The April 25th “Hold Us Accountable” event in the Fairmont Olympic Hotel’s Spanish Ballroom was quite an event. The ballroom was packed- I’m no crowd estimate expert but it seemed like several hundred people, all treated to a grilled chicken lunch and what only a few years ago would have seemed an unlikely panel of competing health systems.
The Puget Sound High Value Network was formed via a competitive process by Washington State’s Healthcare Authority (HCA), a state agency responsible for Washington State’s Public Employees Benefits Board (PEBB), a health program for state employees, teachers, and others. In recent years, PEBB has been proactive in trying to address the healthcare needs of its members, both in terms of the costs and the quality of health benefits offered. The significance of this event goes beyond PEBB members because it is a bellwether of the movement of health services purchasers to move risk from purchasers to providers, thus providing economic incentives to control utilization (and in theory to improve quality). The tag line of the event was “Why Heath Care Systems Want Employers to Demand Quality and Costs”. That italicized “and” is significant.
The featured speakers included Dennis Weaver, MD, an Executive Vice President of The Advisory Board Company, and Nathan Johnson, Chief Policy Officer for Planning and Performance for the HCA. Both described the industry trends toward formation of “accountable care” networks in which healthcare providers take on some of the risk for the costs of care for their populations. The panelists included:
- Gary Kaplan, MD, CEO of Virginia Mason
- David Knoepfler, MD, Chiefe Medical Officer of Overtake Medical Center
- Christopher Kodama, MD, President of Multicare Connected Care
- Bob Malte, CEO of EvergreenHealth
- Sany Melker, MD, Executive VP, Seattle Children’s
- Andrew Thurman MD, President, Edmonds Family Medicine
The major themes I heard from the speakers and panelists included –
- standardizing best evidence-based practices for higher quality
- convenience of access for patients
- a belief that better quality lowers costs and leads to better outcomes
- the achievement of creating a multi-enterprise network that provides beneficiaries choices of providers and geographic locations.
There was little time at the end for questions, but the first one was provocative- with the prevalence of high-deductible plans, how are they ensuring that patients don’t avoid early care, thereby increasing risks of worse outcomes? The responses were that some preventive visits and tests are free.
This was an upbeat, kumbaya event, with everyone seemingly marching in unison to the prevailing movement by health services purchasers to “value-based” care. The providers on the panel continually described the importance of quality. The purchasers clearly want lower costs. The central premise of this approach is that better quality = lower costs. The unasked question- because it is hard and complicated to answer, is how will patient outcomes be measured? When value is defined as outcomes over cost, it’s too easy to just look at lowering the denominator (cost). Increasing the numerator (outcomes) is critically important, and few – if any- healthcare institutions and payers have the infrastructure in place to measure real patient outcomes rather than process standardization metrics.
This was an optimistic moment that I hope continues to produce the great outcomes that are expected. We’ll be watching.