Jan. 2018 Letter from the Executive Director: Shining A Light on Waste in Washington State

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Jan. 2018 Letter from the Executive Director: Shining A Light on Waste in Washington State

Health care waste – the overuse of low-value services – introduces the unnecessary risk of adverse physical and financial harm for patients, drives up costs for purchasers and insurers, and strains the system. This is a serious problem in health care. However, by quantifying low-value care in the system, we can establish a baseline, raise awareness, and spur action.

I am pleased to announce that the Alliance is utilizing Milliman’s MedInsight Health Waste Calculator, a new analytic tool that highlights inefficient and unnecessary medical services based on evidence-based guidelines. We will be releasing our first results in early February, and the preliminary findings are stunning, showing that just a handful of health care services account for millions of dollars of waste in Washington. Only two other states in the country have utilized this tool, one of which has released results publicly. The public release of the Alliance’s Washington state findings will enable a much-needed community dialogue among key stakeholders about low-value care.

But quantifying and putting a price tag on low-value health care is simply not enough. Through collaboration, we’ll work together to determine the specific action steps we can take to eliminate potentially harmful waste through a variety of initiatives. I hope you will join us for the next All-Alliance meeting on Thursday, February 1 when we will release the report on low-value health care entitled, “First, Do No Harm” and also that you will collaborate with us to address the problems we reveal.

Common Measure Set Contract Redirected

I also want to provide an update on our work with the State. Late last year, we learned that the Alliance would no longer be under contract to report on performance measurement work for the Washington State Common Measure Set on Health Care Quality and Cost. Instead, Oregon Health & Science University will be under contract to do the measurement work in its role as the lead organization for the Washington All-Payer Claims Database (WA-APCD).

As you may recall, a Governor-appointed committee called the Performance Measures Coordinating Committee (PMCC) was appointed in 2014 to develop the Statewide Common Measure Set to provide a foundation for health care accountability and measuring performance. The Alliance has provided lead staff to the PMCC since its inception and will continue to do so this year. We will also continue to report on the Common Measure Set, as we have for each of the past three years, as the measures are and will continue to be a core component of the Alliance’s Community Checkup, a well-respected source of information for over 10 years.

We produce the Community Checkup through close collaboration with our many stakeholders across the state to coordinate and validate measure results, and our collaborative structure allows for stakeholders to come together and turn data into action. Performance measure results from two separate all-payer claims databases – the WA-APCD and the Alliance – will undoubtedly yield different results due to variation in databases (for example, the Alliance receives voluntary data submissions from self-funded employers like the Association of Washington Cities, Boeing and King County), attribution methods, populations and more.

Of note, in December 2017, the Office of Financial Management (OFM) issued a report to the Washington State Legislature describing the $6.6 million that has been allocated from federal funds to develop the infrastructure for WA-APCD as well as to support reporting. Four million dollars of these funds were redirected to OFM from the monies awarded through the CMS State Innovation Model (SIM) grant to the Washington State Health Care Authority through a budget proviso in the 2017-19 biennial budget. The Alliance’s contract with the State to report on the Common Measure Set for each of the past three years was approximately one-tenth of the cost of the $4 million allocation.

Ripple Effects Across the State

The redirection of $4 million in SIM funds impacts health care organizations across the state. Many will work with diminished budgets in 2018 because SIM funding has been diverted to support the WA-APCD and its development.

In a time when budgets are stretched thin and there are so many other areas of need, we believe that spending millions of dollars on duplicative efforts merits additional scrutiny. I welcome a conversation with you about our new work with the Health Waste Calculator, as well as the investment in WA-APCD.

Thank you for your ongoing, remarkable support for the work we do together.


Nancy A. Giunto
Executive Director
Washington Health Alliance



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