The Fixer

Ever wonder why a medical procedure costs more at Virginia Mason than at Providence? Or why medical bills often arrive unanticipated months after care? So does Nancy Giunto. Even after spending decades in health care, she admits she doesn’t have all the answers.

Giunto isn’t a doctor. She’s an administrator. But you’d be hard-pressed to find anyone in Washington state who better understands America’s convoluted system of health care.

As executive director of the Washington Health Alliance, Giunto oversees an organization of about 200 groups keenly interested in health care costs and outcomes. They include private employers, government agencies, union trusts, health plans, hospitals, physician groups and pharmaceutical companies.

During Giunto’s eight-year tenure, the Alliance has worked tirelessly to unravel the silos that spawn so much confusion in the health care system. Its annual Community Checkup report highlights quality and value at medical groups and hospitals across the state. Its first Total Cost of Care report provided unprecedented detail on health care costs. It was among the first organizations to prioritize diversity, equity and inclusion in medicine.

Giunto built a career in health care before spending 14 years as an executive director at law firm Foster Pepper. She then joined the Alliance because “hHealth care kept calling me back. I missed it tremendously.”

“I think we have something special in our own state about a willingness to engage,” says Giunto, who retires in July. “I know from my national work that many folks are amazed at the level of transparency we provide. That that only comes from deep trust.”

Health care is both art and science.

I get asked a lot, “How do we fix this complicated system?” Something that’s really important for consumers to understand is that health care cost and quality areis variable and can be measured. Not everyone is the same.

Ask a lot of questions about both the cost and quality of care. Call your insurance company and say you want to understand more about the details on this bill. Talk to your providers. It’s your health and your body.

When I go to the doctor, I ask, “What is this going to cost?” And often my physician doesn’t know, but I figure the more we ask, the more they’ll understand that this is important information.

For me, it starts with having a trusted primary care physician who helps you with the journey. You need to have that person in the system who can help you navigate. It’s fair to ask that person why they referred you to this cardiologist or that pulmonologist. You should get a straight-up answer.

A first point of entry into the system doesn’t start in an emergency department and doesn’t start with the surgeon.

How well do you know yourself? If I go in and really don’t need care, it harms me. It’s a potential financial hit. It causes emotional stress. The cascade of too much care is bad. But when you need to get to a physician, you need to get to a physician.

More is not always better. You may need to be seen by a clinician and enter the system, but oftentimes, we can self-manage.

Many health systems have good websites. Many have triage plans where you can actually talk to a live person. Search on a website connected to a reputable organization that you really trust, one that’s connected with a reputable provider. I wouldn’t just Google “low back pain.”

Making change impacts someone’s business. Understanding that and yet having the courage to still try to push forward collectively is really exhilarating.

No one medical group is great at everything. There’s something to learn from all.

The conversations get deeper and deeper. Health care and business leaders are more willing to talk about affordability and price variation than they have been.

What makes the state of Washington very special is the camaraderie and a willingness among payers, providers and purchasers of care to come together and actually have the conversation. The collaboration that happens in health care to try to address and fix it is just vitally important. That doesn’t exist in many other places. 

With this new tool we have, we should be able to analyze social determinants of health and really look and see in our state where we might have pockets of need. And this tool uses around a couple dozen different metrics by zip code to understand how they compare to another location.

As a former hospital administrator, one of the things I loved to do was walk the halls because you see transformation. Someone comes into the emergency department in really bad shape, and later that day they’re walking. It’s just remarkable stuff.

There are days whenre I go home and I think, wow, how did, how did this just all come together today?

Progress is incremental. Health care is a mess.

I was clear from a very early age that I wanted to do something in health care. I wasn’t sure what.

My family and I are very avid scuba divers. If I could be anywhere, I would be about 60 feet under the water, looking at an amazing and whole new ecosystem.