We’ve tackled the uninsured rate—now we must focus on cost and quality

Tuesday, November 28, 2017

By Dan Lessler, MD, Chief Medical Officer, Washington State Health Care Authority

The Affordable Care Act has helped reduce our state’s uninsured rate to an historic 5.8 percent. Many Washington residents have health care coverage for the first time in their adult lives. Hundreds of thousands more of our neighbors are getting preventive care, medications, and behavioral health services that improve the health of our state. It is crucial that we hold steady on the gains we have made in reducing the number of uninsured.

Yet even as we have improved access, no state is immune to the rising costs of health care. Washington State must still do more to help ensure we are delivering appropriate, high-quality health care without breaking the bank.

The Washington State Health Care Authority (HCA) is moving from paying for volume (number of services provided) to paying for value (good health outcomes and an excellent patient experience). It’s a big change for a multi-billion dollar industry used to paying a fee for every service. But as the state’s largest health care purchaser serving more than 2.2 million residents, we have a responsibility to demand better results for our customers and taxpayers.

The answer for Washington State is simple: Focus on rewarding quality care, rather than the amount of care. HCA is doing this by rewarding quality through innovative contracting.

As we are finishing up this year's open enrollment for our state’s Public Employees Benefits Board (PEBB) Program--which offers Kaiser Permanente and the Uniform Medical Plan (UMP) to more than 370,000 employees, retirees, and their dependents--here are a few ways we focus on cost and quality:

  • Kaiser Permanente’s focus on preventive and chronic illness care has earned its clinics the top spot in our state’s quality health care rankings, as reported by the Washington Health Alliance’s Community Checkup Report. A leader in high-value health plans, Kaiser Permanente offers several plan choices to PEBB members in 2018.
  • Learning from Boeing’s success with accountable care networks, UMP started offering the Puget Sound High Value Network and UW Medicine Accountable Care Network under a new plan option in 2016. Both networks commit to delivering care using best practices, including those developed by our state’s Bree Collaborative. The Bree Collaborative includes respected Washington providers, employers, and insurers that collaborate to develop high standards for medical care. Early data show PEBB members are highly satisfied with both networks, and the networks improved on nearly all of the quality measures in our contracts. It is a promising sign that paying for better value can work for patients, employers, and providers.
  • HCA also contracts with Virginia Mason Medical Center to provide many UMP members with a Center of Excellence for hip and knee replacements. Through this contract, all related services are “bundled” into one payment, which takes into account the patient’s health outcome and quality of their experience. The idea is that the patient is well cared for, well-informed throughout the process, and recovers well without infection or avoidable re-entry to the hospital. Early results support this concept: patients are reporting positive experiences; there are cost savings for both patients and taxpayers; and Virginia Mason provides healthier outcomes with a warranty.

While HCA covers 1 in 3 non-Medicare residents in the state, we cannot drive the market to better value alone. We will continue working with major employers to join us in this movement, and educating patients on how to become better health care consumers. Getting Washingtonians covered was the first step—now is the time to make sure we get better health results for every dollar we spend.