Healthier Washington: Federal funding brings value-based care to the Evergreen State

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For the last several years, Bloomberg has named Washington as one of the most innovative states in the country, due in part to the presence of top technology companies such as Amazon, Expedia and Microsoft. But the state shouldn’t be known only for innovation in technology, as it is also at the forefront of innovation in healthcare, ignited by federal funding that has allowed the state to focus on implementing several healthcare delivery reform initiatives over the last several years.

Creating a statewide strategy to improve health

In April 2013, Washington received a $1 million State Innovation Model grant from the Centers for Medicare and Medicaid Services (CMS) to assist the state in testing models that aim to transform healthcare delivery. Washington will be delivering reforms through a multi-payer supported approach to integrated care and pay-for-value called Healthier Washington, which is part of a five-year Health Care Innovation Plan grounded in three core strategies:

  • Improve how Washington pays for services by rewarding providers when they achieve good outcomes.
  • Ensure healthcare focuses on the whole person by integrating care and connecting patients with community services to achieve the best possible results for individuals.
  • Build healthier communities through a collaborative regional approach that leverages local partners to bring about changes that will improve health for the people in each community.

Through initiatives such as Healthier Washington and by collaborating with public and private organizations, the state aims to drive 80% of state-financed healthcare and 50% of the commercial market to value-based payment by 2019.

Testing new models for innovative healthcare delivery

With the funding available from CMS, Washington is testing four different payment reform models as part of its vision to achieve state-wide value-based purchasing. In order to test these models, the Washington State Health Care Authority is leveraging its market purchasing power of almost 2 million combined public employees and Medicaid (Apple Health) members.

The four models test different approaches and strategies—two of them working with the Public Employees Benefits Board and two working with Apple Health.

Model 1: Early Adopter of Medicaid Integration

This model tests how integrated Apple Health financing for physical and behavioral health accelerates delivery of “whole-person” care. Starting this year, Apple Health beneficiaries in southwest Washington have the full continuum of comprehensive physician and behavioral health services provided through Apple Health managed care plans.

Model 2: Encounter-Based to Value-Based

This model tests value-based payments in Medicaid for Federally Quality Health Centers and Rural Health Clinics. It also pursues new flexibility in delivery and financial incentives for participating Critical Access Hospitals.

Model 3: Accountable Care Program and Multi-Purchaser

This model tests an accountable care approach starting with public employees where the accountable care program assumes clinical, financial, and patient experience responsibility for a defined population of public employees. Reimbursement is based on performance across financial guarantees and measures from the Washington State Common Measure set.

Model 4: Greater Washington Multi-Payer

This model leverages existing data aggregations solutions and analytic tools to support providers to coordinate and manage care, share risk and engage a sizable population across multiple payers.

Driving towards full implementation of Healthier Washington

Throughout 2016, Washington’s healthcare system transformation efforts will continue to shift from planning and design into full-scale implementation. Planned activities include designating all nine Accountable Communities of Health and testing the most effective structures through a “Triple Aim” approach to achieve healthier populations. The state also plans to launch payment models 1 and 3 and to continue building the foundation necessary to launch models 2 and 4 towards the end of the year. The development of more robust state data and analytic capacity also began this year, with the goal of leveraging those capabilities to meet the other goals of the initiative.

For physicians and other healthcare providers in Washington, the impact of Healthier Washington initiatives may come through participation in Accountable Communities of Health, which aim to bring providers and stakeholders in particular regions together as a means for delivering better health through coordinated care. While Healthier Washington focuses on patients covered by public insurance, Accountable Communities of Health aim to support systems and workflows that will have a positive impact on all individuals in Washington.


Further reading:
Expert Commentary: Nathan Bays on MACRA in 2018
At long last: The documentation you need for Improvement Activity audits

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