The Common Measure Set: a transformative tool for benefit strategy
The first step in reducing variation is to measure it, so we know where to target our efforts. In a well-functioning health care delivery system, everyone would be receiving a similar level of high-quality, evidence-based health care for the same condition or service. But findings in the latest Community Checkup report show variation remains a persistent problem in Washington state. This not only can harm patients’ personal and financial health, but it can also drive excessive cost for purchasers.
The latest Community Checkup also provides the first published results for the Washington State Common Measure Set for Health Care Quality and Cost, a set of 52 measures that enable a common way of tracking important elements of health and how well the health care system is performing. The measures can be used to inform value-based purchasing by helping purchasers assess the quality of different health care providers and health plans during benefit strategy design.
Until recently, health care purchasing is the one area in which usual business practices, such as supply chain management, are not employed to manage cost and quality. Purchasers have often felt powerless to negotiate for better value or felt they have little choice but to accept what health care providers and health insurance plans offer. That is changing. More and more purchasers are looking for value and a few are starting to explore value-based purchasing. Savings from reduced benefit costs allows businesses and union trusts to invest in other important areas and pass savings on to their employees or members. Savings from reduced public benefit spending fulfills the state’s commitment to be good stewards of tax dollars.
Case studies in value-based purchasing: Boeing and Washington State Health Care Authority
Value-based purchasing rewards health care providers for value (high-quality care and service at a lower cost) rather than volume. You don’t pay providers for the number of services they deliver, but instead how well they manage health and health care and at what total cost. In value-based provider payment, providers bear more financial risk if they perform poorly and share savings if they perform well. Value-based purchasing is gaining momentum in Washington state. In 2014, Boeing, Providence Health & Services, Swedish Health Services and UW Medicine teamed up to form an accountable care organization (ACO). In this type of arrangement, doctors and hospitals are rewarded for keeping and making patients healthy, rather than a fee-for-service approach where they earn more for prescribing lots of tests or scheduling appointments, regardless of the outcome for the patient.
Starting January 1, 2016, the Washington State Health Care Authority (HCA), which is responsible for approximately one-third of health care spending in Washington state, began offering UMP-Plus, a new benefit option for Washington State public employees in the Puget Sound region. The benefit program includes two clinically and financially accountable provider networks and further accelerates the State’s effort to drive health care market transformation through payment reform. The goal of the Accountable Care Program is to provide “best in class” patient service, integrate physical and behavioral health services and offer high-quality care at a lower cost. The quality of health care services that a provider network provides will be determined by a subset of measures from the Common Measure Set.
HCA is not only committed to improving care for their members, but wants to empower health care purchasers across the state to leverage their market power to demand value, which is why they are sharing information for purchasers about the program, including contract language.
The time is now to leverage influence
A fair health care market makes Washington even more attractive to business. Our state is a national leader in moving toward value-based care in such a broad way. This positions the state well in a competitive market for jobs and businesses.
No single purchaser can move the market by itself. Purchasers right now have an opportunity to leverage their collective influence on the health care marketplace. These efforts would work best if they were aligned around the Common Measure Set so providers and plans are responding to the same expectations across multiple businesses.