Washington All-Payer Health Care Claims Database (WA-APCD) newsletter

Thu, 01/07/2021

2020 year end notes

From our team to yours, we wish you a very happy New Year!

Data submission program

The Washington State All-Payer Health Care Claims Database (WA-APCD) program concludes another successful year of taking in quarterly claims data and maintaining the state’s most complete source of health insurance data. The WA-APCD contains eligibility, medical, pharmacy and dental claims from about 50 commercial health care payers and other programs including Medicaid, Medicare, public employees benefits, and workers’ compensation, representing about 75% of the total state population. This year, the WA-APCD program began taking in school employees benefits program data.

To all of our data suppliers – we thank you for your continued support.

Data release program

Washington State has never had so much health care data in one place, and people have many questions about it. That’s great! This year we approved numerous data requests from state agencies and research organizations including VA Puget Sound Health Care System, University of Rochester, and the Washington State Medical Association. WA-APCD data users are working hard to learn how patients use the healthcare system, how much they pay, and how cost, quality and access might affect each other.

WA-APCD data products & fee schedule review

The WA-APCD program is considering changes to the way we package and price our data products. This summer we distributed two surveys to assist with this endeavor. The first survey went to other state APCDs and the second survey was sent to WA-APCD data users.

In our State APCD Survey we inquired about what data products they offer, what they charge for those products, and how they are funded. In our Data User APCD Survey we inquired what their role was within their organization, what data products they utilized, how often they use the WA-APCD, and comments on our current pricing.

The surveys are just one step in a larger body of work to revisit data product offerings and to make revisions and associated product fee changes in 2021. Look for more progress detail in our next newsletter.

Review & reconsideration leading to launch of the website refresh

Using Onpoint’s Performance Reporting Portal, Providers and practices completed another round of review and reconsideration in December for 2019 data to verify their quality, utilization, and expenditure measures prior to public release. Authorized representatives evaluated results for all reported measures as well as their underlying patient detail. Providers entered reconsiderations for patients when they had additional information that would include or exclude them from a measure. Reconsiderations are applied to the results prior to public release. Facility and practice administrators participating in this round, submitted more than 7,000 reconsideration requests. In February 2021, Washington HealthCareCompare will receive its fourth major data update. It will have refreshed cost and quality information on a wide range of procedures and measures using 2019 data.

Washington HealthCareCompare (WAHCC)

We continue to encourage all stakeholders to point members of the public to www.WAHealthCareCompare.com. This easy-to-navigate website is unique in the healthcare-transparency landscape, and has important information and tools for all users. Anyone can compare the cost and quality of medical services for providers in their community. Cost and quality data combined gives Washingtonians the information they need to ask good questions and make good health care decisions.

Tribal access to the WA-APCD

Tribes can now request access to more restricted Washington State All Payer Claims Database (WA-APCD) data, as part of Washington State legislation RCW 43.371.050.

WA-APCD statute allows potential users to request different levels of WA-APCD data. With the change in legislation, tribes are now included, alongside federal, state, and local government agencies and may also request data products that contain more restricted data, such as proprietary financial information and indirect patient identifiers.

If you would like to apply for access, you’ll need to complete a data request application and sign a written agreement about how you will use and protect the data. These agreements allow for use of the data to understand how patients use the health care system, how much patients pay, and how cost, quality, and access might affect each other.

Visit our data request page for details on accessing WA-APCD data.

Featured data users

In each newsletter we like to feature some of our data users to highlight specific use cases and the valuable public health work that you all are doing.

“OIC has taken advantage of WA-APCD as a resource in two key areas. In 2019, the legislature enacted the Balanced Billing Protection Act. OIC, in partnership with OFM, OnPoint and stakeholders has developed a “surprise billing data set” to provide an impartial source of payment data for health insurers, providers and arbitrators regarding payment for out-of-network claims. The claims data for that database is drawn from the WA-APCD. Having an independent data source to draw upon has played an important role in successful implementation of the Act.”
               - Jane Beyer, Senior Policy Advisor, Office of the Insurance Commissioner

“OIC also is using APCD data to further our Access to Behavioral Health Services Grant project. We are able to engage in detailed claims data analysis related to access to mental health and substance use disorder treatment services for private health insurance enrollees in Washington State. The extent of the database is broad accompanied by a modern user guide with relevant use cases. This has made it easy to setup and run complex queries. The data has directly supported questions regarding:

  • Out of Network Utilization related to Inpatient services
  • Denial Rates for Inpatient Services
  • Denial Rates for Continued Inpatient Stay and Outpatient Services.”

               - Bode Makinde, Data and Visualization Expert, Washington State Office of the Insurance Commissioner

Meetings and events

The WA-APCD is successful because of stakeholder input. Here are some of the various upcoming meetings:

  • WA-APCD Data Users Group meeting - 1/2021
  • WA-APCD Data Release Advisory Committee meeting - 1/19/2021
  • WA-APCD Data Policy Advisory Committee meeting - 2/9/2021
  • WAHCC Website Refresh & Updated Product Fee Schedule Launch - 2/2021