Washington State Purchasers Issue Letter in Support of Efforts to Transform Primary Care

In a letter sent Jan. 26, the Washington Health Alliance (Alliance) and the Purchaser Business Group on Health, formerly Pacific Business Group on Health (PBGH), a PCC Executive Member, join with purchasers in expressing support for the state’s efforts to transform the delivery of primary care. The letter to the Washington State Health Care Authority (HCA), asks providers and health plans to “work together with those of us paying for health care services to generate new payment models that increase the proportion of health care spending on primary care.” Signers to the letter include employers and union trusts that collectively represent more than 350,000 individuals in Washington state. These purchasers include the Association of Washington Cities, King County, Puget Sound Energy, SEIU 775 Benefits Group, and the Washington Health Benefit Exchange.

The letter calls the transformation of primary care “the foundation upon which future success is built,” namely, achieving the “triple aim aspirations of health care—a better experience of care, healthier individuals and populations, and lower per capita cost of care.” Alliance Director of Performance Improvement and Innovation Karen Johnson said, “The health plans committed to working with HCA are to be commended for their leadership in collaborating to improve primary care in a manner that enables providers to focus on what is truly important – caring for patients.” Johnson added, “At the Alliance, we increasingly hear from our provider members about the need to eliminate unnecessary administrative tasks often associated with new payment models. When payers work together to align important aspects of their programs, such as common measures of success, providers are better able to focus on care delivery transformation and less on reporting on multiple measures in different formats.”

The HCA has been focused on the issue of improving primary care for more than a year. The purchaser letter follows the signing of a Memorandum of Understanding (MOU) last fall between insurance plans, the HCA, Governor Jay Inslee’s office, and the Washington State Medical Association to support the HCA’s Multi-Payer Primary Care Transformation Model. Under the MOU, insurers have committed to “use good faith efforts to contract with the practices participating in this initiative,” and medical practices “will be held accountable for meeting transformation and clinical quality metrics.” Amerigroup Washington, Community Health Plan of Washington, Coordinated Care, Kaiser Foundation Health Plan of Washington, Molina Healthcare, Premera Blue Cross, Regence BlueShield, and UnitedHealthcare have all agreed to the MOU.

Today, purchasers signing this letter will present their priorities to the HCA and health plans, specifically, that primary care be convenient and flexible, utilize a team-based approach, support patients with congoing and complex health conditions, and be culturally sensitive. In implementing new primary care payment models, the letter recommends that they be:

  • prospective rather than fee-for-service;
  • transparent in both the payment approach and amount;
  • consistent in the measures and methods used to measure performance;
  • effective in utilizing and sharing patient data to allow for optimal care for individuals and populations;
  • thoughtful in determining provider participation based on delivery of quality care; and
  • clear in identifying a patient’s primary care provider.

In addition to the HCA, the letter is being sent to leaders representing all health plans in the state, as well as the Washington Academy of Family Physicians, Washington Association for Community Health, Washington Chapter of American Academy of Pediatrics, Washington Chapter of American College of Physicians, Washington State Hospital Association, Washington State Medical Association.

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