State Report: Washington

March 1, 2009

Commonwealth Fund State Performance Ranking (2007): 17

State leaders applauded reauthorization of the State Children's Health Insurance Program (SCHIP), which covers children in families that make too much for Medicaid, but struggle to buy private insurance. The legislation, which President Obama signed in February, will help Washington move closer to its aim of providing universal coverage for kids by 2010.

Passage of the SCHIP bill aims to increase federal spending on children's insurance by $32.8 billion between now and September 2013, to be funded by a 61-cent hike in the federal cigarette tax.

PROMOTING MEDICAL HOMES

A Washington healthcare team is working to improve care by promoting patient-centered medical homes. The team's action plan seeks to create an operational definition of medical home in order to measure and improve medical home capacity; develop reimbursement strategies to support providers in adopting a medical home model; and engage consumers and providers in participating in patient-centered medical homes.

By the end of the summer, the team expects to have an operational definition of a medical home as well as performance measures and patient outcomes that can be demonstrated and rewarded. Over the coming years, the state plans to evaluate data sources, performance indicators, reimbursement models, and ways to engage practitioners and consumers. As part of a broader health reform package, it plans to pilot a payment system that rewards providers who incorporate evidence-based practices and elements of patient-centered care by 2011.

REPORT SHOWS ROOM TO IMPROVE

The report used huge volumes of health-insurance-billing data from 1.6 million area residents to compare the treatment patients received at 46 medical groups and all 170 clinics in the region with six or more doctors. Federal data were also used to measure performance at 30 area hospitals. Collectively, the survey covers about 70% of primary-care doctors in five counties.

The yardsticks used for comparison are common standards of care, and results for each facility or group are compared with regional averages in an effort to inspire quality improvement. Most of the data collected are available online, allowing consumers to see how medical groups, clinics and hospitals stack up.

The report found:

However, about 94% of children seen for the cold virus were not given antibiotics, which is considered the proper course of action. Also, nearly 90% of patients with asthma were prescribed long-term medications to control their condition.

The Alliance is made up of more than 160 organizations, including major employers, such as Boeing and Starbucks, health insurers, city and county governments and medical providers. Alliance members said the hope is that the report will spur improvements.

MHE Sources: Centers for Medicare & Medicaid Services; Urban Institute; Kaiser Family Foundation; U.S. Census Bureau; The Commonwealth Fund.