WSR 10-08-058



[ April 1, 2010 ]



WHEREAS, Washington's continued success as a state depends on the health of its individuals and the successful operation of Washington's health care system is essential to the state's economic well-being and quality of care provided to Washingtonians; and

WHEREAS, over two decades ago, Washington envisioned a strategic and consolidated approach to public policy and purchasing of health care by creating the State Health Care Authority; and

WHEREAS, protection of the public's health and the improvement of health status are essential responsibilities of the public health system in Washington State, and

WHEREAS, Washington is committed to improving the affordability and quality of our health care system through the following strategies:

Using evidence-based medicine to ensure that patients receive health care that works;
Expanding chronic care management to better serve the five percent of patients who use 50 percent of our health care resources;
Emphasizing promotion of good health and prevention of health problems;
Using health information technology; and
Increasing data transparency to give consumers better information about health-care costs and quality; and

WHEREAS, in 2007, the Washington State Blue Ribbon Commission on Health Care Costs and Access affirmed four strategies to improve the health of Washingtonians including:

Build a high-quality, high performing health care system
Provide affordable health insurance options for individuals and businesses
Ensure the health of the next generation
Promote prevention and healthy lifestyles; and

WHEREAS, our current economic climate and budget challenges require us to evaluate state agency functions and structures and take steps to streamline their operations to assure that the public receives the maximum benefit from each public dollar expended and to assure clear lines of accountability; and

WHEREAS, investing in prevention improves the overall health and quality of life of Washingtonians, strengthens the productivity of our work force, enhances our ability to compete nationally and globally, and has a measurable financial pay off; and

WHEREAS, Washington State agencies have proven the value of implementing common purchasing strategies such as the Prescription Drug Program and the Health Technology Assessment Program and new models of health care service delivery that span various state agencies such as the provision of medical homes; and

WHEREAS, Congress has passed, and President Obama has signed into law, the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Act of 2010, enacting landmark national health reform; and

WHEREAS, Washington State government must provide clear leadership and accountability to ensure successful implementation of national health reform, which will by its very nature cut across traditional lines of agency and department responsibility;

NOW, THEREFORE, I, Christine O. Gregoire, Governor of the state of Washington, by virtue of the power vested in me by the Constitution and statutes of the state of Washington, do hereby order and direct as follows:

To assure on-going coordination, the Health Care Cabinet is created. The Cabinet shall be comprised of the following permanent members:

Administrator of the Health Care Authority,

Secretary of the Department of Health,

Secretary of the Department of Social and Health Services,

Director of the Executive Policy Office, and

Director of the Office of Financial Management.

The following members will be invited to serve on an as-needed basis with respect to specific issues affecting their scope of responsibility:

Secretary of Corrections,

Director of the Department of Retirement Systems,

Director of the Department of Veterans Affairs, and

Director of the Department of Labor and Industries.

As a non-cabinet entity, headed by a separately elected official, the Office of the Insurance Commissioner will be invited to participate with respect to issues within its jurisdiction.

The Health Care Cabinet may, at its discretion, establish inter-agency work groups to support its mission, drawing membership from any agency or department of state government.

The Director of the Executive Policy Office shall serve as Chair of the Health Care Cabinet. Administrative and staff support for the Health Care Cabinet will be a joint responsibility of the Office of Financial Management, Executive Policy Office and the permanent member agencies.

The Health Care Cabinet shall work collaboratively with tribal, local and federal governments.

The Health Care Cabinet shall be responsible for:

Providing strong leadership and accountability for implementation of state and federal health reform;
Providing advice, guidance, and specific recommendations to the Governor with respect to implementation of state health initiatives and national health reform including defining what successful implementation will look like;
Assuring collective support and a sense of shared responsibility by maintaining open dialogue and strategic partnerships with key stakeholder organizations and groups to further the success of health reform implementation and the overall state health care system;
Assuring on-going information sharing and coordination of efforts with the Legislative Joint Select Committee on Health Care Reform; and
Assuring on-going information sharing and coordination of efforts with the Office of Insurance commissioner so that delivery system improvements are coordinated with insurance reforms.

To initiate fulfillment of their stated responsibilities, the Health Care Cabinet shall immediately:

Conduct an in-depth analysis of the new federal legislation;
Identify the steps necessary to produce an implementation plan; and
Formulate processes and strategies to maximize stakeholder and public engagement and ensure transparency in implementation of reform efforts.

No later than August 1, 2010, the Health Care Cabinet will prepare and submit to the Governor a detailed work plan identifying:

Both short and long range opportunities, issues, and gaps created by the enactment of national health reform;
Structures and processes needed by state agencies to orchestrate reform implementation including those to appropriately assist the private health care sector in its implementation efforts;
Work force capacity and training needs in the public and private sectors; and
Specific action steps, timelines, and assignment of lead responsibility.

A component of the detailed work plan must be recommendations from the Administrator of the Health Care Authority and Secretary of the Department of Social and Health Services, in coordination with the Office of Financial Management and Executive Policy Office, identifying specific actions and timelines to implement uniform policies and to consolidate duties, functions and powers related to state agencies' health care purchasing under the Health Care Authority as envisioned under RCW 41.05.013 and 41.05.022. A broad stakeholder engagement process must be used to assist in developing the actions and timelines called for in this section. All statutory and budgetary modifications necessary to implement this section shall be submitted to the Governor for consideration in the Governor's Recommended Budget for the 2011-2013 biennium.

The Health Care Cabinet shall report monthly to the Governor from the time period of April 2010 through March 2011 and at least quarterly thereafter. Accountability for implementation progress and achieving results will be through the Governor's Government Management, Accountability, and Performance (GMAP) process.

This executive order, which rescinds Executive Order 01-02 and supersedes Executive Order 07-01, shall take effect immediately.

Signed and sealed with the official seal of the state of Washington on this 1st day of April 2010 at Seattle, Washington.

Christine O. Gregoire


Sam Reed
Secretary of State

Washington State Code Reviser's Office