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Process

Assembling the measure results is a multi-step process that includes the following: 

Data submission

The Community Checkup relies on claims and encounter data supplied by more than 25 health plans, self-insured purchasers and union trusts and the Washington State Department of Social and Health Services (Medicaid). The following data suppliers share their data to help create the Community Checkup:

HEALTH INSURERS AND NETWORK ADMINISTRATORS

  • Aetna Health and Life Insurance Company  
  • Asuris Northwest Health 
  • Cigna Health and Life Insurance Company  
  • Kaiser Foundation Health Plan of Washington
  • Kaiser Foundation Health Plan of Washington Options, Inc. 
  • LifeWise Health Plan of Washington 
  • Premera Blue Cross  
  • Regence BlueShield  
  • UnitedHealthcare Insurance Company
  • Washington State Health Insurance Pool

MANAGED MEDICAID PLANS

  • Amerigroup
  • Community Health Plan of Washington  
  • Coordinated Care
  • Molina Healthcare of Washington
  • UnitedHealthcare Community Plan

MEDICAID

  • Washington State Health Care Authority

PURCHASERS AND LABOR UNION TRUSTS

  • Association of Washington Cities
  • The Boeing Company
  • Carpenters Trusts of Western Washington
  • City of Seattle
  • King County
  • Recreational Equipment Inc. (REI)
  • Sound Health & Wellness Trust
  • Washington State Health Care Authority Uniform Medical Plan
  • Washington Teamsters Welfare Trust 

INDEPENDENT PRACTICE ASSOCIATION - PROVIDER NETWORK

  • First Choice Health  

 

Data validation

Data suppliers submit claims data to Milliman, our data vendor. Both the Alliance and Milliman work directly with data suppliers to coordinate and establish data feeds and validate the data submitted and the initial performance measure results. Data submitted for the report is stripped of patient identifications and then aggregated and reported by medical group and clinic location.

Update of the Alliance Medical Group Roster 

Alliance staff does extensive research to validate and update the information for all clinics that have four or more providers across Washington state. Medical groups review this information regularly, and update their practice locations and the providers who practice at them. The Alliance uses this information to develop a comprehensive list of providers by clinic location that is necessary to accurately report quality results by clinic or medical group.

Measure Calculation

Milliman removes information that identifies patients to ensure privacy, and then combines, cleans and validates all the data and calculates measure results. The Alliance defines or confirms the logic used to calculate measures and validates the measure results produced by Milliman.

There is a subset of measures that the Alliance produces directly. For these measures, the Alliance works directly with measure stewards to update measure specifications annually. The Alliance then calculates measure results for this subset of measures. 

Attribution of Results to Providers

Milliman attributes measure results to providers according to the specified logic for each type of measure. For a detailed review of this attribution methodology, see Provider Attribution Methodology.

To report performance results at the clinic and medical group levels, the Alliance links the attributed measure results for each provider to their assigned practice locations in the clinic roster and creates summary results for each of these assigned groups.

Medical Group Review of Draft Results

The Alliance runs medical group and clinic results and posts them to a secure online portal. Medical groups access and review their draft results via the secure portal where they can provide direct input on any data discrepancies, and can notify the Alliance of any potential data issues.

Measure Results Finalized

The Alliance, Milliman and the medical groups resolve any data issues in order to finalize the dataset and run final results.

Measure Results Made Public

Medical groups receive a final report on their own medical group’s results. Results are made public through the annual Community Checkup report and form the basis of future analyses from the Alliance. Additionally, the results are incorporated into the Reports and Scores sections of this website.

Diagram showing the process for creating the Community Checkup.

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