Improving Healthcare Quality, Costs, and Outcomes in Washington State

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. Margaret Mead

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has. Margaret Mead

Naysayers who can’t see how healthcare is going to move from a fee-for-service to an outcome and value-based model should look at the work being done by organizations like the Institute for Healthcare Innovation, the American Board of Internal Medicine Foundation’s Choosing Wisely program, and The Bree Collaborative.

Last week, I attended a meeting of the Dr. Robert Bree Collaborative, an initiative in Washington State spearheaded by Governor Christine Gregoire in 2011 and named in memory of a physician who focused on cutting back use of inappropriate medical imaging in the state. The goal of the collaborative is:

“…to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State.”

Members represent some of the top healthcare organizations in the state, as well as representatives from government, and payers. All meetings are open to the public, and the public is encouraged to attend and provide comments. (At the meeting I attended, most of the public seemed to be made up of healthcare industry folks like myself, although there was one attendee who spoke both as a physician and as a patient.)

The Collaborative’s mandate is to tackle four topics per year for quality and process improvements with the aim of statewide adoption in healthcare. Previous recommendations have included those for total joint replacement which is a hot topic due to new Medicare fines for readmission and lumbar spinal fusion, another hot topic due to the rising costs of back pain to employers, health systems, and in lost productivity. Recommendations include not just process recommendations and standardized ways to track outcomes, but also how to deliver care in a bundle. Payers like bundles because they provide some predictability to costs. Patients like bundles for the predictability of costs but also what they can expect from their care. Bundles pose the greatest challenge for providers, as often many of the services are provided by different organizations, for example skilled nursing or specialized physical therapy. Often surgeons are not even employed directly by the hospital where the patient undergoes a procedure. In this situation the hospital or healthcare organization needs to play quarterback and make sure the other organizations are staying within cost and quality guidelines. Add into this the fact that outcomes are so dependent on patient behavior and you can see what a tall order the Bree Collaborative, and organizations like it, have taken on.

At last week’s meeting topics included updates from groups focused on End of Life Care, Addiction/Dependence Treatment, as well as, an update from the state of Washington on state-wide measures to track quality and outcomes. New initiatives that were approved for 2015 workgroups included Coronary Artery Disease, Prostate Screening, Opioid Use, and Oncology. If you are a patient, provider, or payer stakeholder with an interest in any of these topics, you may want to subscribe to The Bree Collaborative’s newsletter to stay abreast of the workgroup’s progress and any recommendations.

In Western Washington, a new purchasing coalition made up of employers with less than 5000 people has formed. The Northwest Healthcare Purchaser’s Coalition is hoping to drive better outcomes and lower costs by combining the purchasing power of many smaller employers. In particular this group is working with local payers and providers Western Washington to try to lower the costs of back pain by implementing Bree Collaborative Workgroup recommendations at the community level. This means both clinical adoption within local healthcare organizations but also public education and awareness about recommendations for reducing back pain.

Going back to the quote from Margaret Mead that started this post, there is no doubt that The Bree Collaborative members are thoughtful, committed, and working for change. Possibly the one thing that is missing is more voices from citizens. All meetings are open to the public. If you have personal experience either positive or negative, especially around care, outcomes, and costs for any of the topics that the Bree is tackling, you’d be welcome at the next public forum. See you there?

And if you’re not in Washington State, there are initiatives like this going on across the United States. Not all are as friendly to the general public, but it’s our health and everyone needs to find a way to participate.