In March 2010, the Affordable Care Act (ACA) became law, possibly the biggest change in the U.S. health care system since Medicaid and Medicare were instituted in 1965. A key factor of the new law is a higher income limit on eligibility for Medicaid (called Apple Health in Washington state), as well as a simpler process to qualify and apply for this insurance. Commonly referred to as health care reform or Obamacare, the legislation focuses on coverage expansion, cost control and health care delivery improvement. Before, approximately one million people in Washington were uninsured. Now, 320,000 people who likely never had insurance are enrolled in Apple Health.
Leading the state during this historic sea change in public health are three UW School of Public Health alumni at the Health Care Authority (HCA), the agency that oversees Washington’s two top health care purchasers – Apple Health and the Public Employees Benefits Board program. Dorothy Teeter, ’79 serves as HCA director, MaryAnne Lindeblad, ’97, directs the state’s Medicaid program, and Dan Lessler, ’92, is the chief medical officer for HCA.
“I can’t think of two more talented, wonderful people to be working with,” says Lessler, who sets standards for medical professionals and establishes clinical policy for the state. “MaryAnne and Dorothy bring an amazing breadth of experience.”
Washington is home to some of the nation’s most innovative and transformational health care upgrade efforts, and the passage of the ACA has helped bolster that. Implementation of the law marks a fundamental restructuring of the way health care delivery works, and Washington is ahead of the curve. In fact, the federal agencies involved – the Centers for Medicare and Medicaid Services and the Department of Health and Human Services (DSHS) – have looked to Washington for help solving various issues that have arisen since the signing of the ACA.
HCA purchases health care for nearly one-third of the state’s population. This considerable purchasing power can help drive broad transformation within public- and private-sector provider groups, moving toward an era of paying for value and away from a fee-for-service health care system in Washington. To accommodate this value-based purchasing model, HCA led the development of a five-year State Health Care Innovation Plan in early 2014.
“One of the things we heard when we were out developing the innovation plan was that others would be looking to the state as ‘first mover,’” says Teeter. “So, if we wanted people to deliver care in a more cost-effective, valuable way, then we needed to be doing the same thing in our state purchasing strategies and health leadership approach.”
The State Health Care Innovation Plan has three ultimate goals, known in health care circles as “the triple aim:” better health, better care and lower costs. Some of the changes the HCA are addressing include measuring the effectiveness of care and rewarding providers with incentives when they achieve good outcomes.
On the patient side, the changes will mean delivering more comprehensive information on the price of care. “This involves really educating people about the costs and benefits of particular treatments,” says Lessler, “but also informing patients on how better to engage with the clinical community to make sure that they, as consumers, are being heard in terms of their personal values and health care needs.”
Another strategy of the health reform effort is to ensure care focuses on the whole person. The current system creates barriers to addressing physical health, mental health, chemical dependency and basic living needs. In response, the innovation plan calls for methods of integrating behavioral and physical health care, and connecting with community services to achieve the best possible result for individuals. It also requires better alignment at the state, regional and local community levels.
“We need to step back and look at health care through a lens of delivering not just through a physician, nurse practitioner, or psychology service, but also considering social determinants of health – factors that affect an individual’s ability to get services necessary to maintain their health,” says Lindeblad, whose passion stems from a belief that everyone in the U.S. should have access to affordable and quality care.
For Lessler, Teeter and Lindeblad, innovation is a discipline. “In health care, innovation is being able to take findings from research or surveys and then turning that into action,” says Teeter. “It isn’t necessarily some bright new idea. It needs to be founded on data, brought to scale and measured for success. I would call it a quest for continuous improvement on a culture of excellence.”
In July, HCA applied for federal grant funding to help underwrite implementation of the innovation plan. With the opportunity to receive up to $100 million, it’s a competitive process with other states, 11 of which will likely receive grant dollars. With the combined savings and avoided costs from adjusting the state’s health system, the innovation plan has the potential to save an estimated $730 million in the first three to five years of implementation.
At the end of June, HCA launched a group that will identify a common set of performance measures and approaches toward delivery of services, to be used across both the public and commercial health care markets. “My hope is that we can really see measurable and improved outcomes in the communities we serve in our state – that we see a reduction in the number of people smoking, for example, and better access to care for people with mental health and substance abuse issues,” says Lindeblad.
In the next five years, HCA will focus on improving value for the dollars the state spends in health care. Now that people are insured through the ACA, the next level of achievement is to ensure that the care residents can access is of the highest quality. Through collaboration with communities and health care system partners across the state, HCA plans to work toward reforming payment mechanisms to support better care at lower costs.
“Better health for the people of Washington – it’s as simple and complex as that. That’s what I think we all want,” says Lessler. He and his colleagues, Lindeblad and Teeter, see the innovation plan and implementation of ACA as key to achieving that end. And it all starts by addressing the broader public health issues facing communities. Their work is not just about health care. It’s about keeping people healthy.