Answers to your questions
What is Washington HealthCareCompare?
Washington HealthCareCompare is a website for residents of Washington to consult to make better health care decisions. It contains information on health care providers and compares the cost and quality of medical care and services.
What is the Washington All-Payer Claims Database?
Washington HealthCareCompare offers data from the state’s new all-payer claims database, a large collection of medical, pharmacy and dental claims data and other health information from private and public health care payers, such as insurance companies and Medicaid. The Legislature passed a bill in 2014 requiring the state to collect this health information and make it accessible to the public. The aim is to make it easier for Washingtonians to find and use data to make better-informed decisions about the health care they choose and use.
How do I look up medical and dental costs on Washington HealthCareCompare?
- For cost information, click on the ‘Find local prices of a treatment or visit’ tab. Then type in the name of a procedure or treatment or select an item from the drop-down list (e.g., Knee Replacement Surgery) and the ZIP code (where you want to receive care) to estimate your costs for medical procedures and services. Then click ‘SEARCH.’
- For a search on quality, click on the ‘Find quality health care nearby’ tab. Then type in the name of doctor group or office and ZIP code and click ‘SEARCH.’ You can also enter the name of a primary care medical practice without entering a ZIP code.
What are some things I can’t do on Washington HealthCareCompare?
This website does not, at this time, include services and costs associated with specialty services such as dermatology. Find out how much you will pay for procedures provided by specialists by reading your health benefits plan or by calling your insurer using the member services number on the back of your health care ID card.
What data is in the WA-APCD?
The following types of data are included in the WA-APCD:
- Covered medical services claims
- Cost data, including billed, allowed and paid
- Pharmacy claims
- Member eligibility and enrollment data
- Provider data
- Results from the Statewide Common Measure Set
- Historical claims data since 2013
New data is regularly added to the WA-APCD. Dental, workers’ compensation and Medicare services claims data will be included later this year.
What are claims and who provides the WA-APCD health claims data?
Claims data reflect the services and charges that health care providers report to payers (health insurers and administrators) to be reimbursed for services performed. Payers from across the state send health care claims data to the WA-APCD. The WA-APCD includes claims data from Medicaid, Medicare, the Public Employees Benefits Board and the Washington State Department of Labor and Industries as well as Washington’s commercial payers.
What is the Statewide Common Measure Set and how is it related to quality of care?
The Statewide Common Measure Set is a collection of standard statewide records and information that is used to assess and track important elements of health (e.g., access, prevention, acute care and chronic care) and how well the health care system is performing in Washington.
Who provides common measure results?
Common measure results are reported by the state, counties/accountable communities of health (regional coalitions that work to improve public health), health plans, medical groups/clinics and hospitals. These measures are then provided to the WA-APCD by a variety of sources, such as the Washington State Hospital Association, Washington State Department of Health, Washington State Department of Social and Health Services, Washington State Health Care Authority and National Committee on Quality Assurance and the Center for the Study of Services.
Who is developing and managing the WA-APCD for Washington?
The WA-APCD is administered by the Washington Office of Financial Management through its lead organization, the Center for Health Systems Effectiveness. Data services are provided by Onpoint Health Data and web services by Forum One. CHSE has been a leader in finding better ways to deliver health care through the effective use of data. Onpoint Health Data first developed a multi-payer claims database in Maine in 1994 and has since implemented seven APCDs. Forum One is a full-service digital agency working with mission-driven organizations to communicate their data through technology and design.
How is WA-APCD data protected?
The WA-APCD adheres to industry-leading data security standards to protect the confidentiality of personal information and business data. Special safeguards are required for proprietary financial information, direct patient identifiers and indirect patient identifiers. Additionally, reporting for the public that compares medical practices’ performance may include only practices with four or more providers.
How does Washington HealthCareCompare make sure that its data is reliable?
OHSU and Onpoint Health Data use experts in health data assessment who carefully follow a standard process to check that the data is valid and reliable. Only then is data added to Washington HealthCareCompare.
Claims and health care prices
What is a claim?
A claim is a list of health services that you received that was sent by your health care provider (such as your doctor, clinic or hospital) to the health insurer for payment.
How is cost calculated?
Washington HealthCareCompare analyzes the health care claims data it collects and uses established statistical methods to create cost estimates for procedures in Washington. The cost information that you receive is the average for the amount you would expect to pay for a particular medical service or procedure. The amount you actually pay may be a little more or less, based on factors related to your providers and your plan, such as if your doctor has specialized training.
What is included in the cost calculation?
This website uses a cost calculator that takes into account specific components of your insurance coverage to estimate what you might pay for a procedure or medical service.
Health care providers and organization type
How do you define health care provider?
Health care provider or provider is a health care facility, health care practitioner, health product manufacturer, health product vendor or pharmacy. Providers, include physicians and all others certified, registered or licensed in health care, such as nurses, advanced practice nurses, optometrists, pharmacists, chiropractors, physical therapists, psychologists and physician assistants.
How do you define hospital?
Hospital is a licensed acute or specialty care institution.
What is an ambulatory surgery center?
An ambulatory surgery center, also called outpatient surgery center or same day surgery center, is a health care facility where surgical procedures are performed that do not require an overnight stay.
How do you define a medical practice?
A medical practice or group practice or clinic is defined as the presence of four or more providers providing patients with care (i.e., primary care or a specific subspecialty practice), even if medical specialty care is part of the practice.
What is the public accountability section of Washington HealthCareCompare?
The public accountability section will display information and scores for each of the Statewide Common Measure Set measures. Measures are used to track important elements of health and health care performance. Search the public accountability section by clicking on one of nine accountable communities of health in the map. This goes to a page that shows a score per measure (e.g., diabetes care) and allows a comparison to the Washington state score and, if available, the national score for that measure. Search the public accountability section by using the market page, where you can see scores for the commercial, Medicaid and, optionally, health exchange markets.
WA-APCD data products
What types of WA-APCD data products are available for sale?
WA-APCD data products are available for purchase by researchers, agencies and other entities and the following data products are available:
- custom and standard reports (WA-APCD produces analytics output on behalf of the applicant)
- data extracts (machine-readable data files)
- analytic enclave (WA-APCD-sponsored, secure, cloud-based analytics environment offering access to the full WA-APCD database through a scalable, customized suite of tools.).
How do I make a request to purchase WA-APCD data products?
Information about the application process and requirements for purchasing data products is on the Paid Data Requests page of Washington HealthCareCompare.
I have more questions — what should I do?
Please email email@example.com.