Washington State Care Quality Report Finds Progress Has ‘Stagnated’
The 19th edition of the Washington Health Alliance’s Community Checkup report finds that progress on healthcare quality in the Evergreen State has stagnated as organizations face tremendous market pressures, financial shortfalls, consolidations and reorganization and shifts in the fundamental ways people interact with healthcare.
"Despite the historically low rate of uninsured people, access to timely, coordinated, comprehensive and continuous care remains elusive,” wrote Drew Oliveira, M.D., M.H.A. the WHA’s executive director, in a letter introducing the report.
The Washington Health Alliance is a nonprofit that works with its more than 185 member organizations to improve the quality of healthcare for all Washington residents.
Washington state falls well below national benchmarks in child and adolescent well care visits, breast cancer screening, colon cancer screening and cervical cancer screening, the report notes.
Nearly 9% of the population in Washington has diagnosed diabetes, and more than 36,000 residents a year are newly diagnosed. Despite the prevalence of the disease, we do not always follow through on key screenings that are meant to manage the disease and its related complications. The state performs below national benchmarks on key diabetes quality measures, including kidney health evaluations, A1c control, and eye exams.
Oliveira noted that for several years, WHA as a purchaser group chose to focus solely on quality. It looked at defects and waste – overuse, misuse and underuse of care. “Nevertheless, three years ago we began transparent, thorough reporting on both quality and cost of care. The definition of value,” he wrote.
He stressed that those who purchase healthcare must demand outcome-based results. “Healthcare expenses are now the second-largest expense for companies behind salaries and above materials, supplies and other operating costs. Purchasers must embrace the opportunity to treat healthcare as any other part of their business and demand value for their investment. This means making choices that drive quality, flatten costs and result in better, more equitable health outcomes including productivity.”
Oliveira said that Washington’s performance on many essential measures, from key cancer screenings to timely well-care visits, has been waning for years. “Statewide, we have not risen against the National 90th percentile on any measure, the WHA quality benchmark, in some time, and we continue to lose ground as thousands and thousands of Washingtonians are left untreated.”
He noted that to improve the administrative burden on health plans and providers, WHA could be the single source for aggregated quality and cost reporting for provider organizations across participating member health plans.
The Community Checkup also looks at cost. Adjusting health disparities through Milliman Advanced Risk Adjusters’ risk scores, WHA found broad geographic disparities in its Total Cost of Care analysis. On average, the overall per member per month cost of care is $469.90 split between facility inpatient, facility outpatient, professional services, prescriptions, and ancillary costs. Each cost category presents its own opportunities for savings, which can help improve value, the report said.
For instance, the report recommends navigating patients to a primary care provider and to a high-performance specialty network. Savings from a PCP assignment are in the 10 - 30% range through multiple avenues: completion of preventive services, fewer specialty referrals, much lower emergency room rates, and lower hospitalizations.
In addition, global budgeting for geographic areas or hospital systems may better align incentives. Episode-based bundles for specialty care (e.g., cancer) can result in improvements in quality and total costs.
