Reflections and Resolutions from the Corner Office

January 6, 2020 by Washington Health Alliance

I’m proud to say that 2019 brought the Alliance several firsts-in-the-nation and in our state. We:

  • reported on the wide variation of actual prices for inpatient treatment (including facility and physician charges) not only across Washington, but within individual hospitals;
  • revealed the underlying reasons why there was a decline in inpatient spending with our statewide trend analysis results; and
  • ranked medical groups on waste, using the Milliman MedInsight Health Waste Calculator™ for both Medicaid and the commercially-insured and found an encouraging statewide downward trend for the tests, treatments, and procedures we measured.

We received quite a bit of attention for our groundbreaking work this year–you may have seen us in Health Affairs, Modern Healthcare, or Consumer Reports. At the annual Birnbaum lecture, Dr. Eric Larson said the Alliance is giving “great hope for positive change” (you’ll find us about 27 minutes in). Lauded as being among “Washington’s most accomplished health care innovators” and for “literally transforming health care as we know it,” the Alliance and Milliman MedInsight were honored by Seattle Business magazine for our work identifying waste in the 47 commonly overused tests, treatments and procedures.

Looking back at our accomplishments, it would not be complete without acknowledging our incredible Board of Directors, diligent committees, devoted members, and staunch allies. Whether wholeheartedly supporting our work or challenging us to think bigger and expand our horizons, you are the most important part of what we do. That’s why we are very much looking ahead to working with you to make 2020 our best year yet:

  • breaking down inpatient spending trends not only by individual hospital, but also by diagnosis;
  • releasing publicly for the first time The Hospital Value Report showing a comparison by hospital about all aspects of value – quality, patient experience, and cost;
  • launching the 9th eValue8™ process to compare health insurance plans across a wide variety of metrics;
  • issuing our latest Community Checkup report, comparing our state health population to national benchmarks and ranking medical groups;
  • assuming the Lead Organization role for the Washington All Payer Claims Database through a strong public-private partnership with the Washington State Health Care Authority;
  • finalizing and implementing a new methodology to score and rank provider performance on quality in a summarized fashion;
  • advancing our First, Do No Harm report with interested self-funded insurers; and
  • implementing a Board impact project in which every organization represented on that body works together to reduce inappropriate use of opioids for low back pain and for dental care.

We continue to share our evidence-based expertise both within our state and across the country. This year, our message reached from Capitol Hill to the nation’s Capitol, from Kirkland to Kansas City, from Blaine to Baltimore, and from Redmond to Rhode Island (just to name a few). It was particularly rewarding when the Alliance was acknowledged not by one, but by two speakers from the podium at NRHI’s Affordability Summit in Minneapolis; by Milbank President Chris Koller and bestselling author of The Price We Pay: What Broke American Health Care—And How to Fix It, Dr. Marty Makary.

The next year will also bring some changes to our team. Deputy Director Susie Dade announced in December that after 14 years, it’s time to depart from the Alliance in early April and move on to her next chapter. Susie joined the Alliance when it was still a very young start-up and helped to shape and launch so much of what and who we are today. Her contributions to the Alliance are vast and she certainly will be missed. I’m sure you will agree that she will always have a home here. Please take a moment to wish her well and thank her for strengthening the work of the Alliance in so many ways. If you know someone who would like to join us as our Director of Performance Improvement and Innovation, please pass along our job posting. And if you haven’t already, be sure to welcome our new Director of Membership and Business Engagement, Theresa Lampkin Tamura, who joined us in September. She’d be happy to hear your ideas for potential members, All-Alliance meetings, new member benefits, or other initiatives the Alliance should consider. You can reach her at ttamura@wahealthalliance.org or 206-454-2957.

As we embark on this, our 15th year, we will continue to do this important work, to analyze health care data and to release our findings to help improve the health care system in Washington state. But more importantly, we look forward to continuing our work alongside all of you to propel action.

The work we do together to transform health care is challenging.  It takes courage to ask the tough questions and then to support public reporting on the results. As we embark on a new decade of working together to improve the quality and affordability of health care for Washingtonians, I am reminded of this quote, “Be thankful for the struggles you go through. They make you stronger, wiser and humble. Don’t let them break you. Let them make you.”

Wishing you all the very best in 2020,

Nancy Giunto

The Alliance Takes on the Wall Street Journal

August 1, 2019 by Washington Health Alliance

You may have seen the recent Wall Street Journal article, “Posting Health Prices Online Isn’t Cure-All.” In it, the reporter takes a close look at New Hampshire’s twelve years of experience of posting prices online and concludes that there have been few benefits: prices have not significantly decreased, overall spending has been reduced only marginally, and few consumers use the site. Even though “New Hampshire has one of the most comprehensive and oldest hospital price-transparency laws in the U.S.,” the article suggests it’s a failed experiment.

While I agree that price transparency alone will not compel the change we need, I believe the article fell short on the most important ingredient of change. It’s not just how price transparency can change health care, but how transparency coupled with engaged multi-stakeholder support can propel action. As Leonardo da Vinci said, “Being willing is not enough. We must do.” When it comes to the Alliance, doing means bringing all of the different stakeholders together to inspire thoughtful conversations that lead to measurable improvements.

  • To help more than 15,000 employees access high quality health care, King County incorporated Alliance quality data in designing benefit plans and creating employee engagement programs, making it possible for them to make better health care decisions.
  • To better address the health care needs of its 18,000 home health caregivers, SEIU 775 learned from other Alliance members about ways to expand their behavioral health offerings, including launching a new mobile coaching app, video chats, screenings and online mindfulness classes, resulting in higher quality care.
  • The Everett Clinic used the Hospital Value report to identify areas that needed improvement and take action to make that possible.

These organizational choices have resulted in quality improvements for hundreds of thousands of people whose care is not only beating the Community Checkup’s statewide averages for care, but the HEDIS 10% national benchmarks.

We know that providing pricing and quality data is critical, but the key to change is the ability to bring all of the different and, sometimes, competing interests together towards the same goal. That is why we worked with the statewide Choosing Wisely Task Force to create the “Drop the Pre-Op” campaign to reduce the number of unnecessary preoperative lab tests on healthy people before low-risk procedures. In our last waste report, unnecessary pre-ops were responsible for an estimated $85.2 million in wasteful services impacting 122,257 individuals. Tremendous work remains ahead to eliminate these unnecessary tests in hospitals across our state and we stand ready to help in these efforts.

So yes, we agree with the Wall Street Journal that price transparency alone isn’t the answer. But, if we bring all of the stakeholders to the table and combine price transparency with quality measurement and waste reduction, and then put that information to work in purchasing, benefit design, changing practice patterns, and changing consumer behavior, that’s when we will drive changes in our health care system.

How do I know this? Because we already are.

I look forward to making more of that possible with you.

All the best,

Nancy Giunto

The True Value of Exercise

July 2, 2019 by Washington Health Alliance

It’s officially summer and I am appreciating the opportunity to spend more time in the garden with these long warm days, but it got me thinking about some recent studies on exercise. Did you know that according to a recent study by the CDC, less than 25% of adults in the US get enough physical activity? Here in Washington state, the rate is a little better–28.9% said that they fulfilled the federal recommendation for weight-strengthening exercise at least twice a week and 75 minutes of high-intensity aerobic activity like running or 150 minutes of moderately intense exercise such as brisk walking each week from 2010-2015. But may I ask, what about all those other folks? In some states, like Indiana, Kentucky, and South Carolina, the percentage of nonworking women who met the federal exercise guidelines was in the single digits–less than 10%.

Most of us know about the 10,000 steps a day goal, but a Journal of American Medicine Internal Medicine study shows that you don’t have to hit that magic number to make significant differences to your health. In fact, there are benefits to walking much less. In fact, for older women, even 4,400 steps a day helped lower mortality rates compared to those who walked 2,700 steps a day. Sounds so easy, doesn’t it? But it’s not. Across the board, men exercise more than women, and nonworking adults exercise less than working adults. One would think with more time, you’d have the ability to exercise more, but it’s simply not the case.

A Johns Hopkins study published in the Journal of American Medicine illustrates my point. Researchers asked, “What are the trends and health care expenditures associated with not meeting the recommended physical activity for women with cardiovascular disease?” We’re talking about the same requirement, 30 minutes or more of moderate to vigorous intensity exercise 5 or more days a week. Of the more than 18,000 women studied, more than half of them reported not meeting that activity level. In 2006, 58% didn’t meet it and by 2015, that percentage rose to 62%.

And when you take a closer look at the data (which I am wont to do) the results are even worse for specific groups. For women aged 40-64, 53% of them had insufficient physical activity in 2006 and that increased to 61% in 2015. For African-American women, the rate increased from 56% to 67%. For the college-educated, it rose from 45% to 58%. And for women with high incomes, it increased from 49% to 60%. The Johns Hopkins study estimates that $117 billion in annual health care costs are attributed to not meeting physical activity guidelines. We could all improve not only our health but our health care costs by ramping up on exercise.

As if that weren’t enough, the World Health Organization recently issued its first guidelines on preventing dementia and it included the same physical activity recommendation. In addition to not smoking and drinking, you should keep exercising to keep your brain healthy. And a pilot study in Canada explored a home-based exercise program to find out whether it would help older surgery patients recover better. In Canada, more than half of all major surgeries involve patients over 65 and about 40% of them are frail, which increases the risk of complications and disability. There are more than 100,000 older patients who have surgery every year in Canada and while the results of the initial 100 participants are being reviewed, researchers hope to see positive results from an expanded study improving muscle strength, cardiovascular fitness, and flexibility for 750 participants across Canada this fall.

On the opposite side of the age spectrum, exercise can even play a part in an infant’s metabolism. Researchers at The Ohio State University and Joslin Diabetes Center found evidence that a father’s level of exercise can play a role in a child’s body weight and glucose tolerance. Mice in a study were divided between offspring of dads who exercised and had a high fat diet and those who were sedentary. The results show better metabolic health in the adult offspring of those mouse dads who were more active.

Exercise and a healthy diet are two key components of preventing type 2 diabetes. A recent Diabetes Epidemic and Action report indicated that about 623,000 adults in Washington state have diabetes and a quarter of them are not aware of their diagnosis. From our Community Checkup we know that as a state have a way to go to reach the national 90th percentile established by the NCQA HEDIS measures for all diabetes-related care measures, not just eye exams. But we also know that some providers exceed that quality standard already and my hope is they will pave the way for others.

In the meantime, we all know it’s better to be active than sedentary, what we don’t always think about is how it plays a part in our quality of life, health care costs, as we age, and, even in our children’s health and well-being.

Clearly it’s never too late (or too early)! Take some time to head to the gym, take a yoga class or go for a long walk.

All the best,

Nancy Giunto

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