Washington's pioneering ways inform health-care debate

AS Congress moves toward enabling a larger number of Americans to have health insurance, it is clear much more work will be needed to guarantee improved care and reverse rapidly escalating health-care costs.

The best ways to achieve this more comprehensive health-care reform, with major changes in how health care is delivered and financed, are still under development. And many of those pioneering efforts are under way right here in our "other" Washington. Key examples include:

• A medical home for every patient: A medical home establishes a primary-care physician and medical-support team as a single point of contact to serve patients. Evidence indicates that a patient-centered medical home can produce better patient health while radically reducing costs. Patients with a medical home are less likely to go to expensive emergency rooms or seek unnecessary expensive specialist care.

The medical-home clinic opened at Swedish's Ballard campus in April features a multidisciplinary team of physicians, family-medicine residents, mid-level providers and nurses serving as case managers who help patients navigate the health-care system. By design, the clinic enables providers to spend more time with patients, increasing provider and patient satisfaction.

• Accessible, comparative reporting on health-care quality and value: Historically, we've had limited access to information needed to assess the quality of care we receive. Knowing how our providers perform compared to national quality benchmarks and to each other can help us all make more-informed health decisions and spur improvements in our region.

The Puget Sound Health Alliance "Community Check-Up" (available at www.wacommunitycheckup.org) evaluates how often patients receive key elements of proven, effective care at medical groups, clinics and hospitals. The Check-Up provides information enabling everyone to make better decisions that promote and support safe, quality, affordable care.

• Reform of the payment system to promote good health outcomes: Our fee-for-service medical-payment system pays for what is done rather than outcomes. More is generally perceived as better and third-party payer systems give us all a sense of entitlement. Unfortunately, higher spending often does not result in better outcomes and sometimes leads to poorer ones.

Local efforts are testing new payment approaches. Swedish has developed a new model with two insurance providers, Premera and Molina. The clinic receives a flat per-person, per-month fee to provide primary care focused on wellness, prevention and high quality management of chronic conditions. Financial incentives encourage the providers to provide the highest quality evidence-based care.

• An investment in prevention: Although prevention is at the top of what we want in health care, 95 percent of health-care dollars are spent when we're sick rather than on keeping us healthy. We need to learn from developing countries, where the lack of health-care infrastructure has led more rapidly to community-oriented prevention investments.

Public Health — Seattle and King County has demonstrated that using community health workers can substantially reduce illness and costs from asthma in our poorest communities. Some of the best minds in global health, through the Washington Global Health Alliance (www.wghalliance.org), are in the early phases of extending this concept in our poorest areas by creative use of mid-level community health providers, technology, community-action organizations, and linking health and economic development.

We must continue to advocate that the health-reform legislation being developed in Washington, D.C., creates both a better system of health insurance for our country, and also enables the local innovation and implementation of strategies essential to achieving broader reform.

Fortunately, given our region's commitment to health-delivery redesign, our "other" Washington is ideally positioned for this second task of pioneering ways to improve the quality of care and costs.