The Washington Health Alliance (WHA) has been monitoring and reporting on health care in Washington State for 10 years, with a goal of reducing costs and increasing quality. We recently spoke with retiring executive director Mary McWilliams to hear her views about cost and quality.
Mary McWilliams was appointed Executive Director of Puget Sound Health Alliance in June 2008, after serving three years as a founding member of its board of directors. Prior to the Alliance, Mary was president and CEO of Regence BlueShield in Washington, CEO of both PacifiCare of Washington and Providence Health Plans in Oregon, project director at the American Health Management and Consulting Corporation outside of Philadelphia, and marketing director for the Rocky Mountain HMO in Grand Junction, Colorado. She is a board member of the Greater Seattle Chamber of Commerce, Puget Sound Energy, and the Seattle Branch of the Federal Federal Reserve Bank of San Francisco.
Q: In recent years, reducing costs has become more and more important to the work the Alliance is doing, and is stated as the organization’s highest goal. What trends are you seeing?
A: The group purchasers of health care, employers, and labor trusts have historically focused on premiums and service levels of health plans to drive their purchase decisions. But those major purchasers — due to the Cadillac Tax* coming in 2018 — are incentivized to moderate costs below a certain level or face an excise tax. Therefore, employers are increasingly interested in looking beyond the premium to the cost and quality of doctors and hospitals. They’re making decisions on benefit programs that favor high-value delivery systems in order to affect their trend line. For instance, some local employers like King County and Washington State are now considering offering an accountable care organization (ACO) as a health care option to their employees.
Q: What has been and will continue to be critical to reducing costs?
A: Several factors contribute to lowering cost—and data is at the center of them. First off, there needs to be transparency of information on price and quality of care, in the form of tools for the consumer. In the best cases, this kind of data is integrated at the specific health plan benefits level, with a cost calculator on the plan’s Web site for consumers to evaluate costs and quality as a part of their own choices.
Second, purchasers need access to data so that they can evaluate new models for networks and benefit design, like ACOs, and understand the variation in provider performance based on where employees seek care. This community-level view of cost and is important context for their benefits strategy.
Lastly, neutral organizations like the Alliance, which brings parties together in solving the challenge of cost and quality, can help moderate costs. Our primary effort is to provide insights through measurement and reporting of data on cost and quality, so market participants can identify what improvements are needed at a community level.
Q: What can you tell us about underutilization of effective care?
A: Some diagnostic and preventive services that have been shown to be effective are underutilized. Examples are regular blood sugar monitoring for diabetes and cholesterol testing for heart disease. The Alliance uses claims data on three million lives to measure and report on the frequency in which patients are receiving these services from their medical group. We focus on the prevalence of evidencebased practices with our Community Checkup Report, having just printed our seventh edition. This work has shown that protocols for effective care should be used and reported publicly.
Q: Before you retire this summer, what is your focus in these final months?
A: We’re on the verge of major expansion work, both in developing an All-Payer Claims Database for the state, and expanding Alliance reporting statewide. I’ll be busy, keeping momentum up to the last minute so these projects are up, running, and poised for the next executive director to lead through execution.