A decade ago, the public officials running King County, Washington were perturbed by their soaring employee benefits expenses. The upward cost trend in 2003 hit 13 percent, and at that rate, the budget of the county encompassing Seattle and its suburbs would be blown apart within a decade.
County Executive Ron Sims convened a task force, and gave it a broad mandate: re-examine how the county buys its health benefits, but don’t stop there. Look also at the structure and dynamic of the delivery of health care in the region. Six months later, the task force produced a report, and shortly after that the county introduced its Healthy Incentives program for its 19,000 employees and their spouses and domestic partners.
Healthy Incentives asks county workers and their families to take better care of themselves and to patronize higher-quality providers. Over the years since it went into effect, the smoking rate has dropped from 12 percent to 5 percent, and the amount of weight lost by county employees is measured in tons. These measures have saved the county taxpayers $46 million in projected costs between 2007 and 2011.
“We haven’t done a lot of cost shifting to employees,” said county administrative officer Caroline Whalen. “Our reduction is in most part from how people are using health care.” Then she shook her head. “Cost control is very difficult.”
The county’s partner in this endeavor has been the Washington Health Alliance, a collaboration of purchasers and other health care stakeholders that grew out of that first county task force. The Alliance’s work “has been so important to us,” said Brooke Bascom, the county’s communications director for Healthy Incentives. “The environment in which employees choose where to get care has a huge impact on our costs.”
The then-Puget Sound Health Alliance was founded in 2004 with funding from King County. In 2007, the Alliance became one of the four original pilot sites selected by the Robert Wood Johnson Foundation as part of its Aligning Forces for Quality initiative, a multi-year effort that grew to include 16 sites focusing on improving health care quality and affordability.
In January 2014 the Alliance expanded to encompass the entire state and changed its name.
Today, the Alliance has 175 members, ranging from the city of Seattle and the Port of Seattle, to multinational businesses including Boeing Co., Starbucks, and Alaska Air Group. It also includes most of the major hospitals and larger medical groups in the area, as well as health insurers, pharmaceutical companies, benefits consultants, labor unions, and community organizations.
If the Alliance reaches its goals, by 2017 doctors, hospitals, and ancillary providers in Western Washington will land in the top 10 percent in national comparisons of quality, evidence-based care, with a reduction in undesirable variation in cost, quality, and utilization.
“Let’s move everybody up to the 90th percentile,” said Larry P. McNutt, administrator of the Carpenters Trusts of Western Washington and a booster of the Alliance. “Raise all boats in the community, and train the population to understand the value metric.”
"[The Washington Health Alliance] has been the nursery that has allowed quality improvement and process improvement to grow."
Peter McGough, MD, Chief Medical Officer, UW Neighborhood Clinics
Today, the organization supports itself mainly through dues paid by its members. Most recently the Washington State Office of Financial Management (OFM) was awarded $3.4 million from the federal government to create a statewide data center that will help make medical pricing more transparent. OFM is partnering with the Washington Health Alliance in this work.
The dues structure “will keep us on a strong foundation” as the Alliance weans itself from the RWJF funding through 2015, said David C. Grossman, MD, Alliance treasurer and a senior medical director at Group Health.