The possibilities of aligned interests on health care
Margaret Stanley, former executive director of the Puget Sound Health Alliance, writes about the value of bringing diverse stakeholders into local alliances to reform health care.
As national leaders have learned again and again, assembling a fractious group of doctors, hospitals, insurers, businesses, patients and public officials around something as complex and divisive as overhauling health care isn’t easy.
But nowadays, as reasonable, well-intentioned people try to reach agreement on health reform in the midst of the ranting and clouds of misinformation, reaching consensus is especially important, because everyone’s got a role to play in making our health care better.
From what I can tell, it may be easier to achieve true consensus around health care reform at the local level. That’s why much of my hope for a real health care overhaul rests on the power of local organizations, like the one I headed for three years, the Puget Sound Health Alliance. In a few years, we were able to forge partnerships across stakeholder lines to improve the quality and efficiency of health care across the Greater Seattle region.
I want to share with you some insights from our experiences with the humble hope that other regions can benefit, if they want to “take on” health care reform by forging bonds among local organizations and stakeholders. And while I’m not sure any one thing can break through the gridlock in DC around national health reform, perhaps the lesson that collaboration is, indeed, possible around health care may still hold relevance for our national leaders.
Let’s talk first about one of the important catalysts for the change we were able to make in Seattle, a person named Ron Sims. Ron was the former executive of Kings County, which embraces Seattle (now he’s with the Obama administration). Several years back, Mr. Sims was becoming increasingly concerned about the rising cost of health care for county employees.
He got all the competing interests to sit down together because, as county executive, he had the juice to get it done – employers, insurers, doctors, hospitals, drug companies. Not all county executives choose to exert that level of leadership. He did. For instance, he could ask a CEO to attend meetings, and of course the exec would. And it was especially important for the companies to sit down with the doctors. For many, it was the first time they didn’t have to talk at each other through an insurance company.
The idea of measuring quality as a means to improve health care – and at the same time make it cheaper – was very much on people’s minds.
To get there, the first step the organization that became the Puget Sound Health Alliance took was to create 13 teams with representatives of each group to hammer out policy on common health issues such as how best to treat chronic diseases such as diabetes, backache, depression and what to do about the high cost of prescription drugs so that everyone would be on board when it came time to measure the quality of care Seattle’s doctors and hospitals were providing.
Some of the recommendations, inevitably, were unpopular. For instance, the Alliance recommended banning drug-company reps from doctors’ clinics, and some pharmaceutical companies threatened to quit. But they didn’t, and ultimately learned to live with the ban, as did others with similar gripes.
A lot of things were underway around the country even then – employers getting together to figure out what to do about health insurance, and in places like Minnesota they were already measuring and reporting on the quality of health care.
We picked the best ideas and, more importantly, we gave people a place to discuss the huge problems of health care and possible solutions, without duplication of effort or having to have the same arguments over and over.
We put together a very good staff, and people respected that, too. Because we had a diverse health-care community, no single dominant hospital system or big insurer could monopolize the debate.
And, at the right time in our work, the Robert Wood Johnson Foundation came along with the resources and advice to make us even stronger through the Aligning Forces For Quality Program, which helps 15 groups like ours around the country work to build alliances among stakeholders to improve quality.
All this is not to say the Alliance did away with controversy. For example, we anticipate some ruffled feelings over a new program that measures costs for health services and then compares them to national averages. But we understand how to work with, not against, initial criticisms of how we are promoting better health care. It’s part of the Alliance’s job to listen very carefully to the doctors and hospitals and their explanations of why their costs may seem out of line before the Alliance releases the report.
I retired from my position with the Alliance a year ago—but my advice to our national leaders on health care reform would be as unchanged from the days when I helped direct the Alliance’s activities: better health care is possible. There are many ingredients, some of which may be hard to find, but we need to look for the leaders and the catalysts, and we need to bring people along on taking fundamental steps like measuring and reporting on the quality of health care, so that we can save lives and save money.