Government agencies, employers, providers and other players nationwide with a stake in the health care system are experimenting with new ways to solve issues such as access, quality and cost. Although employers are driving many innovations, a handful of states, such as Washington, are proving to be pioneers in their own right.
In a region known as much for its entrepreneurial spirit as its rainy weather, it should be no surprise that Washington has been ahead of the curve when it comes to health care reform. While cultivating startups such as Starbucks, Amazon and Microsoft into worldwide corporate forces, the Pacific Northwest state is also a leader in the development of patient-centered medical homes, having just completed a two-year state-sponsored pilot project to promote a medical-homes model among 33 primary care clinics. The state also has nurtured the University of Washington School of Medicine's primary care doctor training program, which is consistently rated as the best in the nation.
"Government is bad-mouthed a lot, and everyone says that we need to look at the private sector for innovation," says William Dowling, a professor at the University of Washington, School of Public Health. "But in Washington, most of the significant innovations have come from state government."
There are corporate firsts as well. Qliance, the country's first direct primary care practice, and Group Health Cooperative, the first consumer-governed health care system, were founded in Washington. Qliance opened its first clinic in 2007 and Group Health was formed in 1947 by tradesmen as a community health coalition.
Some contend that Washington's place as a leader in health care reform began in 1993 when it became the first state in the country to pass a law guaranteeing all residents access to private health insurance and requiring them to purchase coverage. The Washington version of the individual mandate was repealed the following year, but the concept of universal health care remains a driving force behind the state's efforts to improve the health care system.
Whatever the reasons, Washington seems to provide fertile ground for fresh ideas.
"It's our good fortune to have enlightened leaders who live here," says Pat Justis, manager, Washington Patient-Centered Health Home/Medical Home Quality Improvement. "There's also something about being far removed from the other Washington [D.C.]. We believe that health care reform has to happen at the state level. We can't wait for it."
In fact, Justis' department is a national leader in the development of patient-centered medical homes, a philosophy that emphasizes the doctor-patient relationship with a focus on prevention and disease management. She heads up the Washington Patient-Centered Medical Home Collaborative pilot project, which was launched in 2009 by the state health department and the Washington Academy of Family Physicians. The pilot ended last fall, the state has continued its work and is now preparing to enroll a new crop of clinics into the program.
Washington has also been out front in the area of evidence-based health plan design, which uses the latest scientific research in making decisions to purchase drugs and health care services, says MaryAnne Lindeblad, director of the Washington State Health Care Authority, which oversees Medicaid, among other state public health programs.
"Washington has been quite progressive when it comes to its Medicaid and low-income populations," Lindeblad says. "We were early adopters in expanding managed care for low-income people. The state reform law passed in the early 1990s started us on a path of coverage for all." She says that by November, all Medicaid patients will be enrolled in a managed care program.
An evidence-based approach also guides the state's health care purchasing decisions. In 2007 it was one of the first states to adopt this approach when it introduced the Health Technology Assessment Program to help determine which health services are safe and effective.
"What really sets our state apart from other is our evidence-based purchasing approach and our focus on using data to identify treatments that are effective and safe," says Nathan Johnson, assistant director of health care policy at the state Health Care Authority.
Rita Pyrillis is Workforce's senior writer. Comment below or email email@example.com.