Past Data Requests

The overall goal of this research is to compare VHA and non-VHA health care systems and the choice of veterans to rely on VHA or non-VHA systems for their services. Using data from the VHA and Washington’s all-payer claims data (not linked), the project will compare various parts of VHA and non-VHA systems, such as ICU, primary care, mental health, and specialty care services. The project will assess differences in utilization patterns and outcomes. The project will also assess various policy and operational changes that occurred in the VHA recently that might have affected access to care and the care itself delivered to patients.

The 2023 Washington State Legislature directed the Washington State Institute for Public Policy to assess the potential need for developing specialized long-term care services and supports for adults with traumatic brain injuries (TBI) in the state. TBI is an acute event resulting from an impact to the head causing bruising and other damage to the brain. Health outcomes related to TBI can be chronic and introduce a need for long-term support services including rehabilitative care in hospital, transitional, and community- and home-based settings. Duration of healthcare use resulting from TBI depends on severity and comorbidities. To fulfill the legislatively mandated assignment the proposed study will describe the demographic and geographic distribution of TBI, TBI sequelae and comorbidities, and resources and facilities involved in the treatment of and rehabilitation from TBI among adults in Washington. We will examine if the incidence of TBI and use of rehabilitation services differ across demographic characteristics, geographic region, and payer type. This work will inform state legislators and groups working with the TBI-affected community about the prevalence of TBI and access to relevant health care services, with the purpose to support the appropriate provision of specialized care services and long-term supports for adults with TBI.

To better understand the health care services received by individuals in community reentry and supervision, the Department of Corrections will use the Washington All-Payer Healthcare Claims Database (WA-APCD) to assess health care access, utilization, and effectiveness for this population. DOC will assess the availability of health care claims in the WA-APCD for the study population and whether standard measures of health care performance and effectiveness can be produced. Metrics to be considered include emergency department visits, chronic condition management, and medication adherence measures. The selected measures will also be calculated for individuals in the comparison group, adults eligible for Medicaid under the Affordable Care Act’s Medicaid expansion to see how the justice-involved population accesses and utilizes health care services when benchmarked against other similar adults on Medicaid. DOC also requests claims for non-DOC involved, Medicaid-expansion WA state resident adults to be used as a comparison group in examining health care access, utilization, and effectiveness. 

The research aims to improve how rural public hospital districts make decisions about where to allocate their resources by using claims data to guide those decisions. This is crucial because it helps ensure that people living in rural areas have access to the healthcare services they need despite the challenges they face in accessing medical care. This study will demonstrate how claims data can be accessed, used, and implemented in strategic planning initiatives for rural providers.

This study will provide a longitudinal, program focused account of the impacts of programs funded by the new Pierce County Behavioral Health Fund. This study tests the assumption that behavioral health programs divert patients from emergency systems by tracking their usage of medical services pre and post behavioral health intervention programs. Our research will show if these programs are effective in diverting patients with behavioral health issues away from more expensive systems. Our research will use hazard rates and other modeling work to show the impacts of these programs. Our work will have implications for Pierce County’s procurement of behavioral health services for its constituents (to be explicit, not its employees) and allow for the county to reward improvement over time. It will enable providers and hospitals and the behavioral health system more broadly to make informed choices about behavioral health programs and improve their benchmarking. This sort of data analysis will also hopefully provide a model for other counties on how to use the APCD for this sort of work.

Violence, usually related to gun or firearm use, is a frequent cause of traumatic injury with significant mortality and morbidity. Although there are numerous fatalities due to gun violence, the major of those who have gun or violence-related injury survive their initial but require extensive medical care. Very little is known about survivors of violence and their use of healthcare, especially in the outpatient setting, despite the long-term effects of violence-related injury. Based on previous work, we believe that there are disparities in access and utilization of healthcare services among patients with violence related injury compared those with other traumatic injuries. We propose to evaluate the relationships between access to care, medical outcomes and complications, and regional characteristics of patients in this population. We will identify patients with acute traumatic injury from the Harborview Trauma Registry and evaluate their (1) access to medical care and rehabilitative services during the first year after injury and (2) medical complications and repeat hospitalization using information from medical records review and the Washington State All Payer Database. The results of this study will help researchers, hospitals, and patients understand healthcare utilization patterns and predictors and determine the relationship between appropriate outpatient standard of care after traumatic injury and risk for subsequent hospitalization. This research will help Washington State providers understand the healthcare utilization of high-risk groups and determine options to optimized care and outcomes.

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.