Jumbo shrimp. Routine emergency. We’ve all seen examples of oxymora — seemingly contradictory terms in juxtaposition. Some might say that “higher quality, lower cost” is an oxymoron when it comes to health care. 

However, there is increasing evidence that it’s possible to accomplish both goals, provided all the participants in the health care system — providers, payers, patients and purchasers — are willing and able to work together. 

One example is the successful collaboration between Starbucks, Virginia Mason, and Aetna, which sat down together in 2005 to develop better solutions for Starbucks’ employees with low-back pain.

Back pain is the most common cause of job-related disability in the U.S. and a leading contributor to missed work. More than 10 percent of visits to primary-care physicians relate to back or neck pain, representing the fifth most common reason for all physician visits and accounting for approximately $86 billion in health care spending annually.

After analyzing data and looking at national best practices for management of low-back pain, the group determined that too many patients were receiving unnecessary, expensive MRIs and were being referred to unneeded surgery. While the recommended alternative for many people with low-back pain is immediate access to physical therapy, patients had to wait a long time for appointments. 

Together, the three organizations figured out how to provide same-day physical therapy appointments and encourage a more thorough assessment of patients before referral to advanced imaging or surgery. Employee benefits were also redesigned to reduce out-of-pocket costs for employees using physical therapy services. Starbucks saved a significant amount of money in the first year. Employees were able to return to work more quickly, and patient satisfaction with care increased.

This example included only three organizations. How can similar results be obtained at the community level, across multiple health systems and payers? The Northwest Healthcare Purchasers Coalition (NWHPC) is leading an initiative to do just that here in Spokane. 

The NWHPC is a new nonprofit organization, formed in 2014, to help purchasers of health care work such as employers directly with providers and insurers on health care price, quality, and accessibility. We are also working to educate purchasers and users of health care services about how to get the most value and best health outcomes for their health care dollars.

The NWHPC has partnered with the Washington State Health Care Authority to convene key organizations in the Spokane area to work together on reducing the burden of low-back pain and the cost of its care at a community level through the Inland Northwest Back Pain Collaborative (INBPC). 

Participating agencies, and practices include the Washington state Department of Labor & Industries, the Eastern Washington Center of Occupational Health and Education, Providence Health Care, Rockwood Health System, Group Health Cooperative, the Community Health Association of Spokane, and Northwest Orthopedic Specialists.  Other participants include Premera Blue Cross, Regence Blue Shield, Moda Health, First Choice Health Network, the Washington State University College of Pharmacy, the Physical Therapy Association of Washington, the Washington Health Alliance, Associated Industries, and Fairchild Air Force Base Medical Center. 

Many of these organizations already are working on improving care for individuals with low-back pain. Through the INBPC, we will align and coordinate those efforts using a common set of guidelines developed by the Dr. Robert Bree Collaborative. The Bree collaborative is a legislatively created group in Washington state that recommends best practices for health conditions where there is a pattern of high utilization and inefficient or ineffective care.

Participating organizations will look at their current practices and determine what changes they can make to be consistent with the Bree recommendations. For health care providers, that might mean streamlining the scheduling process so people with low-back pain can be seen more quickly. For insurers, it may mean revising contracts with providers to reward better outcomes associated with low-back pain. For employers, it may mean modifying health benefits to make it easier for employees and dependents to obtain appropriate care for low-back pain. 

And for people with low-back pain, it will mean developing a better understanding of what appropriate health care is. About 80 percent of adults experience low-back pain at some point in their lives.

For the majority of these people, physical therapy, physical activity, and over-the-counter pain medications provide more relief and produce better long term health outcomes than more intensive, invasive procedures. By working together through the INBPC, participating organizations will be able to create common educational materials and consistent messages for patients and the general public to help change our community’s expectations about the best treatment for low-back pain. 

The new back pain collaborative is one example of how different organizations can come together to work on improving health care and how purchasers of health care can drive that process. Collaboration at the community level is critical for assuring the best care for individuals and for managing health care costs. 

Having purchasers — employers and patients — involved in those collaborations is also critical. Patients move between providers, and employers change health plans. Decisions about the optimal treatment for a health issue shouldn’t be driven by where a patient goes for care or who is paying. Purchasers working alongside health care delivery systems and insurance companies, with shared goals and shared messaging, can promote consistency. 

Higher quality care and lower costs? It’s not an oxymoron or a pipe dream. This is a real opportunity for all of us to pursue together. 

Jac Davies is the executive director of the Northwest Healthcare Purchasers Coalition, a nonprofit organization formed last year. She can be reached at jdavies@nw-hpc.org.