FAQs

Answers to frequently asked questions (FAQs) about the Washington State All-Payer Claims Database (WA-APCD)

What is Washington HealthCareCompare?

Washington HealthCareCompare is the website for the WA-APCD. It is designed to assist:

Anyone who calls Washington state home: The site helps consumers make better informed health care decisions. It does this by offering searchable information on health care providers and facilities and cost and quality comparisons of medical care and services.

Policy makers: The site helps health policy decision makers understand healthcare cost and utilization trends through intuitive and interactive dashboards.

Data analysts: The site offers an opportunity for health care researchers and data analysts interested in performing their own analyses using healthcare data from Washington state.

What is the WA-APCD program?

The Washington HealthCareCompare website shows data from the WA-APCD. The database contains medical, pharmacy, and dental claims data, eligibility files, and workers compensation claims from public and private payers.

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 displayed is the average for the amount you would expect to pay for a medical service or procedure. The amount you pay may be a little more or a little less, based on factors related to your providers and your plan.

What kind of data is in the WA-APCD?

The WA-APCD includes the following types of data, going back to 2014:

Covered medical services claims including workers’ compensation
Pharmacy claims
Dental claims
Member eligibility and enrollment data
Provider data
Payment data, including billed, allowed and paid amounts
Results for the Washington State Common Measure Set (WSCMS)

New data is added to the WA-APCD on a quarterly basis.

What are healthcare claims data and who provides it to the WA-APCD?

Claims data reflect the services and charges that health care providers report to payers for reimbursement (payers include health insurers and administrators). 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, the School Employees Benefits Board, the Washington State Department of Labor and Industries, and commercial payers. Self-funded plans may submit data voluntarily.

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 storage is in full compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). The WA-APCD program’s contracted data vendor has earned Certified status by the Health Information Trust Alliance (HITRUST).

How is the WA-APCD managed?

The Washington Health Care Authority (HCA) administers the WA-APCD program and manages daily operations as the program’s lead organization (LO). Under contract with the LO, data services are provided by Onpoint Health Data and web services are delivered by Forum One.

How does Washington HealthCareCompare ensure its data are reliable?

HCA and its contracted data vendor use experts in health data assessment who follow standard processes to check that the data is valid and reliable. This process includes performing data quality checks with data suppliers, allowing providers and practices to verify performance measures and patient and provider attribution, and a thorough testing of reliability scores to the data.

What kind of public accountability role does the WA-APCD program play?

Washington HealthCareCompare includes information and scores for the Washington State Common Measure Set (WSCMS) measures. These measures are used to track important elements of health and health care performance. Results are presented by Accountable Community of Health (ACH) area and type of coverage (this may include Medicaid and 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.

What is the WSCMS and how is it related to quality of health care?

The WSCMS is a collection of performance measures used to assess and track important elements of health (like access, prevention, acute care, and chronic care) and how the health care system is performing for Washington. Read more about the WSCMS

Who provides WSCMS results?

Many of the measures included in the WSCMS are calculated directly from 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 HCA.

What is a health care provider?

A health care provider can be 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. This includes nurses, advanced practice nurses, optometrists, pharmacists, chiropractors, physical therapists, psychologists, and physician assistants.

How are care locations defined?

A hospital is a licensed acute or specialty care institution.
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.
A medical practice, group practice, or clinic is defined as the presence of four or more providers providing patients with care (like primary care or a specific subspecialty practice), even if medical specialty care is part of the practice.