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Board sees steep pharmacy and outpatient cost growth; staff plan deeper APCD dives
Summary
Staff presented a 2017'2024 APCD cost-driver analysis showing large PMPM growth driven by retail pharmacy (price/intensity) and outpatient/other medical categories; board requested further disaggregation, inflation adjustment, and health-status controls.
State staff presented a first-year cost-driver analysis based on the Washington All-Payer Claims Database (APCD), covering 2017 through 2024 and a year-over-year 2023'4 snapshot.
Cathy Temple, senior data analyst, and Marty Ross, data analyst, told the board the APCD covers about 71% of Washington'state residents and is claims-based (it omits some non-claims spending and Medicare FFS data for 2023'4). They said retail pharmacy, outpatient services and an "other medical" category were the…
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