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 

Team-based Education Helps Fulfill PCMH Promise

on Thu, 2014-03-20 00:00   lisabeth
Residents, Students, Educators Embrace Interprofessional Training

What's the best way to bring a good idea to fruition? Make sure people know about it. That's exactly what the Patient-Centered Primary Care Collaborative (PCPCC) did last year when it launched an interactive database(www.pcpcc.org) that features academic and training institutions that have embraced interprofessional training that brings together medical students, residents, clinicians and other health care professionals.

Story Date: 
March 20, 2014
News Author: 
Sheri Porter
Source Link: 
Read More

Regence Blue Shield and Everett Clinic Collaborative Care Initiative

Regence BlueShield in Washington and The Everett Clinic announced that they are partnering on a new collaborative payment model. The initiative between Regence and The Everett Clinic will include a shared incentive reimbursement arrangement in which The Everett Clinic will receive future payment increases tied to mutually agreed-upon, measurable improvements in quality.

New Report Finds Medical Homes Are Reducing Health Care Costs, Utilization, and Improving Health

on Mon, 2014-01-13 00:00   staci
A review of the year’s academic and industry-generated PCMH evaluations finds significant impact across a number of clinical and financial outcomes.

Embargoed Until Monday, January 13th, 4PM

PCPCC: Michelle Shaljian, 347-754-1692, michelle@pcpcc.net

Milbank: Tara Strome, 212-355-8400, tstrome@milbank.org

New Report Finds Medical Homes Are Reducing Health Care Costs, Utilization, and Improving Health

Story Date: 
January 13, 2014

Group Health Cooperative PCMH Program

Group Health Cooperative is an integrated health plan and health care system that has been a leader in developing the medical home. Group Health has integrated into their primary care enhanced technology that has improved patient access and information sharing across a multi-disciplinary care team, dedicated care coordination services, preventive care and screening, and chronic condition management. During their initial medical home pilot, each primary care doctor claimed responsibility for a total of 1,800 patients as opposed to 2,300.

Rainier Health Network Accountable Care Organization (ACO)

The Rainier Health Network (RHN) is the second CMS-designated ACO in Washington State.  The CMS contract covers the management of care for 27,000 Medicare FFS beneficiaries whose care is attributed to the 600 providers participating in the Rainier Health Network.  The goal of the contract is to reduce the cost of care for these beneficiaries by improving the coordination of care, reducing unneeded tests and procedures, and working with patients to help them manage existing chronic conditions more effectively. 

Group Health Cooperative Learning to Integrate Neighborhoods and Clinical Care Program

This program will focus on engaging Group Health patients to help create and test a role within primary care that will connect primary care teams with community resources such as the YMCA and support groups. Stronger clinic-community links are expected to help people get the health resources they need to manage their chronic conditions successfully over the long haul. Chronic conditions include diabetes, depression, and asthma. This strategy has the potential to increase patients' ability to get what they need from both their community and their health care.

Health Homes for Washington State

Washington now has approved 2703 Health Home State Plan Amendment. The State Plan Amendment was 6/28/13 and offers service to Medicaid enrollees with one chronic disease and at risk of developing a second. Washington extends the 2703 definition of "chronic disease" to include 12 additional disorders including cancer, renal failure, HIV/AIDS, and neurological disease.

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