Washington Health Plans Commit to Improving Primary Care Through Multipayer Model

By Sonika Kumar

On October 12, Washington state regulatory officials and members of Governor Jay Inslee’s office and others gathered as eight health plan leaders signed a memorandum of understanding, committing in good faith to work together to improve primary care through a transformational multipayer payment model.

The Washington State Healthcare Authority, the agency that oversees the state’s Medicaid and employee benefits program, spearheaded the development of the model, in collaboration with the state’s payer and provider communities. The model strives to achieve integrated “whole person” primary care, including physical and behavioral health, while emphasizing care coordination, value and incentive alignment, and data-based decisions through stakeholder consensus. It emphasizes eliminating misaligned payments and payer administrative requirements that detract from providing high-quality care.

“Our work as a member-based organization made up of those who get, give and pay for health care is focused on creating a high-quality, affordable system for the people of Washington State,” said Karen Johnson, PhD, director of performance improvement and innovation at the Washington Health Alliance.  “Building a strong primary care foundation is an essential building block, and we applaud the work of the Health Care Authority in bringing payers together to tackle this challenge in a coordinated manner that minimizes the administrative complexity for providers and accelerates the impact for patients.”

Payers involved in the effort will focus on increasing their investment in primary care with aligned payment and incentive structures, such as fixed monthly payments in conjunction with a performance incentive plan, that empower primary care providers to focus their efforts on improving patient access, experience, and outcomes. Success under these new payment models will map to measurable value metrics that all can agree on, such as emergency room utilization rates and childhood immunizations status. Participating payers include Amerigroup Washington, Community Health Plan of WA, Coordinated Care, Kaiser Foundation Health Plan of Washington, Molina Healthcare, Premera Blue Cross, Regence Blue Shield, and United Healthcare.

As part of the new primary care model, providers will work to increase the capacity and access of health care services. Multidisciplinary care teams will provide holistic care through preventative care, treatment for acute and chronic conditions, community support, and specialty referrals as needed. According to research, increased access to and utilization of primary care services promotes reduced overall health care spending, increased patient satisfaction, and lower mortality rates.

“For too long, we’ve asked more and more of primary care practices in terms of quality improvement, population health, whole person care, disease management, etc., without providing the resources these efforts require,” said Emily Transue, MD, MHA, medical director of Clinical Quality and Care Transformation at the Washington State Healthcare Authority. “We need to create a system in which primary care can thrive, and we appreciate the partnership of payers and providers in building a new model with us.”

Washington will join payers and neutral conveners in 22 other statewide and regional health care markets committed to primary care transformation that participate in the Milbank Memorial Fund’s Multipayer Primary Care Network, most of them catalyzed by the Center for Medicare and Medicaid Innovation’s Comprehensive Primary Care Plus payment model.