Margaret Stanley Executive Director Driving Health System Change

Margaret Stanley Executive Director Driving Health System Change at the Regional Level AHRQ September 2007 1

How the Health Alliance was Formed § Purchaser Leadership: King County Executive Ron Sims • Unsustainable cost growth in health care § Task Force Report completed in 2004 üStandardize care based on evidence üStandardize how quality is measured üImprove quality, decrease waste, slow cost growth üAlign incentives to recognize and reward quality § Recommended creation of public-private collaborative 2

The Puget Sound Health Alliance Today § Private, non-partisan, non-profit 501(c)(3) § Focus five counties in Western Washington, with interest in statewide expansion eventually § Funded by participating organizations, RWJF grant and King County 3

The Puget Sound Health Alliance Today § Public and public employers, physicians, hospitals, patients, health plans, unions, associations … § ~160 organizations, representing more than 1. 5 M covered people, not counting health plan enrollment § Board is 50% +1 purchasers, 4 providers, 4 plans, 2 consumer representatives 4

Alliance Major Initiatives üCommunity agreement on evidence-based treatment üBetter information about health care üPublic reports comparing quality and efficiency üUseful information for decision-making üEncourage use of health information technology üAligned incentives to reward quality care 5

Broad Participation in Committees & Teams Consumer Advisory Group Affordability Work Group Prevention Board of Directors Health Information & Technology Committee Heart Disease Diabetes Clinician Advisory Panel Quality Improvement Committee RX Low Back Pain Depression Communication Committee Asthma 6

Involvement by Many in the Community § Over 200 people volunteer time and expertise • Committees include physicians and other medical experts, purchasers, consumers and others § Create ‘Ambassadors’ through participation • Pride in the Alliance product • Builds credibility with peers • Local buy-in to the process 7

Involvement by Many in the Community § Building Community Agreement is a Core Competency • Inclusion, committee processes, coordination • Anyone can join & attend any meeting • Alliance meetings are held quarterly 8

Challenges and Strategies 1. Medical Association / Regence Blue Shield lawsuit -heightened sensitivity to physician concerns • Alliance open-book approach is designed to avoid pitfalls 2. Some major employers won’t join – “free rider” threat • Give employers additional value not available to the public 3. Future financial sustainability • Create a valuable community asset with the data base 9

Challenges and Strategies 4. “To do” list is too long for time, staff & money available • Focus 5. Finding the levers to turn information into action by participating organizations • Use the uniqueness of the organization to create pressure for improvement 10

Success Factors for the Alliance 1. Charismatic leader: King County Executive Ron Sims • Vision of what’s possible, rooted in common sense • Recruited major corporations to join 2. Involvement of purchasers, providers, plans, consumers 3. Together we can do this better than any one organization could do alone 4. Produced good reports in clinical areas 11

Success Factors for the Alliance 5. Have respect in the community 6. Public performance report will include 2. 5 million lives, 14 data suppliers, 16 medical group and 21 measures 7. Seeking the “sweet spot” of quality improvement & cost containment 12

Outcomes Goal Strategies Methods Healthier People Greater Value Improved Quality of Care Useful Information • Agreement on effective treatments • Agreement on how to measure value • Public report on local health care • Useful resources and tools Consistent Incentives • Recognition • Benefit design • Value-based purchasing • Pay for performance for providers • Technology adoption Creating the Tools and Motivation to Support Quality Improvement 13

Collaboration. Accountability. Action. Puget Sound Health Alliance 2003 Western Avenue, Suite 600 Seattle, WA 98121 (206) 448 -2570 www. pugetsoundhealthalliance. org 14