WHA report exhibits sufferers handled for a number of, complicated medical situations account for 13% of healthcare prices in Washington – State of Reform

New research from the Washington Health Alliance (WHA) shows that patients managing multiple or complex medical conditions account for a large portion of the industry’s overall costs.

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These patients, while small in number, accounted for a disproportionate share of the cost, as their treatments and services were more expensive.

WHA recently released its Total cost of care report for medical groups and clinics, which examined the cost of providing medical services to patients. The researchers used medical claims and registry data from the WHA’s All-Payer Claims Database (APCD) to combine the costs of all healthcare services and patient payments and analyze what the state spent on healthcare from 2018-2020.

The report shows the average monthly cost of providing healthcare for Washingtonians organized by the location of their primary provider. Services were reported in 5 main categories including:

  • Inpatient hospital services, which include surgery, childbirth, skilled nursing facilities, and other care services that involve an overnight hospital stay
  • Outpatient services provided by hospitals, which includes outpatient services such as outpatient surgery, radiology, cardiovascular, emergency medicine, and pharmacy
  • Professional services that include a wide range of treatments including physical therapy, occupational therapy, radiology, preventive care, specialty drug treatments and emergency care
  • Prescription drug services including drugs dispensed in retail pharmacies
  • Ancillary services that include ambulances, home health care and specialty consumables including durable medical equipment, prosthetics, glasses and contact lenses

The report shows the average cost of providing services per patient per month. To calculate this amount, all allowable amounts for services for all patients matched to a given provider were divided by the total number of matched patients represented on the WHA’s APCD. This number was divided by 12 to get the monthly amount.

Some patients received little more than preventative care, while others received care for multiple services or complex health conditions. But patients coping with multiple or complex health conditions accounted for 13% of all healthcare costs.

“This level of detail on Washington State’s health spending is the first of its kind,” WHA Executive Director Nancy Giunto said in a press release. “Knowing where our healthcare spending is being spent and seeing the relative health of the population is a crucial starting point. Allianz is proud to make this discussion possible. Now the real work can begin to address healthcare affordability.”

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