In May 2007, the Washington State Legislature passed health reform legislation (Chapter 259, Laws of 2007, SB 5930), calling for payment reform, a shared decision-making demonstration project, and the establishment of the Washington State Quality Forum within the Washington State Health Care Authority. The HCA is a state agency that oversees seven health care programs. The legislation was introduced by Gov. Chris Gregoire as a result of recommendations in a 2007 Blue Ribbon Commission report. The law directs the Quality Forum to collaborate with other partners to:
• Collect and disseminate research about health care quality, evidence-based medicine, and patient safety to promote best practices;
• Coordinate health care quality data collection among state health care purchasing agencies;
• Adopt measures to assess and compare health care cost and quality and provider performance;
• Identify and distribute information about variations in clinical practice patterns; and
• Create an annual quality report with information about clinical practice patterns for purchasers, providers, insurers, and policymakers.
The legislation specifically references the Puget Sound Health Alliance as a partner for the Quality Forum. The alliance is a non-profit organization focused on three objectives: advance transparency of variation in performance to drive system improvement; align purchaser and payer incentives for quality and efficiency in provider reimbursement and co-sponsor collaborative activities designed to stimulate quality improvement. The alliance was established in December 2004 in response to the King County Health Advisory Task Force’s recommendations. A regional partnership, the alliance has built a strong multi-stakeholder “alliance among patients, doctors, hospitals, employers, union trusts, health plans and others to promote health and improve quality.” The alliance’s 21-member board of directors is made up of representatives from public and private employers, union trusts, consumers, health care delivery systems, health professionals, and health plans. Alliance partners agree to share administrative data to produce public reports (Community Checkup Reports, described below) measuring the quality of care provided in the region. The HCA has been and remains an alliance partner, as evidenced, for example, by its representation on the board of directors.
Unfortunately, a budget shortfall has stalled efforts to develop the Quality Forum. A $1.3 million biennium budget (2007-09) and four FTEs were approved for the Quality Forum. An August 2008 hiring freeze prevented the Quality Forum from hiring key staff, and in November 2008 the HCA terminated the project as part of an agency reduction as the budget shortfall grew. HCA is reviewing ways in which it can realize statewide data collection and support the database of quality and performance information that the Alliance has amassed over the years. One key data-driven project of the Alliance is the Community Checkup Report, a free resource that enables users to compare health care provided at medical groups, doctors’ offices and hospitals across five counties. Reports were published in both January and November 2008 and include 21 ambulatory performance measures related to diabetes, heart disease, depression, low back pain, generic drugs, appropriate use of antibiotics, and preventive care. The reports also include 48 hospital performance measures in a number of quality and safety areas.
Per the 2007 legislation, the HCA is leading the Shared Decision Making/Patient Decision Aids (SDM/PDA) demonstration project to evaluate and promote the effective use of tools that help patients exercise shared decision making about treatment options for preference-sensitive health conditions. The alliance is one of several organizations involved in the project. Practices selected for the SDM/PDA project will incorporate patient decision aid tools into clinical practice, provide practitioner training and support, and submit evaluation data about the value of applying a shared decision making process for certain health conditions to their patients.