Health Care   Point of View

State of Reform

January 19, 2023

Earlier this month, four members of our DH team, Christine Varela, Paj Nandi, Shireen Khinda and I attended the annual State of Reform conference in Seattle, Washington’s largest health care policy forum. 

The conference offered an opportunity for leaders across the industry to gather before the start of the legislative session to discuss the top issues in health care and public health.  

Our team had the chance to reconnect with partners, clients and friends, make new connections, and hear from policymakers and some of the top health leaders in our state, in both the public and private sectors. 

Here are some of our key takeaways from this year’s conference. 

Health care spending must be focused on achieving better outcomes. 

A major theme that emerged during the opening keynote panel was the disparity between the high cost of health care in the United States and the poor measurable outcomes such as maternal and infant mortality rates. 

The panel featured Sue Birch, director of the Health Care Authority, which is Washington state’s largest purchaser of health care, and Drew Oliveira, executive director of the Washington Health Alliance, a multi-stakeholder alliance that includes many large health care purchasers in both the public and private sectors.  

“We spend a lot of money on health care in this country, and we get a horrible return on our investment,” Birch said. Birch also emphasized the need for health care spending to prioritize addressing the social determinants of health and working upstream to focus on the root causes of poor health. 

Social investments improve outcomes.

Throughout the conference, there was an emphasis on social determinants of health such as housing, employment, education and household income, which have major impacts on health outcomes. 

For instance, the phrase “housing is health” has become a commonly used phrase among health care leaders and advocates in recent years to describe the need for safe, stable and affordable housing to achieve better outcomes, particularly among populations at higher risk of being unhoused. 

One discussion about substance use interventions highlighted the idea that effective strategies need to address not only the substance use disorder itself, but also the individual’s housing situation.  

Additionally, grants for community-based organizations (CBOs) should provide flexibility to offer long-term services, such as supportive housing.

Equity must continue to be a priority. 

In the wake of the pandemic and its disproportionate impact on communities of color, there is a demonstrated need to bring equity-centered work to the forefront, largely tied to systemic racism and other forms of marginalization. 

Advocates spoke about how CBOs are key to advancing this work, as they center community-led and culturally responsive approaches in providing holistic care and services. These organizations fulfill a need often unmet by insurance companies, particularly for those whose financial capacity is a barrier to do the work and/or be at the decision-making table. 

Valeriana Chikoti-Bandua, executive director of the Social Justice Fund Northwest, gave the closing keynote by sharing her personal journey and approach to “rectifying harm from a trauma-informed lens,” particularly to Black communities. She also discussed actionable steps to prioritize health care equity such as providing trauma-informed care, checking biases and partnering with CBOs for culturally relevant connection and resources for community members in need.

State continues to lead on long-term care.

As the last of the baby boomers head into retirement, the need for a stable and sustainable long-term care system is ever more apparent. 

Washington is one of the nation’s leading states in providing long-term care to its residents, largely in part to its implementation of WA Cares, a first of its kind state benefit that covers long-term care costs for workers who opt into the program beginning in July. AARP representatives acknowledged the state’s commitment to home- and community-based services that give people the option to continue living in their homes with independence and dignity in their later years. 

The benefit can be used for a variety of needs, including supporting unpaid family caregivers, hiring home care aides or paying for adult family homes, assisted living or skilled nursing facilities.

No quick fix for the healthcare workforce crisis.

The shortage of health care workers is one of the most pressing challenges facing our state, especially in fields such as nursing, behavioral health and long-term care.  

Health care workers are under immense pressure, heightened by the pandemic, which pushes many people to leave the industry resulting in severely understaffed environments.  

We have our work cut out for us; it will take years to train enough people to alleviate staffing shortages and several multi-stakeholder initiatives involving labor, business, government and nonprofits to develop long-term solutions to this crisis. 

In order to progress in relieving strain on hospitals, it’s important to think differently and look at innovative solutions, such as continuing to expand telehealth services to make care more accessible or removing barriers to discharging patients who no longer need hospital-level care. 

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