On the mend

No matter the fate of the Affordable Care Act, UW faculty and alumni continue to seek remedies for our health care system.

In 2014, Caleb Chamberlain was like many 20-somethings: healthy. He was living at home with his parents in Olympia, working two jobs and trying to find direction in his life. The last thing on his mind was the need for health insurance. “When you’re young, you basically think you’re invincible,” he says. Then pneumonia struck his lungs in two places. Chamberlain was so sick he couldn’t stand up, and his mom called for an ambulance.

Fortunately, the Affordable Care Act of 2010 helped Chamberlain. He got health insurance because of Apple Health, the Medicaid coverage that Washington state implemented with bipartisan support. Because his income was so low, Chamberlain qualified for complete coverage of his care and his prescriptions.

Washington state has been leading the nation in taking innovative approaches to health care. It is one of 14 states to create its own health-insurance exchange. In Washington, the number of people without health insurance has dropped from 14.5 percent in 2012 to an estimated 7.3 percent as of 2015, according to a report issued by Insurance Commissioner Mike Kreidler. Nearly every county saw a drop in numbers of uninsured. Almost 120,000 Washingtonians qualified for federal subsidies and Washington’s state-based exchange, and Washington Healthplanfinder helped 157,000 Washingtonians get coverage.

But now Washington’s public officials and politicians are on the edge of their seats bracing for the potential repeal of the Affordable Care Act, which President-elect Donald Trump promised during his campaign. A repeal could leave thousands of low-income residents without health care coverage, or leave the state on the hook to replace the federal money that feeds into Apple Health.

Whether the Affordable Care Act is fully or partially repealed, or not changed at all, there’s still much to do to transform an unwieldy, inefficient health care system. And UW faculty and alumni will continue to lead the way.

Richard Onizuka, a former UW faculty member, served as the first CEO of the Washington Health Benefits Exchange when it launched in 2013. Initially, the exchange had challenges starting with web sign-ups and call-ins, but quickly smoothed things out. “It was a very wild ride,” says Onizuka, who retired a year ago. “But it was also very fun because we didn’t have a script we were following. We had to create it on our own.”

Douglas Conrad, UW Professor Emeritus of Health Services, served on the Health Exchange’s initial 11-member board. After 35 years teaching and researching risk and insurance principles, managerial finance in health service and managed care, being named to the board was like letting a kid loose in a candy store. “It was an exciting opportunity for me to put my action where my lectures are,” he said at the time.

Although Conrad is no longer on the board, five of the 11 current members hold UW degrees. Ex-officio member Dorothy Teeter, ’79, currently heads the Washington Health Care Authority, which purchases health coverage for those on Apple Health and state employees. Under her leadership, the state serves as a “first mover” in adopting new practices. With more than two million Medicaid patients and state employees, the health care authority makes up one-third of the state’s non-elderly population and can lead the way for other organizations. “Just about every system takes care of our Medicaid program people or our state employees. We, the public purchasers of health care, are transforming health care by the way we purchase coverage,” says Teeter.

The passage of the ACA served as a springboard for transforming Washington’s fragmented, costly system into one that makes access easier for diverse groups, lowers costs and improves the quality of care. In 2014, Washington was awarded a $65 million federal grant to deliver health care through an innovative project model called Healthier Washington. “The vetting that the UW faculty did in reviewing our grant application was invaluable. Without them our grant proposal wouldn’t have been as strong as it was,” says Teeter.

She also points to the Dr. Robert Bree Collaborative as another example of UW leadership in health care. In 2011, the Washington state Legislature established the collaborative to improve health outcomes and cost effectiveness. Legislators named the initiative after Bree, a UW physician who was a pioneer in medical imaging. The collaborative brings together public and private stakeholders, including UW Medicine doctors and administrators, to identify and recommend evidence-based ways to improve health care quality.

Norma Coe, David Grembowski, Tao Sheng Kwan-gett and Doug Conrad are all faculty in the Department of Health Services within the School of Public Health who have been heavily involved in reform in Washington state. Their research is all about improving health policy and the health of our communities.  “The three objectives are better health, better care and lower cost, that’s the state’s triple aim,” says Conrad.

Right now, there is no consistent standard for measuring health performance in Washington state. That’s changing. Eventually it will be clear whether a provider is giving the best treatment for, say, diabetes, or cardiovascular disease.

This is where UW faculty members who excel in data crunching and evaluation play a critical role. Conrad leads the state evaluation team for the Healthier Washington project. He and senior faculty in the UW Department of Health Services use their expertise in health economics and finance, organization and management, program evaluation, information technology, population health, and epidemiology to inform our next steps. The Group Health Research Institute will join them in this work, along with state agency experts.

UW faculty are the non-partisan experts who have devoted their lives to researching and teaching what makes health policies work effectively. Alumni of the UW dot the health care landscape at almost every level and are working every day to make the system better. Stay tuned. More innovation in health care is coming. Almost all of us will be affected.