How Low Can You Go?

March 2, 2020 by Washington Health Alliance

Last week, I had the opportunity to attend the Seattle Business magazine awards gala to recognize Health Care Leaders in the state. It was wonderful to see Alliance members and allies, and to take a moment to acknowledge the important work we do.

This year, the Alliance recognized outstanding performers from our third edition of First, Do No Harm, using the Milliman MedInsight Health Waste Calculator to calculate how much unnecessary or likely unnecessary care was delivered to Washington residents of the 47 tests, treatments, and procedures commonly regarded as overused by Choosing Wisely and the US Preventive Services Task Force.

The evening was a wonderful opportunity to honor two shining examples of how we in Washington state are reducing unnecessary care and the emotional, physical, and financial harm that often cascades from it. Because of the patients they serve, that is top of mind for Dr. Mia Shim, the Medical Officer of the Community Health Services Division for Public Health—Seattle & King County, recognized for delivering the lowest number of low-value treatments in the state for the Medicaid-insured, at 46% fewer than average services at a 54% lower than average cost per month.

“Our patients may not have the basic resources or education to navigate our complex health systems, so they really need us to be thoughtful and adaptive about what brings them value. For their sake, we need to avoid unnecessary tests and treatments, which can be both harmful and costly.” Dr. Shim credits their performance in First, Do No Harm to Public Health—Seattle & King County’s long history of providing patient-centered evidence-based care, explaining that they were “very early in recognizing the hazard of overprescribing controlled substances, including opioids, and developing clinical teams to oversee and standardize controlled substance prescribing practice more than ten years ago.”

Dr. Shim says they have a bottom-up approach to providing value, “many of the best ideas come from people who see patients every day. So, it’s important that they have dedicated time for quality improvement work that is tied to outcome. To deliver value, we must both improve the quality of services and reduce costs, and the frontline staff are leaders in achieving value.”

I also took a moment to acknowledge PeaceHealth Medical Group for its outstanding performance for the commercially-insured population, delivering 37% lower than the average number of low-value treatment and 35% less than the average spent monthly.

It was a pleasure to recognize them and to see these Alliance members and organizations honored for their valuable contributions:

    • Lisa Brandenburg, Chief Health System Officer at UW Medicine (Outstanding Medical Center Executive-Puget Sound);
    • Dr. Nancy Davidson, Executive Director and President, Seattle Cancer Care Alliance (Outstanding Medical Group Executive);
    • Dr. Craig Hampton, Medical Director of Cardiac Surgery at CHI Franciscan (Outstanding Medical Director);
    • Dr. Rick Ludwig, Interim CEO of Pacific Medical Centers and Medical Director of U.S. Family Health Plan at Pacific Medical Centers (Lifetime Achievement Award);
    • Dr. Glenn Lux, President/CEO, Allegro Pediatrics (Outstanding Medical Group Executive);
    • Dr. Aileen Mickey, Chief Medical Officer at EvergreenHealth Medical Group (Outstanding Chief Medical Officer);
    • Dr. Jay Shendure, UW School of Medicine & Brotman Baty Insititute for Precision Medicine (Achievement in Medical Research); and
    • CHI Franciscan Mission Control Center and Confluence Health | Central Washington Hospital (Innovation in Health Care Delivery).

A heart-felt congratulations to all!

All the best,

Nancy A. Giunto

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 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