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Yes, You Can Transform Healthcare at the State Level — and Here’s How Washington State is Doing It


Guests: Nancy Giunto & Mark Pregler

Narrator (00:00):
Welcome to 360 degrees of healthcare with Dr. Stan an in depth. Look at our industry from our very own chief medical officer who will talk with other medical and industry professionals on the changing and evolving landscape of the healthcare system from the inside.

Stan (00:21):
Thanks for joining us. My name is Stan Schwartz. I’m an infectious diseases physician with decades of experience in healthcare. As a student, a teacher, a fellow, a researcher, a practicing physician in both solo and group practices, a health system executive, and now a healthcare entrepreneur. And as I get older as a patient, I want to share my 360 degree view of healthcare with you. My thanks to zero studios for support of this podcast. My guests today are Nancy GTO and mark PLAR. Nancy is the executive director of the Washington health Alliance, which is based in Seattle. And mark is their director of data management and analytics. This Alliance has been doing some incredible work on bringing quality and cost transparency to a huge swath of the population of Washington state through their community checkup project and their new total cost of care results. I was so excited when I first hear heard about this idea. We had to have them on our podcast. In my view, they’re doing things right now that many people say simply can’t be done and we’ll put links in the reports to their reports and our show notes for you to take a look at. So welcome Nancy, welcome bark. I understand your organization’s been around for about 18 years now, and I see that you’re really one of the strongest coalitions in the United States. Can you tell us briefly about your mission and your constituency?

Nancy (01:56):
Well, Stan, it’s a real pleasure to be with you. Thank you for the invitation. So the key mission of the Washington health Alliance is to promote health and improve quality and affordability in the healthcare system in Washington state, we’re focused on Washington state. We are supported by 185 member organizations across the state that, that, um, represent all the key stakeholders in healthcare, including purchasers. And that is our term for employers and union trust. Those who pay the bill health plans, providers as well as consumers. Mostly we reach consumers through our employee, uh, employer, purchaser members. And I can tell you a little bit about the history if you would like to know that as well. Uh, so the history of the Washington health Alliance really started in 2003, when then king county executive Ron Sims, who still sits on our board king county being the largest county in the state of Washington, looked at escalating healthcare cost, uh, and had no real means to check quality or to evaluate quality and the alliances, really his brainchild bringing together multi stakeholders who typically work in a silo together around the table to try and improve healthcare.

Stan (03:23):
So can you give us overview of the project that we’re gonna talk about today and what was the impetus for this project and how long did it incubate before it hatched?

Nancy (03:36):
So, Stan, I think you’re referencing our total cost of care work. And I’m gonna let mark start us out here and we’ll tag team a little bit for your audience.

Mark (03:44):
Yeah. So total cost of care report was really driven, um, you know, by our purchasers wanting a little bit more transparency in cost within the healthcare system in Washington state. Uh, so, you know, we worked together as a multi stakeholder collaborative as Nancy explained where we brought the purchasers, the providers and our, our payers and the state together and through our committee process, um, you know, developed out a methodology for how we would measure this and at what levels of granularity we would measure this. Uh, and it, I, I think, you know, in terms of Washington, we’re probably the first in the state to do this at the level we’re doing, uh, which our first release was geographic base. So for our accountables communities of health, there’s nine, uh, ACHs in the state of Washington and also the counties 39 counties. Um, and, and really the goal was to shine a light on where healthcare dollars were going. Um, you know, we, we talk about the ability of purchasers to look at data compared to their population information. They may be getting from their health plans. Uh, it was really to drive that, that, uh, you know, that view, if you will, of, of where the dollars are going,

Stan (04:57):
What, what insight does this project give to purchasers that’s different from what they’ll get from, uh, blue cross, Aetna, Cigna, and so forth.

Mark (05:08):
It’s a multi-payer view. So what we typically find with purchasers, they may get SIM similar results from their plans that, uh, may include comparison to the PA the plan book of business, uh, in, in addition to their own population, uh, within our data set, we’ve actually blended data across the data supplier. So it’s a multi-payer view, uh, representing over 4 million covered lives in Washington state, so much richer data set. Uh, that gives a little bit, um, I guess, broader example in averaging of what’s happening in total cost of care across all the different payers in the market.

Stan (05:44):
So it, it sounds like you’ve developed what some states have in all payer claims database, but you guys have done this on a totally voluntary basis. They’re not required to report this, which I think is just incredible. How, what challenges did you have to surmount to get the payers and the plans to give you these data? Because they don’t really like to share that. It seems

Nancy (06:12):
So we, you know, it’s right, Stan, it is, um, unique in the, in the nation to have a voluntary effort, as robust as the one we enjoy in the state of Washington. And, you know, we’re entrusted with claims level information from 35 data submitters, including commercial plans in the state health plans in the state, as well as Medicaid managed care organizations. And something quite unique is that we have many Arissa purchasers who also entrust us with data. And it, isn’t only the quality data that mark and his team work with. They also provide us bill paid and allowed charges, and it is very unique to have that level of insight. And that level of trust. Mark can maybe speak a little bit more about the database, you know, itself, just the size of it and, and how, you know, a little insight and high level, how we work with the data.

Mark (07:13):
Sure. So, uh, today the database represents over 4 million covered lives in Washington state, as Nancy said, it’s, it’s roughly half commercial, half Medicaid. Uh, so today we do not have Medicare data, but that’s something we’re looking at in the future. Uh, we work with, uh, a valued partner of ours Milliman, who is our data aggregator. Um, so all the data suppliers hold business associate agreements with Mein to make sure everything is HIPAA compliant. Uh, the data comes in and is made available to us in a variety of different ways. We have analytic capabilities that Mellman offers. We have our own analytic capabilities that we’ve built on top of this, uh, to really produce the analytics we’re reporting on today. So our quality measures, total cost of care measures. We’ve done resource and utilization statistics in the past. Um, so quite robust. Uh, I, I would, you know, I think toed our own horn a little bit to say it’s probably one of the best AP CDs in the country. Um, it’s very visible, very recognizable and has a lot of credibility with our, our stakeholder audiences within the community,

Stan (08:18):
AP C D uh, the acronym for all payer claims database.

Mark (08:23):

Stan (08:23):
Correct. Um, one of the things I noticed, uh, in your report is that most, everything is risk adjusted. So you have the old apples to apples comparison. Is that something you do or is that something that’s done at the Milliman level?

Mark (08:39):
It’s a combination of both. So we actually use Milliman Mara’s, Milliman’s advanced risk adjustment software. Uh, so they’ll run our data, uh, through, through their grouper and they’ll assign the risk scores down to the patient level. And then by the time we get it, we’re rolling it up. You know, whether it’s county level geographic results, uh, to, to calculate basically the illness burden of the population that we’re measuring for whatever level of granularity we’re measuring

Nancy (09:06):
And, and Stan as a physician, you know, how very important that is, right. You know, doc Dr. First are wanting to know that there’s a like comparison. First of all, they’re wanting to know that the patients are really theirs and we have a validation process where they help us with that. But they also want to know that this has been adjusted for, uh, you know, like patients in terms of the illness burden, that they have really important.

Stan (09:34):
What’s the biggest takeaway as far as insight that you’ve gotten so far from the project as a result of this project, we learned what’s the big, what’s the big picture thing that you’ve learned?

Mark (09:48):
I would say there’s a lot of variation. Um, maybe not surprising, but the variation exists. And as I said at the onset, you know, our, our initial goal for this, this first release was to shine a light on where the dollars are going. And it was really to set the stage for future work, to understand what’s driving the spend in different categories. Uh, we’ve seen shifts from inpatient to outpatient services. We see variation in ambulance services for different regions in the state. Uh, but we need to dig in further to understand why that’s happening. And, you know, those are things that we’re looking to do in the coming months. Uh, having discussions at our board, uh, to figure out how best we do that without disclosing anything that might be considered proprietary.

Nancy (10:32):
And, and Stan, I would just add here, I think when you saw the presentation, it was the geographic level. As you’ve been mentioning, we have approval now from our committee structure, as well as our board to release at the medical group level where we’ll, um, name, name, names, and identify publicly, um, those organizations and how, and how they perform provided that there are enough patients, um, included in their group and that we privacy standards, but we report very and

Stan (11:06):
Question I, so one question I have, when you talk about variation, do, can you confirm or deny that cost does or does not build, does not buy quality?

Mark (11:18):
Well, I don’t know if we can confirm or deny that we’re looking at that. I think Nancy will talk a little bit about some upcoming work around our quality composite score. Uh, but we do see, you know, for certain groups it’s clear that they’re lower cost and have higher quality than others. Uh, for some it’s, it’s pretty equal. And then there are those that are high cost and low quality. So we do see it. Um, that’s certainly gonna be something we’re gonna release in the near future here. Um, so I don’t want to disclose too much of that. Uh, we still have to get through an approval process on it, but, uh, we do see it. Yeah.

Nancy (11:55):
I would say Stan, in some reporting that we did several years ago, where we were using, um, you know, measures that are, that are out of the C vetted measures from, from a, we did, we did dispel the notion that to be that, that high, a high quality hospital, it, it, um, does not have to be the most expensive in the market. And there, that was pretty profound insight for our purchasers. And, um, you know, again, this is the age old question, the really important question that you ask. I think it’s still true today that a lot of people who write the checks, the purchasers believe that high, the high to get the highest quality must pay the highest price. And we would say that that isn’t true, uh, universally based on our analysis.

Stan (12:49):
So thus far who have been your most active users of the data and how have they used the data.

Nancy (12:58):
So, you know, I think we have to think about the response to that question really stand by by group. So, you know, Marcus mentioned the purchasers, like to see a comparison of their population against a Mar a total market average. And so to health plans like that insight, um, I, I would say that our purchaser members have used the data to do benefit design work, for example, looking at generic drugs and, and use in screening. And, uh, I senting through modifications to design many have also used the work to, uh, to consider how to where the priorities are for wellness programs, for their, for their employees and members. Tho those are a couple of big picture items. I think the health plans look to our data and information as really important neutral third party insights that can help, you know, can help their credibility as they’re sharing with their members.

Nancy (14:05):
You know, the data they have internally when it’s substantiated by a neutral third party that adds strength to their point of view. They use the information we have on, uh, medical groups and clinics in their contracting. Obviously it supplements their internal data, but it’s just one more, um, you know, check or, or look to, uh, trusted data source to, to validate what they’re communicating you know about. And, and I think that our providers we’ve created, uh, an approach here that I would, I would describe it as it’s not a gotcha approach. We’re not interested in, um, shaming folks performance. We’re interested in highlighting bright spots. We understand that no one organization is best in everything and that there’s something to be learned from one another. So we really treat this as a way to look at best practices and learn from one another in a can conversation about what works and what, and what doesn’t. Obviously everyone wants to be at the top of the list. That’s what they strive to do. And we love that. That’s what they strive to do, but we’re not interested in penalizing those at the bottom, but embracing them in the conversation is what we try to do.

Stan (15:20):
So when you talk about benefit design, have any of the purchasers use the data for crafting their network in terms of incentives to go here that you won’t get? If you go there, for example,

Nancy (15:35):
Y yes. Um, you know, more and more stand, not as much as we would like to see in the market candidly, but I think more and more, um, folks think in those ways, uh, um, you know, again, uh, this is in concert with their brokers and many of them have very close relationships with their health plans as well. So it isn’t just the alliances work. It’s more of a team approach this, but we hope that it offers insights to them. And we try to prompt them with the questions, you know, to ask and facilitate the conversations between, for example, health plan leaders and purchasers to have those rigorous conversations.

Stan (16:21):
It would seem that having this rich, external source of data could be, could be a, you know, something that takes something that you have to deal with benefit and broker benefit consultants and brokers with as far as giving employers information that they either may not have, they don’t agree with, or they really don’t wish to, to, you know, to look at, has that been a problem at all?

Nancy (16:53):
Well, you know, I would say that our membership includes, uh, some of the largest brokers and senior leaders and the market, and we invite them into the dialogue. And I think Stan, the question you ask really, you know, speaks a little bit to the overall structure. We have a robust committee and board of director structure where we invite on any given month 90 or more leaders from across the state, into our committee, our board system, to help us define the work, refine the work, uh, look at reports before they’re issued publicly. So, so folks feel that they’ve had a place to, you know, to help vet the information and, and to be a part of its development, uh, including, as I mentioned earlier, uh, physician validation of the results at, at the patient level, right? So it, it is really that infrastructure and community engagement that really matters, you know, mark and I often say that, you know, trusted data is the start it’s table stakes, but, but what you really need is to convene groups together, to support the methodology and approach such that they’ll be willing to take action.

Mark (18:16):
I think that’s actually one of the most important aspects that lends to the credibility of our work is our stakeholders are directly involved in shaping it.

Stan (18:29):
Are you able, you know, what are the things that I hear from employers is that it’s really, I can get data on, you know, big things, you know, where’s the best hospital to get a coronary bypass at, but I can’t get data on where’s the best place for my employers, my employees to get an MRI scan or a CT scan, cuz there aren’t really, you know, easily available quality results there. What do you do to get down to the everyday healthcare level?

Nancy (19:02):

Mark (19:04):
Yeah. You know, I don’t know that we’re down to that specific level yet. Uh, in our total cost of care reports, we do use Mellman healthcare cost guidelines or eight CGS and it represents about 60 or so service categories, uh, that are grouped into five, um, service settings. So inpatient, outpatient, professional prescription drug, ancillary services. And in those results it would show, uh, when we released the medical group results, what the total cost of care would be for things like CT scans or MRIs. So I think it gives them additional information, um, to assess and analyze and compare to their own spend if they’re getting reports from their payers, uh, again, it’s the benchmark capability that, that we’re offering in that regard. Um, so it gives them, you know, the ability to see at a pretty granular level, but certainly not down to the procedure level work we want to get at some point in the future.

Stan (20:02):
Can you gimme an example, going back to benefit design at, you know, a real life example of how an employer or purchaser is actually use the data?

Nancy (20:13):
So one of our largest purchasers, uh, looked at, looked at data on generic drug use as compared to the market. This is a purchaser that has a lot of unions involved, uh, in the work and was able to influence a, a different tiering of drug design across in, in collaboration with their labor management team, by showing the data and that their performance was not strong in generic drug use as compared to the market and way off the, you know, another, another example I would, I would use Santa’s been used by, by many of our purchasers actually is thinking about how to, uh, in incent or dissent, uh, emergency room use when it isn’t really an emergent condition, right. And how to not only put benefit, design changes in place, but to educate their members and, and staff a about when it’s appropriate to use an ed.

Nancy (21:21):
And, and when you should consider, uh, an urgent care or calling a primary care physician, as opposed to accessing your care through an emergency department, those are a couple of examples right now I would share that we have a major initiative underway where we have 30 organizations across the state that are looking together at how to improve care for low back pain, uh, in our state. And that’s a multi-stakeholder approach phase. One of this work was driven by data. We were able to show, uh, by individual purchaser, mark and his team were able to show where low value care, uh, is occurring by 47 different measures and where high value care wasn’t occurring as much as they might like to see like screening and well child visits. And based on individualized reports, the purchasers got nine purchasers participating in round one, selected low back pain as the area to focus on for state improvement. And we fashioned a multi stakeholder collaborative around it and are making progress.

Stan (22:39):
Do you, has, has the work that you’ve done, excuse me, has the work that you’ve done influenced prices at all to your knowledge, or is it too soon to see that?

Nancy (22:54):
I, I, I, I would say too soon to see mark, but what would you, what would you say to that?

Mark (22:59):
Yeah, I, I would say it too soon to see right now, but I think once we get the medical group level results out, uh, where that data may be a little bit more actionable, um, I think we’ll start to see something, some movement happen in that regard.

Nancy (23:13):
You know, Stan, I, I don’t know your experience, but my experience surely is when working with purchasers, there’s still not a common knowledge about the tremendous variability in quality or cost. Mark mentioned this earlier. You know, we, I, I still, when I speak to audiences of, of primarily purchasers there, they’re, they’re astonished at the variability. They just assume that whatever door they walk through is high quality and similar costs. And I think that foundation education still needs to continue in our, in our market.

Stan (23:53):
We see, I mean, my experience with that has been yesterday. I looked at a claim set for a company and saw a cataract operation for $2,000 in the exact same operation for $13,000, you know, a back operation for $47,000 and a similar fusion for $296,000. And you know, who knows if the outcome is better or worse because we, we can’t get, you know, that kind of data. Um, have you done any work around quality of care on, on ambulatory sensitive conditions like diabetes, chronic obstructive lung disease and so forth, or you mainly procedural based?

Mark (24:39):
Well, our quality measures, we largely use he DS and QA HEDA specifications. Um, so we do have measures in those categories. Uh, we haven’t done specific work, uh, to drive change there, but we certainly reported at a variety of different levels on our community checkup website. Um, so from state level all the way down to clinic location level,

Stan (25:01):
One of my aspirations is that at some point we could tell an employer that if you have a high population of people with diabetes and here in Oklahoma, you know, we’re in the 10 to 11% range that incentivize your covered members to go to clinic a because they have the best data and that’s eventually gonna save you money. Do you foresee that in your future to be able to do that?

Nancy (25:28):
I think that’s a fabulous aspiration, Stan, and, and we, we would love to be doing that. I mean, I would say that the way the Alliance would approach that work is by offering insights. Here’s what we see from the data. And here’s what we can tell you. We can respond to questions from the data, but not being a purchasing coalition. We don’t offer, you know, specific advice about how to build your network. And I think your, you understand your audience will understand because of the level of data that we are entrusted with. We need to be very mindful of protecting it from all kinds of things, including any kind of antitrust concern. So we’re not in the business of advising employer a here’s exactly how you should design your benefits, rather here’s your data. Here’s how it compares to the market. Here’s some insights we offer you consider, you know, the choices that you would make.

Stan (26:30):
So do you foresee that you will ever offer a rolled up composite score for providers kinda like consumer reports does for, you know, toasters and automobiles?

Nancy (26:42):
Well, we’re, we’re so glad you asked this question, Sam, because we’re very excited about some brand new work that is very current right now. So for a couple of years, working with our quality improvement committee and our health economics committee, primarily we developed a quality composite score that was 29 measures, a subset of what we report on our community checkup that an expert panel helped us put into four domains and we could roll up and share a quality composite score that is available now on our website, we’re in the process right now, given the total cost of care work that mark and his team are, are driving to add a cost component to that, to that metric, to really get us to value. And, um, we envision this as a user friendly tool where they can show by preference how they would wait, you know, the quality scores versus cost. And, and we’re really excited about this because we think this is quite revolutionary and I’ll let mark add to that. Uh, we’re in the process now of gaining committee approval, we have approval from our quality improvement committee. We have other committee process to go through and ultimately the board, but we envision this coming forward in the next several months.

Mark (28:10):

Nancy (28:10):
I, what would you add mark?

Mark (28:11):
I’d add that in maybe the next month or two, we will be releasing a, a visual, um, that basically plots medical groups and clinics, uh, on a cost in quality, uh, access so that we can see where they, they fall within a quadrant based visualization. So that’s really the, the introductory step. But then as Nancy says, when we get to the preference aspect of it and a, a particular user can slide and, and select, which is most important to them, quality or cost, uh, they will actually create a blended composite score and, uh, remap those groups. So, uh, definitely interesting work to be, to be coming soon.

Stan (28:50):
have you, have you seen the phenomenon where a particular group or provider is really good at one thing and really not very good at another thing and where a composite score really doesn’t give you the guidance you need.

Mark (29:07):
Yeah. I, I think you, what we often see is depending on the waiting of the four domains in our composite score, you can have a group that does really, really well in chronic conditions as an example, maybe not so well in prevention and screening, uh, and they may still rank pretty high on the composite score given the way the waiting works in those four domains. So we do see that, um, you know, there are some groups that are strong in all categories, some that are weak in all categories, but they seek to improve and, and to understand what others might be doing. But, um, you know, I think by and large, we find that there are cases that, uh, groups Excel in, in certain areas,

Nancy (29:49):
You know, stand from this work. This is never, never perfect. And, and, you know, we try, we try to working again through our robust committee structure to, to get consensus about the best way to approach it, understanding that it is never going to be perfect, but we don’t want perfection to get in the way of continuing to drive transparency forward. We understand it’s evolutionary and that we’re all learning as we go. But if we waited for perfection, we’d never release anything.

Stan (30:27):
So the one thing that you can’t be is lake wo, begon where all your clinics are above average. , you will have, you know, no matter how you cut it, they’ll always be a group that’s in the lowest quartile, but yet even that lowest quartile could be a whole lot better than national benchmarks. How do you, how do you rationalize that when a provider says, yeah, I’m below average year, but I’m above average everywhere else. Yeah.

Nancy (30:53):
Well, I, I would just go back to, you know, when we gather around the table, we often say, no one is great at everything. We’re all here to learn CR create the environment where it’s safe to ask questions and, and create a place where people are really trying to do what’s best to improve the system. Um, and it it’s hard Stan, and you know, it, you know, it is true that, um, you know, not everyone can focus on all the measures that we report on. I would also say that I think it’s rewarding to them when they do focus and they see improvement, we hear about it. Like we’ve been low on X and we really made a concerted effort and look how we’re we’re doing now. Um, I would also say that, uh, you know, there are some measures where we are, you know, I’d use the term topping out of the state and our, our medical director, uh, has teed up for a conversation with our committee. What do we do about some of these, because you can be shown below average or at average, with just a little nuance in how you’ve app, you know, how you’ve scored and is it really fair if you’re at 96 and someone’s at 97, that they’re better and you mm-hmm, , you know, worse. And so it’s always that balance as well. Um, thinking through with the clinical leaders when we’ve kind of got it in the state and when we can let a measure go for public reporting, it’s real important stuff.

Stan (32:34):
Um, two more questions are all the providers that gave you data. Are they all members of the Alliance?

Nancy (32:42):
go ahead, mark.

Mark (32:45):
So yeah, we, we are, we’re actually not getting data from the provider community. It’s actually coming from the health plans or the self-funded purchasers, and to be a data supplier of the Alliance, you also need to be a member of the Alliance. Um, so they’re all participating, very active members. Many are on our board of directors, uh, most are on our committees in some form or another. Uh, but they all participate very actively and, and contribute their data. Um, as we said on a voluntary basis. So it creates a very rich program.

Stan (33:16):
Have any of the providers squawked at having their data supplied by payers and plans?

Mark (33:25):
Not that I’ve heard, no.

Nancy (33:27):
We we’ve not heard any pushback in that way. I mean, they do. We’ve had to a couple of inquiries in the last couple of weeks about some recently released reports. They have questions and they’re wanting to understand more and, you know, just have a dialogue about results or, or a little bit deeper dive on the methodology. But in my, uh, almost eight year tenure here, we’ve never had a medical group say, um, don’t, you dare report in this way.

Stan (34:03):
One of the terms I’ve heard you guys talk about in the past was, and, and mark, you talked about, this was the concept of directional benchmarking. Could you expound on that a little bit?

Mark (34:15):
Yeah. So directional benchmarking, it’s a phrase we use, um, you know, our data, as I mentioned, it’s 4 million covered lives. It’s not representative of, you know, every claim service or healthcare service that’s being provided in the state. Um, so when we do this multi-payer view and bring the data together, it’s reflective directionally of what’s been happening in the state. And when we, we combine that with benchmarking, if, if you’re a purchaser, if you’re a large self-funded purchaser, and you’re looking at this, it doesn’t take into account your unique population, the burden of your population or what your plan designer benefits may be. So we like to say, it’s, it’s directionally showing what’s happening in the market, but it may not be a perfect benchmark to what’s happening in your,

Stan (35:07):
So the final question is a twofer. What do you see, where do you see you, your project being in five years? And what advice would you give to any other organization, a coalition, a company, a state, uh, medical society who aspires to kind of do what you do as far as the first stake in the ground they need to plant to get started.

Nancy (35:35):
So I’m gonna, I’m gonna take the second part first and I’m gonna let mark talk about the, the project stand. So, so the advice I would give to anyone trying to do this is build trust. It it’s the only, it’s the only foundation in the glue by which you can develop this work. You must have trust across stakeholder groups, and you must have a robust enough infrastructure that allows folks who are going to be reported on to influence the development of reports and the way they’re going to be displayed to the public. And I would just then also reemphasize set, you know, set the table in a way that it is a collaborative conversation about ways to improve, as opposed to a report card on high performers versus low performers. It’s about learning together with a common goal of improving healthcare and affordability in the state or in the region or whatever your coalition represents. And mark, you can talk about total cost of care because there’s some additional exciting things on the horizon for next steps there.

Mark (36:45):
Yeah. So with, with total cost of care, um, as I mentioned, we want to get the point where we’re looking at cost drivers, what’s actually causing changes within the system or, uh, within spend. Um, but the other piece, and we haven’t talked about it today is, is adding an equity lens to that data. Um, so we are currently working with algorithms that we’re produced out of the university of Wisconsin. They refer to it as their area deprivation index, and we worked with our data suppliers to add these deciles, uh, into our data set. And we’re beginning to analyze that not only from a cost standpoint, but from a quality standpoint too. So we can take the reports we produced and array the results across these 10 deciles to see if there, there are differences in how services might be provided, you know, the quality of the services or the cost of the services based on the demographic of where you live.

Mark (37:43):
Um, so that should be coming hopefully in the next six months or so. Uh, and then beyond that, I think looking out at the five year horizon, it’s always, you know, our, our goal to continuously improve the work we’re doing and our reports and analytics, and hopefully get more granular. Transparency is a big thing. And, and if I were looking back five years from now, you know, I would hope that the transparency effort had an impact and either slowed the cost curve or reduced it all together. And we see a huge increase in the quality at the lower cost overall. So, you know, we keep doing that. We keep refining and reevaluating the work we’re doing based on what our stakeholder needs are and, and keep growing that as an organization, hopefully to make change within the system.

Stan (38:28):
Just, just ping one question off of what you just said, as far as the demographics, are you gonna be able to weave in so-called social determinants to any extent, ethnicity, income, all those things?

Mark (38:42):
Yeah. So the area deprivation index actually uses 17 attributes from the American community survey and the university of Wisconsin researchers had done a great job applying that down to the census block level. So it’s, it’s pretty granular in that aspect. Uh, it doesn’t necessarily take into account race, ethnicity, or language. That’s certainly a, an area of data that we’re missing. Uh, we’ve worked with the health plans, the health plans don’t have it, but there are certainly efforts underway to try to improve that data collection. And as we do, we’d like to see that come in as well. So we can have the race, ethnicity, uh, equity view to the results as well.

Stan (39:23):

Mark (39:24):
Certainly an important aspect of the, the future work we’d like to be doing.

Stan (39:28):
This is so exciting this to, to, to listen to this work you’re doing and listen to your aspirations, but I need to warn you that I’ll be knocking on your door in about 18 months to get a follow up, because I want to see where this goes. And I I’m particularly interested in how people who buy healthcare will use the product that you’re developing, cuz I think that’s so important. Thank you so much. My guests today have been Nancy GTO and mark PreK from the Washington health Alliance talking about their total cost of care project. And I’ll put links to their work in our show notes today. Thanks for listening and a special thanks to zero studios for sponsoring this podcast. Zero health worked with mid-sized self-insured employers to help them save up to 50% on their healthcare by connecting employers and healthcare providers in healthcare marketplace. And at the same time, providing a great benefit to employees, learn more on the web@zerodothealthorsendanemailtoinfozero.health.

Narrator (40:35):
We hope you’ve enjoyed the time with our very own doctor Stan for 360 degrees of healthcare with Dr. Stan Schwartz, a part of zero studios tune in subscribe and review our podcast to keep current with the ins and outs of the medical and healthcare industry from the inside out.

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