Are we there yet?
In the introduction to our 2018 Community Checkup – just released this week – we use the metaphor of a journey to describe our health care improvement efforts in Washington state. Along with our health care partners and stakeholders, we have been on this journey for more than two decades. And like kids in the back seat of the car on a long family road trip, we can’t help but ask, “Are we there yet?”
Unfortunately, based on the evidence provided by this report, as well as our second health care waste report also released this month, it appears that although we are a little further down the road, we still have a long way to go.
When we look at how we are doing compared to others around the country based on the Statewide Common Measure Set and the National NCQA HEDIS measure set we are falling short in many critical areas:
- Access to primary care and preventive screenings, especially for children
- Life-saving screening for early detection of diseases such as cancer and chlamydia
- Chronic disease and medication management
In many of these measures, we are at or below the 50th percentile range when compared to national benchmarks – a long way from achieving our goal of being in the top 10 percent in the delivery of quality, evidence-based care and reduction of variation in cost and quality.
Washington state improved in comparison to national benchmarks on several measures since our 2017 Community Checkup report, for example in well-care visits for adolescents in the commercially-insured population and follow-up care for children on ADHD medication for the Medicaid-insured population.
Additionally, findings from our second “First Do No Harm,” report, which uses the MedInsight Health Waste Calculator to analyze low-value health care services, indicate there is much room for improvement in reducing low-value health care in our state. Our results found that an estimated $341 million was spent on low-value care between July 2016 and June 2017. Also, the data show that of the 48 treatments and services analyzed, 88% of overuse is attributed to just 10 common tests, procedures and treatments. Of these, the number one area of waste for the combined commercial and Medicaid population was “Opiates Prescribed for Acute Low-Back Pain in the First 4 Weeks,” underscoring an opioid epidemic that is now considered a national crisis.
When we look at the data and see less progress than we were hoping for, it can seem overwhelming and discouraging. But I would like to take this opportunity to call out some successes as well: Several medical groups have ranked among the top five performers since implementation of the Statewide Common Measure set (2015-2018): Kaiser Permanente Washington, Swedish Medical Group and Virginia Mason Medical Center for the commercially-insured population and Kaiser Permanente Washington for the Medicaid-insured population. Additionally, two medical groups have been in the top five for three out of the last four years: The Everett Clinic for commercially-insured medical groups and UW Medicine-Valley Medical Group for Medicaid-insured. These organizations stand as beacons in our journey to excellence.
In the coming year, we will continue to provide you with information to help you identify specific areas of improvement and suggest action steps your organization can take to improve health in our state. Our goal of healthier outcomes in Washington state is attainable, but reaching it will require every single one of us to confront our contributions to low-value care and underuse of effective, proven care and push for change.
With best wishes for the season and the coming year,
Nancy