From Director of Performance Improvement and Innovation Karen Johnson

As the future brightens and our lives start to look and feel “normal” again, it seems fitting to reflect on all that has transpired over the last year and a half. We have been tested and challenged in ways few of us could have imagined. As part of that reflection, it feels right to ask what we have learned as individuals and as organizations that we want to carry with us into a “new normal”?

Don Berwick shared his perspective on this in a JAMA Viewpoint article on May 4, 2020 – just a few short months into the harsh realities of COVID, including the deep health care fractures and inequities it so readily exposed. As many were making predictions and prognostications about what the “new normal” in healthcare might look like–how COVID might finally be the catalyst for change so desperately needed to correct many of health care’s wrongs, Berwick summed up his perspective with this simple statement, “Fate will not create the new normal; choices will.” He encouraged all of us to think of the “new normal” as less of a prediction and more as a series of choices that we control.

At the Alliance, we are privileged to work with more than 185 member organizations who share the vision that Washington will be in the top 10 percent nationally in the delivery of quality, evidence-based care and in the reduction of unwarranted variation, resulting in a significant reduction in medical cost trends. As a purchaser-led organization, we look to our members who represent public and private employers, union trusts, and multi-employer plans to help lead the way to achieving that vision.

Today the Alliance is publishing Aligning to Drive Value: Using Data, Relying on Evidence, and Building on Trust. This white paper shares the learnings gained through our work with eight purchaser members of the Alliance who chose to commit their time and talent over the last ten months to working together in collaboration with providers and health plans on ways to improve the value of care received by individuals in Washington state. Aligning to Drive Value describes this purchaser-led, multi-stakeholder project (launched in the midst of COVID).

Using customized reports prepared by the Alliance that identified high- and low-value improvement opportunities, the purchasers selected improving the value of care for low-back pain as a shared priority for action. Low-back pain is one of the most common conditions in the U.S. affecting nearly every individual, directly or indirectly, at some stage in their lives. Low-back pain is also one of the most expensive with private payers footing the majority of the bill (57%), followed by public insurance (34%), and individuals (9%). Focusing on low-back pain aligns well with the Alliance Board Opioid initiative launched in early 2020 that includes acute low-back pain as an area of focus, along with dental pain.

There is broad agreement on the optimal (evidence-based) care of low-back pain that includes a range of non-invasive, non-opioid alternatives, including cognitive behavioral therapy. Despite high levels of agreement, including this report from the Dr. Robert Bree Collaborative, wide gaps between evidence and implementation continue to exist and the Driving Value Project seeks to change that.

You can learn more about this project at the next All-Alliance webinar on August 4th at 10 am when we will discuss our learnings and future plans. Joining us will be Dr. A. Mark Fendrick, Director of the University of Michigan Center for Value-Based Insurance Design who is serving as an advisor on this ongoing initiative. Watch for the details in your inbox shortly!

At the Alliance, we are privileged to work with organizations that choose not to place the “new normal” in fate’s hands. Instead, they are stepping up and making deliberate choices that will create the future they want for their employees, family members, and communities.

We thank Arnold Ventures, who supported the Driving Value Project, the Alliance members whose participation makes this work possible, and all who embrace choice and action over fate.