The Dr. Robert Bree Collaborative “ … to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State.”

When I was asked to chair the Dr. Robert Bree Collaborative in March of this year I jumped at the chance.  After more than 40 years in medicine in Seattle, this was the perfect opportunity for me to work with many old and new colleagues and all the stakeholders in the ambitious effort to transform health care in Washington.  I had spent almost 30 years at Group Health as a clinical oncologist and as a physician executive working to improve quality and lower costs for every patient. I knew the Bree could give me a chance, and at my age maybe my last chance, to promote the changes that are needed to transform medicine.

Why change?

We know all too well that health care is in crisis. The outrageous costs of some care are too common: the ER bill for over $30,000 for 30 minutes, an ambulance ride for over $3000 for a ride of less than a mile, and a healthy couple “slowly going under “ because their premiums, copays and deductibles are now twice as high as their mortgage and food costs. These stories are told over and over. In addition given the fact that soon healthcare will make up 20% of our national productivity, these costs rob our country of resources that could be used for education or other vital services. Our extravagant health care costs making us less competitive in the world.

We also know that despite having the highest costs of care in the world we are getting some of the poorest quality of any western country. Waste, marginal therapies and inappropriate treatment are too frequent. We know all this but still we are slow to change.

The Bree Collaborative with the engagement of all stakeholders, insurance companies, doctors, hospitals, employers, professional associations, and patients gives us the unique opportunity as responsible citizens to reduce costs and improve quality. Today the Bree has completed 12 evidenced based recommendations to improve care and decrease costs.  Many community champions are leading efforts to implement bundled payments, reduce hospital readmissions, improve obstetric care and initiate advanced directives for end-of-life planning.  This is good work but it is not enough. Wider implementation and engagement of the entire community remains our greatest challenge.

Change is too slow and the need right now is urgent. Too many people are being harmed by inappropriate treatments. Too many have no access to any care. Too many people are paying too much and getting too little.  There is too much waste and inefficiency in our health care system.


I firmly believe that the Bree Collaborative with all stakeholders working together is positioned right now to drive change and realize our common goal of better care at a lower cost. That is why I jumped at the chance to join and why I won’t quit until we see the change that is needed.

Hugh Straley, MD
Bree Collaborative Chair