Healthcare purchasers, including employers and health plan sponsors, in the state of Washington have banded together to support the state’s efforts to support primary care transformation by moving away from fee-for-service to support whole-person integrated care.
Purchaser organizations in the Washington Primary Care Purchaser Group include Association of Washington Cities Employee Benefit Trust, King County, Purchaser Business Group on Health, SEIU 775 Benefits Group, Washington State Health Care Authority (HCA), Washington Health Benefits Exchange and the Washington Health Alliance
The group was formed in May 2022 to support advanced primary care as represented by the Washington Multi-payer Primary Care Transformation Model (PCTM).
“Primary care is essential to ensuring every resident in Washington lives a healthy, productive life,” said Drew Oliveira, M.D., MHA, executive director of the Washington Health Alliance, in a statement. “Aligning our healthcare purchasing to bolster a whole health, integrated care model will alleviate care gaps and guarantee everyone can have a lifelong, productive primary care relationship.”
The commitment from this group, representing more than 700,000 commercially insured lives in Washington, comes as state and federal efforts move toward implementation. Making Care Primary, a federal Centers for Medicare & Medicaid Services effort administered by the state, is set to launch in 2024 with healthcare providers and health plans signaling interest to participate this fall. That initiative would incorporate the PCTM.
Recognizing that the impact of any one purchaser alone is limited, the purchasers in this initiative have collaboratively committed to a good-faith effort to coordinate with each other and the HCA to transform the way in which primary care is delivered and financially supported in participating practices. As a result, these purchasers say they will use their collective influence to increase equitable access to advanced primary care by continuing to:
• Steer members to use advanced whole-person primary care and encouraging them to choose a primary care practice;
• Work to ensure access to advanced primary care services;
• Modify benefit design to reflect the priorities of advanced primary care;
• Align their standards and expectations; and
• Apply their health purchasing power by using procurement processes to select the carriers most prepared to engage in advanced primary care and using contracting processes to engage advanced primary care practices.
Purchasers individually and collectively say they are committed to developing a menu of possible actions in support of the PCTM and implementing as many as possible. Possible future actions may include:
• Developing aligned parameters to provide consistent direction to contracted vendors such as insurance carriers, TPAs, primary care clinics, and others in contracting, procurement, and payment.
• Meeting regularly to discuss purchasing strategies, including engaging in joint purchasing.
• Leveraging contracting and procurement processes to select vendors that can demonstrate effective primary care support strategies, and being willing to replace a vendor if needed. Primary care support strategies may include participating in the PCTM, providing practice supports (financial or technical assistance), and offering alternative payment methodologies with value-based purchasing.
• Supporting aligned transformative payment approaches that move away from fee-for service payments for primary care.
• Requiring contracted vendors to be part of the PCTM, delivering a common model and competing on how well they implement it.
• Developing a “case” to help members understand the benefits of advanced primary care.
• Engaging in direct contracting with providers where effective to support advanced primary care.
• Supporting development of a centralized data repository for reporting and evaluation.