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Value-based purchasing (VBP) is a strategy Health Care Authority (HCA) is using to improve the quality and value of health care services a person receives. We’re advancing VBP through:
On this page
- Multi-Payer Primary Care Transformation Model
- Hepatitis C free Washington’s drug modified subscription purchasing model
- Model for federally qualified health centers and rural health clinics (also referred to as APM4)
What’s a “payment model?”
A payment model, also called a model or alternative payment model/alternative payment methodology (APM), is a way to change how providers are reimbursed for the services they provide. Our state’s models focus on paying for quality and value of care, rather than volume.
- Apple Health (Medicaid)
- HCA pays managed care organizations (MCOs) a per-member-per-month premium rate that covers all a client’s care. To connect payment to quality of care and value, HCA withholds two percent of an MCO’s monthly premium, to be returned based on performance.
- Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB)
- Cascade Care public option plans
- Accountable Communities of Health (ACHs): MTP advances VBP through regional ACHs. Each ACH supports providers in adopting VBP and is required to develop plans to enable the success of APMs.
- MCOs are eligible to earn MCO VBP incentives (through a “challenge pool”) for achieving annual MCO VBP targets. The amount of incentives available to an individual MCO is determined by the attributed statewide managed care members. Learn more in our Measurement Guide.
We’ve included VBP quality and value requirements in our Apple Health, PEBB, SEBB, and Cascade Care public option contracts.
We’re collaborating with Community Health Plan of Washington. See our Partners page for more information on this collaborative work.
Our goal is to drive 90 percent of state-financed health care to value-based payment by the end of 2021.
View the VBP Roadmap, which outlines the road ahead for 2022-2025. The roadmap also covers our key priorities during this period, which include details on how we plan to achieve each priority. Over the next few years, we’ll be focusing on:
- Making progress toward our 90 percent goal.
- Promoting payment models.
- Collaborative contracting.
- Increasing VBP through our MTP initiatives.
- Expanding partner and community engagement.
- Improving health equity and addressing social determinants of health.