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 facilities and compares the cost and quality of medical care and services.
What is the Washington State All-Payer Health Care Claims Database program?
Washington HealthCareCompare website displays data from the Washington State’s All-Payer Health Care Claims Database (WA-APCD) - the state’s all-payer claims database established through legislation in 2014 that directed the Office of Financial Management to establish the WA-APCD. The database contains medical, pharmacy, and dental claims data, eligibility files, and workers compensation claims from public and private payers. The database serves as a vital source of health care data in Washington state.
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. Type the name of a procedure or treatment or select an item from the drop-down list (e.g., Knee Replacement Surgery). Include a ZIP code where you want to receive care to estimate your costs for medical procedures and services. Then click ‘SEARCH.’
- To search for quality, click on the ‘Find quality health care nearby’ tab. Type the name of doctor group or office or select a group from the drop-down list. Entering a ZIP code is optional. Click ‘SEARCH.’
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 including workers’ compensation
- Cost data, including billed, allowed and paid amounts
- Pharmacy claims
- Dental claims
- Member eligibility and enrollment data
- Provider data
- Results for the Statewide Common Measure Set
- Historical claims data since 2014
New data is added to the WA-APCD on a quarterly basis.
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. Self-funded plans may submit data voluntarily.
What is the Statewide Common Measure Set and how is it related to quality of health care?
The Statewide Common Measure Set is a collection of performance measures 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 the Statewide Common Measure Set results?
Many of the measures included in the Statewide Common Measure Set are calculated directly from the claims data and are based on national performance measures. The rest of the measures are provided by several Washington State agencies and organizations including the Washington State Hospital Association, Department of Health, Department of Social and Health Services, and Health Care Authority.
Who is developing and managing the WA-APCD for Washington?
The WA-APCD is administered by the Washington Health Care Authority through its lead organization, the Health Care Authority. Data services are provided by Onpoint Health Data and web services by Forum One. Onpoint Health Data first developed a multi-payer claims database in Maine in 1995 and its APCD solution in 2002. The organization has since implemented half of the nation’s statewide APCD solutions. 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 privacy and security standards to protect the confidentiality of personal information and business data. The data center is in full compliance with HIPAA and HITECH and Onpoint Health Data has earned Certified status by the Health Information Trust (HITRUST) Alliance.
How does Washington HealthCareCompare make sure that its data is reliable?
HCA 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. This process includes performing data quality checks with data suppliers, allowing providers and practices the opportunity to verify performance measures and patient and provider attribution, and thorough testing of reliability scores to the data.
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 your health insurer for payment.
How are medical service prices 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 median 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 personal cost calculator?
This website uses a cost calculator that takes into account specific components of your insurance coverage (e.g., deductible, co-insurance) 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 outpatient center?
An outpatient center, also called ambulatory 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, found by clicking on the “Statewide Performance” link, displays information and scores for the Statewide Common Measure Set measures. Measures are used to track important elements of health and health care performance. Results are presented by accountable community of health (ACH) and type of coverage (e.g., Medicaid, commercial). The ACH score is compared with the Washington state score and, if available, the national benchmark of the 90th percentile performance among all Medicaid plans nationwide (Target).
WA-APCD data products
What types of WA-APCD data products are available for sale?
The WA-APCD offers four data products: Analytic Enclave Subscription, Data Extract, Custom Analytic Report, and Release Upon Request Data Files.
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 Data Requests page of Washington HealthCareCompare.
I have more questions — what should I do?
Please email firstname.lastname@example.org.