The main purpose of this project is to support the WSMA’s role on the Surprise Billing Workgroup created by 2HSB 1065 with a goal of reducing healthcare costs for Washington’s patients. We will analyze the WA-APCD data to assess variations in costs by procedure and geography to identify differentials in utilization of out-of-network providers. The Surprise Billing Workgroup is responsible for advising how best to use the WA-APCD to establish commercially reasonable reimbursement. Specifically, our aims are to 1) support the determination of a commercially reasonable reimbursement from the WA-APCD data, 2) have data-driven awareness of ways in which WSMA can implement best practices to support legislature’s efforts around this bill. These two aims enable us to drive toward our mission to “Provide strong physician leadership and advocacy to shape the future of medicine and advance quality care for all Washingtonians.” We would like a fully-formed understanding of the bill’s impact on Washington State’s healthcare ecosystem, as our association plays an important role representing the physicians and physician assistants in our state. The results will not be used for commercial purposes.

Currently due to improved screening, earlier detection, and advanced cancer therapy, two thirds U.S. cancer patients can live longer than five years. There were more than 15.5 million U.S. cancer survivors alive in 2016. However, cancer patients have eight times higher risk of developing cardiovascular disease (CVD) than non-cancer patients, due to the cardio-toxic cancer therapies and shared risk factors. Since multisystem comorbidity requires care from multiple specialties, an effective relationship between oncologists and cardiologists may be essential to achieving optimal care. However, the question of how to build such an effective relationship between oncologists and cardiologists to obtain optimal outcomes remains unanswered. To assist decision making of cancer patients, providers and communities, Zhi Pan’s proposed PhD dissertation aims to provide an understanding of the oncologist-cardiologist relationship and thereby facilitate better design of more effective approaches for pursuing optimal prevention, treatment, and population health of adult cancer patients at high risk of developing CVD. This study has three aims: (1) Identify distinct patterns of the oncologist cardiologist relationship in caring for the target population. (2) Determine the impact of oncologist cardiologist relationship on outcomes and quality of care for the target population. (3) Test whether payer status and coverage, provider features, patient demography, and community characteristics affect the oncologist-cardiologist relationship and patient outcomes for the target population.

DUA amendment to add a use case and file linkage fee. This study focuses on a cohort of Washington State children between zero to three years’ old who participated in Early Support for Infants & Toddlers (ESIT) program. We will follow their education paths in pre-K and Kindergarten and investigate the role of health factors in children’s education outcomes. Particularly, we profile the population by their eligibility for early learning intervention services due to specific developmental delays or disability. In addition, by connecting with Washington State All Payers Claims Database (APCD), using linkage data elements (i.e., internal_member_id, first name, last name, middle name, gender, date of birth, and ssn) we will investigate what medical diagnosis and procedures these children have received and cluster condition specific sub-populations.

Each year there are about 4 million births in the US. About 70% of women take at least one prescription medication in pregnancy, and for many of these medications, there is inadequate safety data. Large observational studies are instrumental in closing this evidence gap because pregnant women are routinely excluded from clinical trials. Our team has had many successes in generating evidence on the safety of medications used in pregnancy including antibiotics, antihypertensive medications, and antidepressants. To study an even wider range of medications and evaluate more important but rarer outcomes, we will need to draw on larger data resources, such as WA-APCD, to identify large populations of pregnant women and their infants. The objective of this research proposal is to carry out feasibility work to investigate whether the Washington State All-Payer Database can be used to study medication use in pregnancy. Specifically, we will investigate means to identify pregnancies and to link mothers’ data to their babies. Once we can establish this data linkage, we will conduct descriptive analyses to support grant applications. For instance, we’ll count the number of mom-baby pairs contained in WA-APCD and describe their characteristics, examine frequency of use of various medication classes in pregnancy, and describe the prevalence of outcomes of interest such as birth defects. We may submit a conference abstract and a manuscript describing methods we used to link moms and babies with aggregated data as described above. Ultimately, results from future research based on the WA-APCD data could help pregnant women and their clinicians make informed decisions about medication treatment in pregnancy.

Funding for the evaluation of Washington State’s Medicaid Transformation Project (MTP) is from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Center for Medicare and Medicaid Innovation. The Center for Health Systems Effectiveness (CHSE) at Oregon Health & Science University (OHSU) was selected by the Washington State Health Care Authority (HCA) as the independent external evaluator for the MTP evaluation. CHSE will use a list of provider organizations generated from the WA-APCD to conduct surveys that are part of the evaluation.

The main purpose of this project is to aid the Office of the Insurance Commissioner in its mission to promote a healthy insurance industry in Washington state and to protect consumers. The goal of the project is to improve our understanding of market dynamics in order to assist our efforts to promote a stable insurance market that includes healthy competition based on quality and cost. Our project will include exploring the available data and its best application in market analytics, understanding trends in service utilization and network access, assessing the impacts of pricing on consumer utilization and plan choice, and preparing analytical reports and analysis for stakeholders; Results will be used by and distributed to appropriately identified stakeholders to improve efficiency of the insurance market, promote competition based on quality and cost, inform regulatory development, and deliver value to consumers.

For the Long-term Prescription Opioid Use After Injury study: The Centers for Disease Control and Prevention identify opioid overdose as an epidemic in the United States. While many overdoses occur using non-prescription opioids like heroin and fentanyl, approximately 80% of current heroin users report their opioid use beginning with nonmedical use of prescribed opioids, highlighting the important role clinicians play in this epidemic. Almost half of injury patients who present to the Emergency Department are discharged with opioids. While there is concern that overprescribing opioids may be contributing to the opioid epidemic, many clinical guidelines for opioid prescription remain at least partially consensus-based and opioid prescriptions have continued to rise in the ED setting. Studying the intersection between injury and long-term opioid use is important both to develop evidence-based interventions to reduce injury and long-term opioid use, inform clinical guidelines for opioid prescription and improve outcomes among injured patients. The proposed project focuses on trauma-related long-term opioid use following injury. Specifically, this project aims to 1) identify patient, injury and treatment characteristics associated with long-term opioid use, and 2) assess if long-term opioid use following initial injury increases risk for subsequent injury. For the Helping Individuals with Firearm Injuries study: About 200-250 individuals present to an emergency department in King County, primarily Harborview Medical Center (HMC), for firearm-related injuries each year. Almost two-third of these patients require admission for their injuries. While the number of patients with firearm injuries who present to HMC is relatively small, these individuals are at substantially high risk of subsequent rehospitalization for another firearm or assault-related injury, arrest for firearm-related or violent crime, non-firearm-related nonviolent crime, or firearm-related death in the five years after discharge from the hospital.1 Thus, interventions among this group of individuals to promote their health and well-being and reduce the high risk of recidivism, morbidity, and mortality are critically needed. Such interventions may also lead to lower rates of firearm violence and its consequences in the community. We propose to conduct a randomized trial of an intervention program that combines a hospital-based intervention, structured community outreach program, and multi-agency attention. We will provide a brief intervention delivered at HMC to bolster the interaction that all these patients will have with the hospital Social Work staff. To our knowledge, this is the first randomized trial of a multicomponent dual hospital and community-based intervention exclusively focused on GSW victims. Findings of this study can directly impact practice and policy through informing the development of evidence-based programs pertaining to firearm violence in the future.

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.