The aim of this project is two-fold: first, to explore potential causal pathways for diseases and associated complications related to choices in the delivery of healthcare and health associated behaviors; and second, to understand how these potential causal pathways may affect healthcare costs. To address these research questions, we seek to analyze claims both at individual and population levels to determine if there are key factors – such as age, sex, and geography -- which may contribute to increased risk for certain conditions. The contribution of this research will be to help shape the way risk is understood and mitigated, including promoting the deployment of targeted preventative healthcare interventions (such as risk management tools, strategies, and programs) to avoid costly and unnecessary healthcare utilization. We hope that this research and development can be used for a variety of purposes, notably, in identifying populations early that require more concentrated interventions to prevent disease and disease complications.

Parents, particularly mothers, often experience unstable employment around the time a child is born, resulting in reduced income at precisely the time that families need increased resources to provide for a new child. Employment changes around a birth can cause health insurance coverage gaps, increase likelihood of poverty, and alter the trajectory of parents’ future earnings. Poverty in early life can have detrimental effects on children’s health, development, educational achievement, and future economic wellbeing. Paid family leave has emerged as a potentially promising policy solution to reduce employment instability among working parents, smoothing income disruptions while supporting caregiving. Washington state recently implemented a generous Paid Family and Medical Leave (PFML) policy, which went into effect in 2020. Under PFML in Washington, parents who worked at least 820 hours in the year prior to a birth qualify for up to twelve weeks of paid leave to bond with a new child, and mothers with a serious health condition related to pregnancy can receive up to eighteen weeks of combined family and medical leave. This paper studies the effect of access to PFML in Washington on mothers’ employment status, earnings volatility, and job continuity around a birth. To estimate the policy’s causal effect, a regression discontinuity design will compare employment outcomes among mothers whose work history places them just above and below the eligibility threshold for paid family leave. Health insurance claims data on births from WA-APCD, merged to employment and paid leave program records from the Washington State Employment Security Department, will be used to estimate policy eligibility and assess employment outcomes. As several other states adopt similar policies and paid leave is debated at the federal level, this research offers important evidence on the effects of Washington’s paid family leave policy.

A goal of a study is to investigate how a zero-premium affects the enrollment decisions and plan choices of consumers in the ACA health insurance market, especially in the Marketplace. Using individual-level enrollment and claims data collected by the state-run Marketplace, the study also aims to analyze types of people reacting to zero-cost plans by age and number of specialists seen. This study could contribute to understand the health insurance demand at a specific price of zero and to provide an implication on the subsidy (premium discount) design in the regulated market, to have more people insured.. A goal of a study is to investigate how a zero-premium affects the enrollment decisions and plan choices of consumers in the ACA health insurance market, especially in the Marketplace. Using individual-level enrollment and claims data collected by the state-run Marketplace, the study also aims to analyze types of people reacting to zero-cost plans are and how the magnitudes of effects would vary by enrollee's age or income level. This study could contribute to understand the health insurance demand at a specific price of zero and to provide an implication on the subsidy (premium discount) design in the regulated market, to have more people insured. An identification strategy of the research mainly comes from a unique premium-linked subsidy structure in the Marketplace and the policy change made in 2017. 

The purpose of this project is to use data analysis to inform the development and implementation of services that can improve maternity care outcomes for pregnant people and infants in Washington. Preterm delivery is an important health outcome as newborns delivered preterm have significant development and health complications that can extend throughout their lives. The rates of preterm delivery for White people in Washington is 7.7% and for Black people is 13.6%, an unacceptable disparity. Geographic variance in access to care impacts the care experience as well, and 31% (12) of Washington counties lack a hospital with a maternity ward.

The analysis will have two phases. First, we will analyze the perinatal care journey for birthing people and their infants to identify variations in outcomes and patterns of care that are associated with positive and negative outcomes such as low utilization of prenatal care, excessive ER use, or lack of adequate postpartum care and follow-up. Second, we will analyze the potential return on investment for expanded and new services, by investing in value-add programs that have the potential to reduce medical spend and improve outcomes in both short-term and long-term

We believe the analysis will demonstrate an ROI associated with increasing access to maternity care in locations and communities that currently are underserved. As a maternity care provider, we hope to then implement solutions in partnership with payers and other health care providers which will lead to tangible outcomes improvement for Washington.

This program evaluation aims to inform Washington State public health and Hepatitis C virus (HCV) implementing organizations about state-wide progress towards HCV elimination and inform priority investments for the next phase of ‘Hepatitis C Free Washington' implementation. Outcomes of interest include HCV screening, linkage, and treatment completion rates over time as well as cost to the State of Washington and patients. We plan to merge APCD data with WDRS data to estimate linkage to treatment rates.

The Physician and Physician Practice Research Database (3P-RD) is intended to be a prototype database that captures information on physician and physician practice characteristics to help address current data gaps within health services research. NORC will be using available administrative data and provider databases to capture the universe of active physicians and physician practices to develop the 3P-RD database. This prototype will be for AHRQ's internal research purposes, and will also include a design that can be potentially used to create public release research databases. The 3P-RD prototype will contain data for 13 states and include data elements related to physicians and physician practices' characteristics pertinent to analyzing health services research and policy questions. This prototype is part of the feasibility study NORC is conducting that will identify options and provide recommendations for AHRQ’s consideration of how to establish a program that regularly creates and maintains these databases. Examples of possible health research or policy questions the database will be useful for answering include, but are not limited to: 1) How many unique physicians holding a current license to practice medicine in the state are actively providing services? 2) Of the physicians who actively provide services, what percent provide services to patients full-time versus part-time? 3) What are the patient population characteristics for practicing physicians (i.e. % commercial vs Medicaid vs Medicare as well as gender / age characteristics)? 4) How does the mix of provider types within a physician practice change over time? 5) How are physician practice migration patterns changing over time? 6) What factors are associated with physicians’ practice behaviors?

This amendment adds a use case to the University of Washington, Department of Epidemiology Data Use Agreement. The use case title is "Use of Extreme Risk Protection Orders in Washington." The use case involves linking a cohort of approximately 500 participants involved as a Respondent or Petitioner in Extreme Risk Protection Orders (ERPO) filed in the State of Washington from December 1st, 2016 through September 30th. 2020 and approximately 4,500 participants admitted to the Psychiatric Emergency Service at Harborview Medical Center from January 1st, 2012 through November 30th, 2016 with WA-APCD medical claims records to identify medical utilization patterns. This DUA amendment does not add any new data elements

Researchers at the RAND Corporation will reprice commercial medical claims from MHDO using Medicare's groupers and pricing algorithms and will release a public research report that includes commercial prices as a percent of Medicare prices for hospitals and hospital systems identified by name. This research report will update and expand on the findings in a RAND reports released in May, 2019 (https://www.rand.org/pubs/research_reports/RR3033.html) and September 2020 (https://www.rand.org/pubs/research_reports/RR4394.html). The public research report will include hospitals from around the country and will be created using claims data from three sources: selfinsured employers, state-based all payer claims databases (APCDs), and health plans. Benefit to Citizens of Washington: This project will benefit the people of Washington by providing them with a detailed hospital price report for hospitals in Washington, as well as comparisons among hospitals in Washington versus hospitals in other states. Key audiences for the report will be (1) self-insured employers that participate in the study and that are assessing the reasonableness of the prices they are paying for hospital care, (2) other employers that are struggling with high and rising health care costs and that want to better understand patterns and trends in hospital prices, and (3) policymakers and researchers who are concerned with hospital pricing and price transparency. 

Estimating impact of ARR on HIE enrollees: The Auto-Reenrollment and Renewal (ARR) policy on the Health Insurance Exchanges (HIEs) was designed to prevent unintentional discontinuous enrollment among HIE enrollees by automatically reenrolling enrollees in their default health plan if an active selection was not made during open enrollment. However, in the five years since ARR was implemented, policymakers have become concerned that ARR is enhancing consumer inertia that is then distorting market signals on the HIEs and increasing premiums, and have considered modifying ARR. The purpose of this research is to establish the impact of ARR on consumer inertia and consumer welfare within HIEs.

This study seeks to identify racial and geographic disparities in the care of Parkinson’s disease (PD) in Washington State, particularly King County. The study will use medical records (Medicare, Medicaid, and commercial) to characterize PD-related diagnoses, treatment, and specialty care in WA zip codes and to then determine how zip code or African American, Asian American, Latino American, and American/Alaskan Indian race/ethnicity may influence PD care. Using findings from these analyses, a pilot program will be designed to target underserved communities and help them better access specialist care and community services. More particularly, the pilot will identify and assess barriers to people with PD accessing specialized care (e.g., transportation, location and hours of medical facilities, marketing) and design access programs and interventions that address those barriers, including mechanisms that incentivize community doctors and primary care physicians to refer PD patients on to Movement Disorder Specialists. The study and pilot will initially address disparities within the African-American population of SE Seattle and South King County in contrast to the African American population of NW and North King County, with the idea that other population groups can be addressed in a future phase 2 project. By completing both the initial study and the pilot program, patients diagnosed with PD may be better served so that they can live healthier and longer lives, while reducing costs to the health-care system as a whole.