Driving Health System Change at the Regional Level AHRQ September 2007

1. Driving Health System Change at the Regional LevelAHRQ September 2007 Margaret Stanley Executive Director

2. 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 • Standardize care based on evidence • Standardize how quality is measured • Improve quality, decrease waste, slow cost growth • Align incentives to recognize and reward quality • Recommended creation of public-private collaborative

3. 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

4. The Puget Sound Health Alliance Today • Public and public employers, physicians, hospitals, patients, health plans, unions, associations … • ~160 organizations, representing more than 1.5M covered people, not counting health plan enrollment • Board is 50% +1 purchasers, 4 providers, 4 plans, 2 consumer representatives

5. Alliance Major Initiatives • Community agreement on evidence-based treatment • Better information about health care • Public reports comparing quality and efficiency • Useful information for decision-making • Encourage use of health information technology • Aligned incentives to reward quality care

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

7. 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

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

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

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

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

12. Success Factors for the Alliance • Have respect in the community • Public performance report will include 2.5 million lives, 14 data suppliers, 16 medical group and 21 measures • Seeking the “sweet spot” of quality improvement & cost containment

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

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