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Multi-payer Primary Care Transformation Model
Primary care is the foundation of our health care system. Evidence shows greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality.
The Multi-payer Primary Care Transformation Model will be a framework that aims to strengthen primary care through multi-payer payment reform and care delivery transformation.
The purpose of the Multi-payer Primary Care Transformation Model (PCTM) is to create better health and better care for patients, smarter spending, and improved clinical experience for providers.
The overarching goal of Washington’s health care transformation efforts is to achieve the quadruple aim of enhancing patient experience, improving population health (i.e., health outcomes), reducing costs, and improving the work life of health care providers, including clinicians and staff.
- Promote and incentivize integrated, whole-person and team-based care. This includes primary physical and behavioral health care services for acute, chronic, and preventive needs.
- Improve primary care provider capacity and access.
- Increase investment in a transformed primary care system while better managing total cost of care over time.
- Align payment incentives as well as quality metrics across payers and providers.
- Work with interested public and private employers to spread and scale the model throughout Washington State.
We have been working with Washington State health care plans and primary care providers on developing this model during this last year. Two work groups were formed in May 2019 to refine the model elements. One work group helped refine the payment component of the model. The other work group helped refine the proposed quality metrics.
Through 2020, we will continue working with work group members, partners, and others to implement the Multi-payer Primary Care Transformation Model. View the roster of our work group members.
|November 24, 2021||Last chance to complete the primary care stakeholder survey!|
|November 2, 2021|
|June 14, 2021|
|May 28, 2021|
|July 31, 2020||Public comment for HCA’s proposed primary care model extended to August 7|
|July 27, 2020||Reminder: public comment for HCA's proposed primary care model ends July 31|
July 10, 2020
- Signed Multi-payer Primary Care Transformation Model memorandum of understanding (MOU)
- Purchaser Primary Care Transformation support letter (January 26, 2021)
- Results of Multi-payer Primary Care Transformation Model survey (May 2020)
- Primary Care Expenditure Template (contract requirement in calendar year 2020 Medicaid MCOs contracts)
- Primary Care Expenditure Template (contract requirement in most calendar year 2020 public and school employee contracts)
Multi-payer Primary Care Transformation Model description (January 27, 2022)
Multi-payer Primary Care Transformation Model description feedback (January 27, 2022)