At last week’s meeting, the Health Care Cabinet heard about lessons
from Washington
state’s successful reforms. Washington has consolidated health care
planning across both the public and private sectors. The structure isn’t the
key – what’s surprising is that they can get to a thoughtful consensus through
power-sharing. Like many states, they are working on integrating behavioral
health and primary care and emphasizing public health initiatives. In a very
fortuitous turn, they didn’t reach their ambitious goals for rushing people
into accountable care/risk sharing models. Recognizing that local context in
health care is powerful, Washington’s planning is locally tailored and organized
by regions – one size does not fit all. They also include a locally defined “early
warning system” to monitor for problems. Proposed metrics include provider
payments, ED use, wait times for care, patients shifting between providers,
crisis calls and prescription drug utilization changes.
Washington is the last state on our list. We’ve found some
themes among the successful states we’ve studied at the Cabinet that do not
reflect Connecticut – local non-profit insurers, strong histories of
collaboration -- in and outside government, reliance on smart analytics and
evidence, and constructive, supportive leadership that engages and respects all
voices. A Washington stakeholder was quoted saying, “We are lucky here because
collaboration is in the water.” They are very lucky.
Input consultants received from Connecticut stakeholders
demonstrated how “siloed” our state is. Many were not aware of successful initiatives
already implemented by others in our state. Now we begin framing
recommendations. Given the disagreements over guiding principles, and even the
definition of a principle, it may be a long haul.
