The Washington Health Alliance’s released its Total Cost of Care report looking at how much is being spent on health care in Washington state as well as on the different types of care. The report provides 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.
The Alliance used medical claims and enrollment data from its voluntary All-Payer Claims Database to create the report on approximately 4 million people with Medicaid and commercial insurance. By looking back on three years of data, the report makes it possible for policy makers, health plans, care providers and health care purchasers–employers, unions, and others–to take needed action.
Based on the patient’s county of residence, the Total Cost of Care report categorizes the claims from multiple payers into five major categories:
- Facility Inpatient—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.
Data reported by the Alliance identifies differences in the relative health of populations and the differences in the costs of care in Washington state.
Using data from multiple payers and self-funded purchasers and risk-adjusting the results using age, gender, service utilization and diagnoses, the Alliance set the state average as the benchmark and analyzed spending on a per member per month (PMPM) basis.