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.