitals, 16 health plans, and all 39 counties in Washington.

Read the Alliance’s Community Checkup highlight report. 

New this year, we have introduced the lens of equity to help sharpen the focus on where actions can yield tangible results. Leveraging the Neighborhood Atlas (the Area Deprivation Index or ADI), a tool validated by the University of Wisconsin School of Medicine and Public Health, we are reporting for the first time that all too often our least advantaged neighborhoods receive a substantively lower quality of care.

Where you live matters. For example, if you live in a more socioeconomically disadvantaged area, you may not be receiving cancer screenings at the same rate compared to those in more privileged areas. Similarly, less than 40% of commercially insured children get appropriate well-care visits when they live in more disadvantaged locations.

View the full Quality by Area Deprivation Index Highlight.

Do you really need a primary care provider? The quick answer is yes! This is the first year we report quality results for people who have claims but do not have an attributed primary care provider (PCP). For Washingtonians without a PCP, the ability to receive the appropriate care is significantly inadequate. For example, of commercially insured women without a PCP, only 36% receive recommended breast cancer screening. For those with a PCP, that rate can go as high as 91%, almost a three-fold difference.

View the full Variations in Health Care Quality Highlight.

Clinical care across the country was impacted by the Covid-19 pandemic. However, clinical processes and outcomes as reported by the National Committee for Quality Assurance continue to improve nationally. Unfortunately, those same measures of quality in Washington have mostly remained flat in comparison. While we aspire to rank at or above the national 90th percentile, we find ourselves below the 50th percentile on more than 70% of these measures. The health care system is failing Washingtonians on dozens of quality measures that could dramatically improve their health, allowing people to contribute to their communities, remain productive in their jobs and improve the affordability of care overall.

It is well documented that almost half of families are having significant difficulty with the costs of healthcare. High-quality care is paramount; however, it must come at a reasonable cost. Families should not have to choose between housing, transportation, food, and healthcare. Too often, delays in care are due to the financial rationing choices that people are forced to confront. Health care value means we have a system that delivers appropriate, high-quality care at a reasonable cost that is also affordable for families. Failure to do so will further widen the care gap that most often impacts our vulnerable communities.

We all have a lot of work ahead of us to catalyze change in Washington’s health care system. This must be a collective effort. It begins with everyone making a choice to change.


Drew Oliveira, MD, MHA
Executive Director
Washington Health Alliance