Paying for value
Paying for value is one of the main Healthier Washington strategies to achieve the triple aim of better health, better care, and lower costs. Meeting this goal will require shifting reimbursement strategies away from a system that pays for volume of service to one that rewards quality and outcomes. To that end, Washington will drive 80 percent of state-financed health care and 50 percent of the commercial market to value-based payment by 2019.
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Washington will use its position in the marketplace to drive transformation as both a first mover and market convener.
Washington purchases health care coverage for more than 2 million people through Apple Health (Medicaid) and through the Public Employee Benefits Board Program. The state will use its purchasing power to lead by example and accelerate the adoption of value-based reimbursement and alternative payment strategies.
- Early Adopter of Medicaid Integration (Payment Model 1)
- Encounter-based to value-based (Payment Model 2)
- Greater Washington multi-payer (Payment Model 4)
- Accountable Care Program and multi-purchaser (Payment Model 3)
More than 41 percent of current Medicaid beneficiaries and 1 in 10 Washingtonians are served in a federally qualified health center (FQHC) or a rural health clinic (RHC) for primary care. Most of rural Washington is served by federally designated Critical Access Hospitals (CAH). These providers offer some of the most innovative and integrated delivery models in the state, yet their reimbursement structure stifles care delivery innovation. In these settings, payment changes are especially difficult given statutory and regulatory barriers and business models that rely on encounter-driven, cost-based reimbursement.
With strong support from these clinics and hospitals, the state will introduce a value-based alternative payment methodology in Medicaid for FQHCs and RHCs and pursue flexibility in delivery and financial incentives for participating CAHs. The model will test how increased financial flexibility can support promising models that expand care delivery options such as email, telemedicine, group visits and expanded care teams.
Washington will test integrated data platform capacity to allow providers to coordinate care, share risk and engage a sizeable population across multiple payers. Using a claims and clinical data aggregation strategy will allow providers to enter into value-based payment arrangements and effectively engage in care coordination and population health management. Integrating data across multiple payers and delivery systems is essential to presenting providers with a unified view of their patient population.
The state will use its market convening power to update a statewide core measure set to inform purchasing strategies and care transformation (see Performance Measures page). The state will continue to convene community stakeholders, public and private purchasers, and payers around payment and benefit redesign and consumer engagement strategies to contribute towards a Healthier Washington.
Washington is working with the University of Washington Accountable Care Network and the Puget Sound High Value Network LLC to test a new accountable delivery and payment model, known as the Accountable Care Program (ACP). The ACP will provide “best in class” patient service and experience and access to high-quality and timely service at a lower cost.
Each network under the ACP will deliver integrated physical, mental health, and substance use disorder services, and assume financial and clinical accountability for a defined population of PEBB Program members. ACPs are reimbursed based on their ability to deliver quality care and keep PEBB Program members healthy, not on whether they performed a specific test or service.
HCA is work with other private and public health care purchasers to replicate the payment model and further accelerate market transformation.
The HCA Value-based Roadmap lays out how HCA will fundamentally change how health care is provided by implementing new models of care that drive toward population-based care.
2015 ACP contract materials
ACP contract attachments and exhibits
- Partner information request
- Geographical analysis
- Alternative payment models template
- Quality measures form
- Partner request attestations
- RFA letter of application
- Certifications and assurances
- Business reference form