Alliance Purchasers Work Together to Drive Health Care Improvements in Washington State


White paper shares learnings and outcomes from collective efforts to improve health care value.

SEATTLE, WA-The Washington Health Alliance (Alliance) recently completed a purchaser-led project with the central aim of using data and collective action to improve the value of care received by individuals in Washington state. In a white paper released today, Aligning to Drive Value, the Alliance shares the learnings gained through its work with eight self-funded purchaser members, which includes private and public employers, union trusts, and a multi-employer plan. Together, they provide health benefits to approximately 550,000 individuals or about 7% of Washington state’s population.

Each purchaser received customized reports prepared by the Alliance that identified high- and low-value improvement opportunities. The reports included 48 measures of low-value care using the Milliman MedInsight Health Waste CalculatorTM  and 24 measures of high-value care selected from the Community Checkup, a comprehensive report on health care quality that has been published by the Alliance since 2008. The participating organizations agreed to share their results with one another for the purpose of identifying a priority for collective improvement efforts and to work in collaboration with provider and health plan organizations on a plan for action.

Purchasers identified 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. When looking at health expenditures by condition, research confirms that low-back pain combined with neck pain is the most expensive at $134.5 billion (2016) with private payers footing the majority of the bill (57%), followed by public insurance (34%), and individuals (9.2%).

Helping employees receive the best possible care for the unavoidable aches and pains of life that result in lost productivity and significant healthcare spending are important priorities for many employers. “We have identified addressing musculoskeletal conditions, including low-back pain, based on the significant number of individuals impacted and the growing costs associated with its treatment.” says Amanda Hutchinson, Health and Wellbeing Advisor at the City of Seattle. “We are pleased to be able to share our learnings with others and benefit from continued involvement in the collaborative process of refining and implementing solutions with other members of the Alliance.”

There is broad agreement on the optimal (evidence-based) care of low-back pain that includes a host of non-invasive, non-opioid alternatives, including cognitive behavioral therapy. Despite high levels of agreement, wide gaps between evidence and implementation exist. The project included mapping the evidence to action using the “tools in the toolbox” that represent important levers for health care change.

  • Practice culture that supports changing practice patterns.
  • Provider payment models that reward evidence-based care.
  • Benefit designs that encourage smart choices.
  • Patient engagement tools and resources that empower informed and shared decision-making.

The purchasers worked together and in collaboration with provider and health plan leaders to identify patient and provider-focused strategies to improve the care of low-back pain. “Success requires all stakeholders to use the tools in the toolbox as levers for change. The way Alliance members are working together is transformative in the use of clinical evidence to drive aligned action that has the potential to increase clinically indicated care and reduce unnecessary and potentially harmful services for low-back pain patients.” says Dr. A. Mark Fendrick, Director of the Center for Value-Based Insurance Design at the University of Michigan and an advisor on this project.

The initiative continues with a focus on implementation. “The Alliance is so proud to work with its members who share a vision for improving health care,” says Alliance Director of Performance Improvement and Innovation Karen Johnson. “Their willingness to look beyond organizational boundaries and work with one another to drive meaningful health care improvement in Washington state serves as a model for others.”

This effort was supported by Arnold Ventures, a philanthropy that seeks to improve lives through evidence-based solutions.

About the Washington Health Alliance

The Washington Health Alliance (Alliance) is a 501(c)(3) nonprofit nonpartisan organization working collaboratively to transform Washington state’s health care system for the better. The Alliance brings together more than 185 committed member organizations to improve health and health care by offering a forum for critical conversation and aligned efforts by health plans, employers, union trusts, hospitals and hospital systems, health care professionals, start-up companies, consultants, consumers, and other health care partners. The Alliance believes strongly in transparency and offers trusted and credible reporting of progress on health care quality, value, pricing, and overall spending. The Alliance publishes its reports at and provides guidance for consumers at so that individuals can make informed health care decisions.

About the Milliman MedInsight Health Waste Calculator

Increasingly, public and private purchasers, regional health improvement organizations, health insurers and others are looking for ways to identify and measure waste to fuel quality improvement efforts and many are looking to the Milliman MedInsight Health Waste Calculator™ (Health Waste Calculator). The Health Waste Calculator is an analytic tool powered by Milliman’s MedInsight software and encapsulates VBID Health’s market knowledge on wasteful healthcare spending. The tool identifies and quantifies the use of unnecessary or potentially harmful clinical services, including those defined by national initiatives such as the U.S. Preventive Services Task Force and Choosing Wisely®. For more information about the Health Waste Calculator, contact Marcos Dachary at

Date: June 24, 2021
Contact: Karen Johnson
Phone: (816) 309-6472

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