Government Weighs In Steve Hill, Administrator, Washington State Health Care Authority

1. January 2008 Government Weighs InSteve Hill, Administrator, Washington State Health Care Authority

2. Source: State of Washington Office of Financial Management (July 2005)

3. Source: State of Washington Office of Financial Management (July 2005)

4. Mortality Amenable to Health Care

5. Does the US Spend Too Much or Too Little on Health Care?

6. 1 (69%) 2 (31%) 3 (7%) 4 (.6%) 5 (.002%) 6 (.00003%) Health Care Quality Defects Occur at Alarming Rates Sources: modified from C. Buck, GE; Dr. Sam Nussbaum, Wellpoint; Premera 2004 Quality Score Card; March of Dimes IRS Phone-in Tax Advice Recommended well-child visits (WA) Treatment of Bronchitis (WA) Breast cancer Screening (WA) Hospital acquired infections Adverse drug events U.S. birth defects Detection & treatment of depression Hospitalized patients injured through negligence Overall Health Care Quality in U.S.(Rand Study 2003) Defects per million Airline baggage handling U.S Airline flight fatalities/ U.S. Industry Best of Class NBA Free-throws ∑ level (% Defects)

7. Preventing Complicationsand Premature Death Patients get recommended care only half of the time; consequences are avoidable. Condition Shortfall in Care Avoidable Toll Diabetes Average blood sugar not measured for 24% 2,600 blind; 29,000 kidney failure Hypertension < 65% received indicated care 68,000 deaths Heart Attack 39% to 55% didn’t receive needed medications 37,000 deaths Pneumonia 36% of elderly didn’t receive vaccine 10,000 deaths Colorectal Cancer 62% not screened 9,600 deaths Source: Elizabeth McGlynn et al, RAND, 2004

8. How can the best medical care in the world cost twice asmuch as the best medical care in the world? Uwe Reinhardt Variations in practice and spendingand across American’s Best Hospitals (USN&WR + Cedars) 120,000 Spending per Medicare beneficiary with severe chronic disease (Last 2 years of life, 2000-2003) 100,000 Cedars-Sinai 76,934 UCLA Medical Center 72,793 New York-Presbyterian 69,962 Johns Hopkins 60,653 UCSF Medical Center 56,859 Univ. of Washington 50,716 Mass. General 47,880 Barnes-Jewish 44,463 Duke University Hosp. 37,765 Mayo Clinic (St. Mary's) 37,271 Cleveland Clinic 35,455 80,000 Inpatient + Part B spending per decedent 60,000 40,000 20,000

9. Spending and QualitySupply-sensitive services and the paradox of plenty Medicare spendingper beneficiary 2003 Green -- US HRRs Blue -- FL HRRs Red -- WA, OR HRRs

10. Dartmouth Atlas – How Do We Compare on Medical Back? Victoria, TX Olympia Seattle, Tacoma Everett Honolulu, HI

11. A Similar Vision from the Institute of Medicine EMPLOYERS CARE SYSTEM BETTER OUTCOMES Supportive (i.e., performance-sensitive) market environment Organizations that facilitate the work of patient-centered teams High performing patient-centered teams • Safe • Effective • Efficient • Personalized • Timely • Equitable GOVT & PLANS • CARE SYSTEM RE-DESIGN IMPERATIVES • Redesigned care processes • Effective use of information technologies • Knowledge and skills management • Development of effective teams • Coordination of care across patient conditions, services, and settings over time • Use of performance and outcome measurement for continuous quality improvement and accountability Source: Adapted by Arnie Milstein, M.D., from Crossing the Quality Chasm, IOM, 2001