Washington Health Alliance report shows disparities in healthcare costs occur in relation to where residents live


Shane Ersland


A recent Washington Health Alliance report examined the cost of healthcare through an equity lens, and found that where people live in the state has a direct impact on their care.

The alliance paired healthcare cost data from its All Payer Claims Database, which covers 4.5 million residents, with the Area Deprivation Index (ADI) tool. Merging its data with the tool, validated by the University of Wisconsin School of Medicine and Public Health, allowed the alliance to determine how socioeconomic advantages have direct impacts on the cost, utilization, and overall impact of healthcare in the state.


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Alliance Executive Director Drew Oliveira, MD, recently discussed the report’s results with nearly two dozen healthcare professionals to drive a conversation around changes that are necessary to establish a more equitable healthcare system in the state. He said the report builds on work the alliance released in March, which examined the healthcare impacts on residents who do not have a primary care provider (PCP).

“As a primary care doctor, I always myopically thought everyone had a primary care doctor. We know that’s not true.”

— Drew Oliveira, executive director, Washington Health Alliance

The alliance found that about 20% of the population have commercial claims in the system, but don’t claim a PCP. About 20% of Medicaid enrollees also have claims in the system but don’t claim a PCP. About 14% of residents have no claims.

The alliance found disparities in care for residents who did not claim a PCP compared to those who did. Only 36% of people who had claims but no PCP had a breast cancer screening, compared to the state average of 67%. Only 36% of people who had claims but no PCP had a colon cancer screening, compared to the state average of 61%.

The new report examines commercial coverage data from 2021 using total cost of care and ADI information. It found that:

  • For commercially-insured residents, as their ADI score increased, their spending rose for hospital-based care, but declined for professional care.
  • As a resident’s ADI score increased, their risk score also increased. Despite this, the percentage of people without any claims went up.
  • While the average cost of care increased dramatically, the costs can be highly variable and difficult to predict for areas that are more disadvantaged.
  • The illness burden increased for commercially-insured residents in all cost categories, with risk scores rising most substantially among patients who had “facility inpatient” care.
  • The percentage of people with commercial insurance who don’t appear to be using it increased in residents with an ADI score of 5.8% through 13.3%.
  • About one-third of patients with commercial insurance did not seem to be associated with a PCP, which had a demonstrated impact on the quality of care received.

“In order to address healthcare equity, we need to look not just at the quality of care our communities receive, but also the cost of providing that care. Without a concerted effort to address the costs, we continue to have a system where socioeconomic barriers keep residents from receiving appropriate care and perpetuates poor health outcomes.

With this report, we show for the first time [that] where someone lives can impact the cost of caring for them. We do not intend to just highlight the trends uncovered in the report, but to actively engage with our members, and other healthcare stakeholders to identify how we close these care gaps to ensure the health and wellness of all Washington residents.”

— Oliveira