Washington State Medical Association (As Written)

September 15, 2006

Thank you, Doctor Dunbar, for that kind introduction.

Thank you for inviting me to your conference and taking time out of your busy lives and busy practices to be here today. Your attendance demonstrates how much you care about the future of your profession and the care and safety of your patients.

Last year, I joined several thousand people to Race for the Cure and support the fight against breast cancer. At the end of the race, a woman came up me on the verge of tears. She was in her early 30�s with two small children. She told me she was single mother without health insurance and had just been diagnosed with breast cancer.

State government was able to offer her a little assistance and a little hope, but we could not cure her disease or provide her the health insurance she so desperately needed.

I know that each and every one of you hears stories like that every day. I know that�s why you have come here today.

Over 600,000 Washingtonians are uninsured, including 100,000 children. Many more are underinsured.

They are struggling to pay for their prescriptions.

They are using emergency rooms for routine care.

They are trying to find their way, through a complicated medical system, during a very difficult and vulnerable time in their lives.

We also have small business owners who think of their employees as family but cannot find affordable insurance.

As providers, you too are struggling to keep your doors open with the rising number of uninsured patients, the increasing cost of liability insurance and inadequate reimbursement rates.

Our current system is unsustainable. It is costly. And it falls short of improving the health and safety of our population.

We are all here because we care about patients and we believe we can change the system.

We all want to make sure that every single person in this state has access to the highest quality care.

We all want our families, friends and neighbors to live healthy, productive lives.
We all want Washington to be the healthiest state in the nation.

We all want families to go to the doctor without fearing that a diagnosis will drive them into bankruptcy.

This is a national crisis, begging for a national solution. But I don�t see one coming and we can�t wait for the federal government to act.

We must be bold. We must be courageous. We must work together. We must step up as a state to be a laboratory for finding solutions for our health care crisis.

We�ve done a lot of good work to date and I�m very hopeful about the future.

We have heard from business owners, patients, doctors and other health care providers.

We held a health care summit last October to bring everyone together who cares passionately about this issue.

I held a series of town hall meetings around the state and access to quality, affordable health care came up at every single meeting.

In thinking about solutions, I have been very informed by the work of Goerge Halvorson and Geroge Isham, authors of the book �Epidemic of Care.� If you haven�t read it, I recommend you do.

It guided my thinking as we developed a five-point strategy to improve quality, contain costs, and broaden access to our health care system.

First, we must significantly increase our use of evidence-based medicine.

We need to look at results, not television commercials, to guidehealth care decisions. That means eliminating ineffective and dated treatments by focusing on those that work.

The authors of �Epidemic of Care� highlight a national survey of 135 doctors. Each doctor was asked how they would treat the same patient, with the same condition. Those 135 doctors recommended 82 different treatments, including some that were out-of-date, or had been proven ineffective.

In Washington we have the same challenge: different treatments prescribed in different places � with different outcomes.

We need to evaluate medical procedures and recommend treatments that have a demonstrated history of effectiveness and results.

A recent RAND study says that patients receive the recommended care for their condition only 55% of the time. Shifting towards evidence-based care, we can and we will do much better.

Evidence-based care also means having standards for delivery of care. Because patients should expect the same standard of care whether they�re in Seattle or Ritzville, Yakima or Vancouver.

A good example is the State Department of Health�s Diabetes Collaborative, which sets uniform guidelines for best practices and most effective treatments.

Second, we need to better manage chronic illness.

Today, 5 percent of patients consume 50 percent of our health care costs.

We must better manage the care of those patients who currently suffer from chronic illness. And we must anticipate those who will be in the 5 percent tomorrow.

For example, we know that many people in our state either suffer from diabetes or are at a high risk of developing this disease.

We know that diabetes can be controlled or prevented by leading a healthier lifestyle. And we know that a diabetic patient will do far better if their lipid levels and their blood pressure are controlled and monitored.

But, only 40-60% of our diabetic patients are adequately monitored and treated for these indicators.

We have the science. We have the tools.

We need a system that better utilizes preventative medicine, early treatment and chronic care management models to improve patient outcomes.

My third strategy is to build more transparency into our system. People who purchase health care should have a system that makes them informed consumers � shopping for health care by price and quality.

When we buy a car, we have easy access to information about the quality, reliability and efficiency of the models we are considering. We need that same kind of information in the health care system.

I support groups like the Puget Sound Health Alliance that are building a common database so that consumers have accurate, consistent information on quality and cost.

We must do this in a coordinated fashion.

Fourth, we must bring our health care system into the 21st century. As the technology state let�s use the best information technology to improve the quality of care.

We�re wasting too much time and money on duplicate and unnecessary procedures and processes because our system doesn�t allow adequate sharing of information.

My aunt was hospitalized because she had several doctors prescribing different treatments and medications.

She had to be hospitalized � but once we got her to one doctor and one set of prescriptions, she got much better.

It�s estimated that 30% of all medical testing doesn�t have to be done, primarily because diagnostic information is not getting from primary care providers to specialists. What if an emergency room doctor could pull a patient� medical history up on their computer before they even greet the patient?

If we share information better, we�ll reduce costs, enhance quality, and give providers the information they need when the patient walks through the door.

Finally, we need to take responsibility for our personal health by promoting healthy lifestyles and choices in our schools, workplaces and communities.

Like Ben Franklin said: �An ounce of prevention is worth a pound of cure.�

It�s about wellness!

It�s about patients getting flu shots. It�s about children getting their well-child visits. It�s about encouraging our friends to get mammograms and making sure our husbands get prostate cancer screenings. It�s about diet and exercise.

I know how important early diagnosis and treatment can be.

It�s because of my own experience that I feel expanding preventative and predictive medicine is so important.

We can all raise awareness through campaigns like the Community Health Bowl, which kicks off on Monday.

We must continue our battle against teen smoking and must curtail smoking among adults. We�ve made progress by moving from 10th to 5th among the 50 states for low smoking rates. First is where we need to be. Let's keep going!

Employers, like state government, can educate and motivate employees to live healthier lives. We�ve rolled out the Washington Wellness Works program for state employees.

In this program, employees take a health risk assessment, get access to programs like smoking cessation, and are encouraged to get an annual checkups.

I believe this five-point strategy will improve the quality and affordability of health care in our state. We�ve laid the groundwork for implementing this strategy over the last two years, and now we must look to the future.

First, we still have work to do on the Medical Quality Assurance Commission. We are working with your leadership to evaluate options. While we haven�t finalized our strategy, I am very encouraged by the progress we�ve made.

I know that each and every one of you cares deeply about professionalism. You want to be certain that we have safeguards to identify and report unprofessional conduct, without penalizing good doctors. So do I. Let�s continue our work in this area.

I am also co-chairing the Blue Ribbon Commission on Health Care, charged with developing a five-year plan to address health care costs and access for all Washingtonians.

The commission began meeting in July. We have outlined our vision and goals.

We want to improve access. We want all Washingtonians to have access to health care coverage that provides effective care by 2012, with all children covered by 2010.

We want to improve health. We want to move up from 14th to be one of the top ten healthiest states in the nation, and we want to eliminate health disparities.

We want to improve affordability. We want the rate of increase in total health care spending to be no more than the growth in personal income.

These are big goals. But I am encouraged by the progress the commission has made so far.

We asked for public input, and boy! Did we get it! The commission received over 600 pages of ideas to consider from 65 organizations and individuals around our state. The Washington State Medical Association sent their ideas and I want to thank you for your input in this important process.

We have a lot of work ahead of us. The commission is reviewing all of these proposals and will make recommendations on our five-year plan by December.

As the Blue Ribbon Commission moves forward, my goal is that it will continue to deliberate in collective and productive manner and that we will not allow partisanship to divide us.

The problems we face are not Republican problems, or Democratic problems. They are doctors� problems and patient�s problems. We must come together across the aisle and across the state.

I need your help. I need your ideas. I need, and the people of Washington need, you to be a critical part of this solution.

During the last legislative session, we came together on an issue where no one thought common ground could be found. Together, we agreed to take a step forward on medical malpractice and we passed House Bill 2292. Thank you and congratulations on your leadership.

Now the law honors the doctor patient relationship. It encourages candid communication with patients and their families, in cases where the outcome is bad or unexpected. When providers can make statements of regret or fault, they build trust in the medical system.

It was a good first step. Together we did something special. We showed that when we work together, we can address very difficult issues because fundamentally, we all care about patients.

Let�s build on that success and recognize that moving forward we all have to do our part � doctors, hospitals, nurses, public health professionals, employers, insurers, consumers and public officials.

Our task will take a shared vision and united effort to achieve.

We have to do this. Getting by just isn�t good enough. This is about real people with real needs. Real choices and real costs.

I�m ready to make some changes that will fix our system for the long haul.
Working together we�ll improve access to care, improve quality, and reduce costs.

Let�s go to work!

Thank you.

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