WAHBE will use the APCD to further our understanding of the individual market and its claims experience and how the Exchange market fits into the larger market. The individual market has seen a great number of changes and uncertainty in recent years. As the platform for individual market coverage in Washington, WAHBE looks to further policies that increase stability, affordability, and options within the market. The APCD will allow WAHBE to use data to model policies and how these policies affect our population. The purpose of WAHBE’s project fits within the WA APCD goals outlined in state law as this will enable the Exchange to benchmark its performance against the market and allow the Exchange to utilize best practices that best fit our population. Furthermore, it will enable the Exchange to promote competition based on quality and cost among carriers.

APCD data will be used to support project planning and implementation, regional funds flow, monitoring and quality improvement for Accountable Communities of Health (ACH) throughout Medicaid Transformation Efforts, and as ACHs spread transformation efforts beyond the Medicaid population. The five ACHs that will receive data through this application represent 21 counties, cover 45% of the statewide Medicaid population, and work with all five Medicaid Managed Care Organizations. The data will allow ACHs to examine patterns of access, cost, quality, and utilization of care throughout their regions and monitor the progress of transformation projects and strategies. Throughout the shift to Value-Based Payments and Integrated Managed Care, ACHs will identify strategies that bring value to the community and incentivize quality improvement.

The Washington State Department of Health requests access to the APCD Enclave in order to conduct several projects to 1) assess disease prevalence, disease progression, comorbidity and related costs of high burden and high cost diseases; 2) assess the degree to which health conditions are screened in alignment with recommended best practices, and to identify barriers, drivers and costs related to screening; and 3) assess the degree to which prevention and treatment practices are in alignment with recommended best practices, and the barriers, drivers and costs related to treatment. These projects will characterize disease burden, screening and treatment services by demographic information and county to facilitate the identification of underserved populations. Together, this information will assist the public and providers to make informed care choices by providing information on the status of statewide best practices related to screening and disease prevention, and gaps related to patient demographics and geography. Purchasers will also be able to use this information to understand cost-effectiveness of early intervention, and to establish expectations and promote best practices for early intervention. Finally, this information will support targeting program and policy interventions aimed at reducing disparities and the overall burden of high cost health conditions impacting the overall cost of health care in Washington.

Access to the WA-APCD will improve the Department of Labor and Industries ability to help injured workers heal and return to work by enhancing our ability to reduce harmful care and increase access to high quality, evidence based care and care providers.  It will also enhance L&I’s ability to further the Healthier Washington statewide goal of increasing value based purchasing and aligning best practices with other state agency purchasers and commercial carriers.   As a public purchaser and participant in multi-agency purchasing initiatives. L&I analysis are publicly available and will be used to work with partner providers as well as business and labor stakeholders to incentivize high value, best practice care.

The objective of this research proposal is to characterize the direction and magnitude of changes in medical and pharmacy benefits and provider networks that occur as a result of Medicare eligibility.  Specifically, we aim to:  1) Count the number of patients age 60-70 years old entering Medicare for different sociodemographic, clinical, and insured populations. 2) Describe the direction and magnitude of changes in benefits and provider networks, defined using standard and innovative methods for different sociodemographic, clinical, and insured populations. Using the APCD, we will infer medical and pharmacy benefit generosity in different plans using observed out-of-pocket cost values and we will track changes in providers using anonymized provider IDs.

In the global health sense, the United States is an outlier given its high cost of per capita health care spending and relatively poor health performance. The Affordable Care Act (ACA) aimed to address this issue at the national, state, and local level through supporting regional transformation and innovation. The four-part goal of improving health and quality of care while reducing cost and eliminating health disparities is embodied in a multitude of additional transformative efforts across WA State. One common thread across these efforts is the need for data on utilization and cost of health care services, and how these compare across populations and change over time. Public Health – Seattle & King County (PHSKC) is applying to use APCD data to support data-driven planning, implementation, monitoring, and evaluation across a spectrum of health and human services transformation initiatives in WA state, including Medicaid transformation projects through Accountable Communities of Health (ACHs), national and local health reform (e.g. ACA), and investments in social determinants of health (e.g. early childhood development, housing, education, criminal justice, etc.) programs. Specifically, PHSKC aims to use APCD data to: i) assist government agencies and their partners to make evidence-based decisions about community health and social improvement initiatives, ii) assist health and human service provider organizations to make evidence-based decisions about planning, implementing, and fine-tuning (i.e. quality improvement) Medicaid transformation projects in collaboration with ACHs, iii) support a broad array of stakeholder groups, including ACHs, health and human services providers, government agencies, and the public, to understand variation in utilization and cost of health care services across communities, and how this changes over time in response to collective efforts to improve health and well-being, and iv) support transformative payment models being used to improve efficiency and quality of health and human services, including Medicaid transformation projects.

Genentech would use this data to identify Medicaid Managed Care claims that occurred at hospitals (identified by NPI) in the years 2014 through 2017. Genentech will identify package size equivalents (by NDC) that were billed to Medicaid Managed Care programs in Washington State in each quarter. Genentech will compare this dispensing data to its own 340B sales data to the same hospital NPI’s that billed Medicaid Managed Care Programs. The point of the analysis is to identify if these hospitals purchase/dispense patterns were compliant with state 340B guidance, and if the hospital purchase/dispense pattern resulted in 340B duplicate discounts paid by Genentech. At this time, WA State Medicaid Managed Care CLD’s do not provide the treating facility NPI, effectively preventing Genentech from performing even a basic adjudication of these claims before it is required to pay Medicaid Rebates to WA State on them.

To obtain a sense of per unit Charge and allowed cost. Per unit for inpatient cases would refer to per day or per case amounts. Per unit for outpatient cases typically refers to per case amounts. For items such as MRIs or CT Scans a per scan amount may be needed. Data end users would remain internal at this time, concentrating on network management teams who are working to better understand how the data can be used. Data end users at this time will be internal to Cigna as this initial request is for a data sample to better understand how the data might be used. Our approach to ensure adherence to format will include working closely with the HCA to confirm that the output meets the requirements found in section 182-70-500. This will be clarified as we work with a data sample to provide a sense of the available data.

The purpose of this study is to elucidate the effects of the COVID-19 pandemic on the health outcomes of individuals living with alcohol-associated liver disease (ALD) or alcohol-associated cir20rhosis (AC) in Washington State. To this end, our primary aim is to describe and compare rates of hospitalization due to complications of ALD or AC in Washington State between 2019 and 2020.  The burden of ALD is high and rising; ALD is now the leading cause of chronic liver disease (CLD) and most common indication for liver transplantation in the United States. ALD is an “ambulatory care-sensitive” condition. Optimal outpatient management can slow disease progression; decrease utilization of emergency services; and decrease rates of hospitalization and mortality. However, the COVID-19 pandemic has limited in-person ambulatory services, with varying degrees of restrictions across the United States. Telemedicine became a primary conduit of outpatient care; however, concerns regarding equitable access and long-term health outcomes remain. To our knowledge, there are currently no studies that characterize the burden of hospitalizations for ALD/AC in Washington State during the COVID-19 pandemic. The results of this study will contribute to literature on the impact of the COVID-19 pandemic on health outcomes for patients with ALD/AC. Study findings will aid efforts to continue to characterize and predict the short- and long-term outcomes of the pandemic on at-risk populations, particularly in Washington State. Our findings will support the development of recommendations to target resources towards preventative services to address the unique needs of patients living with ALD/AC.