Washington

Washington has long embraced the PCMH model of care delivery through both private and public sector initiatives. Beginning in the 1990's, partnerships between pediatricians, families, and the Washington State Department of Health Children with Special Health Care Needs Program were established to build the concepts of the medical home into primary care pediatric practices. In 2008, the Substitute House Bill 2549 authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.  Substitute Senate Bill 5891 established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.  State law, Chapter 48.150 RCW, specifies that a direct primary care medical home must be integrated with an issuer’s Qualified Health Plan (QHP). If a QHP filing contains a direct primary care medical home, then the Health Benefit Exchange will recognize the Office of Insurance Commissioner’s approval of the plan to confirm that the medical home is integrated with the QHP.

The HealthPath Washington partnership between the State of Washington and the Centers for Medicare & Medicaid has decided to discontinue implementation of the capitated managed care project. This project was created to integrate medical, behavioral health, and long term services so that benefits could be delivered through managed care organizations.

The Washington Healthcare Improvement Network (WHIN) offers services to primary care clinicians and practice teams to develop health/medical homes, manage care for patients with multiple chronic conditions and improve care transitions. WHIN also serves:

  • Behavioral health teams that plan to collaborate with primary care.
  • Care/case managers or coordinators who are part of a health/medical home team.
  • Pharmacists that plan to collaborate with primary care.
  • Naturopathic doctors and consultant specialty providers on a case-by-case basis.
CHIPRA: 
No
MAPCP: 
No
Dual Eligible: 
No
2703 Health Home: 
Yes
CPCi: 
No
SIM Awards: 
Yes
PCMH in QHP: 
Yes
Legislative PCMH Initiative: 
Yes
Private Payer Program: 
Yes
State Facts: 
Population:
6,862,300
Uninsured Population:
11%
Total Medicaid Spending FY 2013: 
$8.2 Billion 
Overweight/Obese Adults:
61.4%
Poor Mental Health among Adults: 
37.3%
Medicaid Expansion: 
Yes 

Qliance direct primary care

Qliance is a national leader in the burgeoning direct primary care movement, whose adherents provide unrestricted access to primary care through longer appointments, extended hours, and phone and electronic communications with providers so patients can take care of health needs promptly and avoid downstream care and costs.

Substitute House Bill 2549

This bill authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.

Substitute Senate Bill 5891

This bill established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.

How two accountable care organizations and Boeing are testing value-based care

on Mon, 2015-02-16 00:00   lisabeth

A new partnership between two accountable care organizations and Seattle’s largest employer hopes to become a model for value-based care. The Providence-Swedish Health Alliance and UW Medicine have entered into separate and direct contracts with Boeing, among the first ACOs in the country to create a tailor-made healthcare plan with a private employer.

Story Date: 
February 16, 2015
News Author: 
Susan Morse
Source Link: 
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New Primary Care Model Delivers 20 Percent Lower Overall Healthcare Costs, Increases Patient Satisfaction and Delivers Better Care

on Thu, 2015-01-15 00:00   lisabeth

A review of two years' worth of healthcare claims data on thousands of patients reveals, contrary to the prevailing view, that unlimited primary care drives down overall costs while improving patient outcomes and experience.

Story Date: 
January 15, 2015
Source Link: 
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Medicine Is About to Get Personal

on Mon, 2014-12-22 00:00   lisabeth

How can Americans get better health care for less money? There's a quiet experiment going on among primary-care physicians, and the results are intriguing

Nowhere outside the pages of Dickens is there a more aptly named fellow than Garrison Bliss. A trim, gray man, he has twinkling eyes and a face lit by a smile of such authenticity that it makes you think of Shaker furniture. But he’s a doctor, not a mystic. And he’s smiling because he believes he and his cousin have found the answer to one of the toughest questions in health care.

Story Date: 
December 22, 2014
News Author: 
David Von Drehle

Cigna Collaborative Care Program - EvergreenHealth Partners (EHP)

Collaborative accountable care is Cigna's approach to accomplishing the same population health goals as accountable care organizations, or ACOs. The program will benefit nearly 3,300 individuals covered by a Cigna health plan who receive care from Northwest Physicians Network's (NPN) 150 primary care physicians. The program with NPN is Cigna's first accountable care program in the Puget Sound area and in the state of Washington. 

Boeing Intensive Outpatient Care Program

The Boeing IOCP pilot ran from January 2007 through July 2009. The program enrolled employees and pre-Medicare retirees and their adult spouses, who participated in Boeing’s self-funded, non-HMO medical plans. The project was designed by Mercer Health and Benefits and clinically managed by Renaissance Health, in partnership with Regence BlueShield of Washington, Healthways, ValueOptions, and leaders of three physician groups.

Cigna Collaborative Accountable Care (CAC) Program - The Polyclinic

Cigna and The Polyclinic have launched a collaborative accountable care initiative to improve patient access to health care, enhance care coordination, and achieve the “triple aim” of improved health, affordability and patient experience. The program became effective October 1, 2013 and is Cigna's second accountable care initiative in the region.

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