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Driving Health System Change at the Regional

Level

AHRQ September 2007

Margaret StanleyExecutive Director

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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

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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

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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

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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

DiabetesLow Back Pain

DepressionHeart

Disease RX

Broad Participation in Committees & Teams

Quality Improvement

Committee

Health Information & Technology

Committee

Communication Committee

Board of DirectorsConsumer Advisory

Group

Affordability Work Group

Prevention Asthma

Clinician Advisory Panel

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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

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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

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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

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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

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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

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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

Useful Information Consistent Incentives

Improved Quality of Care

Creating the Tools and Motivation to Support Quality Improvement

Greater Value

Greater Value

Healthier People

Healthier People

• Agreement on effective treatments• Agreement on how to measure value• Public report on local health care• Useful resources and tools

• Recognition• Benefit design• Value-based purchasing• Pay for performance for providers• Technology adoption

Outcomes

Goal

Strategies

Methods

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Collaboration. Accountability. Action.

2003 Western Avenue, Suite 600Seattle, WA 98121

(206) 448-2570www.pugetsoundhealthalliance.org

Puget Sound Health Alliance