Spotlight on Washington
Monday, April 13, 2015
Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s signature effort to lift the quality of health care in 16 diverse communities, reduce racial and ethnic disparities, and provide models for national reform. AF4Q brings together people who get care, give care, and pay for care to work together toward the shared goal of better health and health care.
Today's issue of Spotlight features the work of AF4Q's Washington Alliance.
Quality Field Notes: Regional Collaboratives Can Improve the Value of Local Health Care

Health care collaboratives offer an independent forum for convening stakeholders, some of whom are competitors, filling a role no one else in the community can. All stakeholders—including patients, clinicians, hospitals, health plans, businesses, and the government—are affected by the local health care system and any changes in it. This means that all groups need to have the opportunity to be involved in planning and shaping change. Bringing these unlikely partners together can be a challenging task, since they are from different industries that have diverse and sometimes conflicting goals. Below Susie Dade, deputy director of the Washington Health Alliance, discusses the role of regional health improvement collaboratives.

Regional health improvement collaboratives have been described as neutral conveners that bring diverse parties together to work toward transforming health care in a community. Can you talk about how your organization plays this role?

Dade: I would challenge the concept of neutrality. When we started the Alliance in 2005, there was more emphasis on neutrality than there is now. The idea of a multi-stakeholder collaborative was new and we were building relationships and trust. One of the things that we hear from almost everyone now is a desire for the Alliance to provide bolder leadership on challenging issues and in aligning stakeholders around activities to improve value. I don’t know how you can provide bold leadership during a time of rapid change and challenge the status quo and be completely neutral at the same time. So, the word “neutral” may have applied in the very beginning, but I think it has been replaced with “objective, third-party convener.” We have an agenda to improve the value of health care in our market and our job is to advance that agenda by bringing together organizations and individuals who share the cause and to create collective impact.  Sharing information about current performance (i.e., transparency) is a powerful way to identify opportunities for change and improvement.  It’s a fine balance, I think, between making people uncomfortable enough to drive change, but not making them so uncomfortable that you alienate them and threaten participation. I think that’s the dance that regional health improvement collaboratives do every day.

Less Waste, Less Harm: Choosing Wisely in Washington State

The first statewide report in the nation to measure Choosing Wisely® recommendations finds that patients in Washington may be exposed to care they don’t need—and potential harm. The report, Less Waste, Less Harm: Choosing Wisely in Washington State, offers county-by-county results for nine different Choosing Wisely recommendations. To support physicians seeking to integrate Choosing Wisely recommendations into their practices, the Washington State Choosing Wisely Task Force has developed an action manual that outlines eight steps for leading change that include developing a change vision and generating short-term wins.

The results are based upon claims data representing 3.3 million lives in Washington State and was issued by the Washington Health Alliance in conjunction with the Washington State Choosing Wisely Task Force, a group of more than 20 medical leaders from the largest health care organizations in the state. The task force is co-sponsored by the Alliance, the Washington State Medical Association and the Washington State Hospital Association.

Among the key findings of the report:

  • Overuse exists. Patients may be getting unnecessary care that costs money and could potentially put them at risk.
  • Variation exists. Often the rates between the lowest and highest performing counties vary by more than twofold.
  • Where you live and the type of insurance you have (commercial vs. Medicaid) may influence the type of treatment you receive.
The Long Road to Lower Health Care Costs

Health care leaders in Washington State have been working for a decade to rein in rising health care costs, led by the Aligning Forces Alliance in Washington.

Although it includes members from all sectors of the health care economy, the Washington Health Alliance is at its root a purchaser-led organization, and has focused on identifying value in terms of patient experience, quality, and price. The Alliance has published several comprehensive reports, called “Community Checkups,” that give comparative data on health plans and provider organizations. They show how each medical practice stacks up on a variety of measures, such as diabetes care, prevention, avoidance of unnecessary imaging and use of antibiotics, and patient experience. Hospitals are evaluated on how they perform on care, for conditions including pneumonia and heart failure. Health plans are evaluated on how well they help members stay healthy, manage chronic disease and become good health care consumers, as well as how plans use provider contracting and payment to drive improved quality and value.

If the Alliance reaches its goals, by 2017 doctors, hospitals, and ancillary providers in Western Washington will land in the top 10 percent in national comparisons of quality, evidence-based care, with a reduction in unwarranted variation in cost, quality, and utilization.

“[The Washington Health Alliance] has been the nursery that has allowed quality improvement and process improvement to grow.”
Peter McGough, MD
Chief Medical Officer, UW Neighborhood Clinics

Aligning Forces for Quality (AF4Q) is the Robert Wood Johnson Foundation’s (RWJF) signature effort to lift the overall quality of health care in targeted communities, reduce racial and ethnic disparities in health care and provide models for national reform. Alliance teams represent the people who get care, give care, and pay for care.
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