Several health industry leaders have committed to an initiative that aims to improve access to high-quality primary care in Washington.
The Washington State Health Care Authority (HCA) hosted a coalition of payers, purchasers, and providers to celebrate the signing of a memorandum of understanding (MOU) to transform primary care delivery in the state on Tuesday.
Michele Ritala, benefits strategist for King County’s employee benefits program, said people who maintain a regular source of primary care enjoy better access, and get better quality, more equitable care.
“They’re happier with their healthcare experience,” Ritala said. “As employers, we want that for our employees and their families. However, primary care is in a crisis right now. We know about that because our employees tell us, ‘We have to wait months to get a well-being checkup with our primary care (provider).’ We’ve had employees say, ‘My primary care (provider) left their practice—or they’re retired—and I’ve got to work on finding a new one.’ They can’t find anyone who has any availability.”
Washington currently has 39 percent of the estimated primary care providers needed to adequately serve its population. And increased expectations for providers—including administrative burdens related to a fragmented payment system—puts stress on the primary care provider workforce, and decreases access to care for residents.
Hiroshi Nakano, vice president of value-based initiatives at the University of Washington Medicine’s Valley Medical Center, said many patients who lack primary care seek services in emergency departments, are frequently hospitalized, and then discharged back into the community to start their medical journey all over again, at a higher cost to the system and continued suffering by the patient.
“Having a robust primary care system in Washington ensures that patients get the right care at the right time. From a provider’s perspective, the work to align payment, cost, quality, patient and provider experience is an important step in ensuring high-quality affordable healthcare in Washington across all insurance types.”
— Nakano
The policies outlined in the MOU aim to balance the alignment of alternative payment models with flexibility to accommodate payer-specific constraints. One of the MOU’s goals includes shifting payment models away from fee-for-service toward a framework that incentivizes higher-quality care.
Dr. Brandi Basket, chief health officer at NeighborCare Health, said that when purchasers and insurance carriers align on standards and payment models, providers can more easily work to provide increased access to higher-quality care.
“FQHCs (federally qualified health centers) like NeighborCare are a core part of the Washington healthcare safety net,” Basket said. “As the intersecting public health needs of communities become more complex, we continue to see more complex needs coming through our doors. Our patients are becoming sicker. And when coordination is lacking at the highest levels, it takes time away from partnering with our patients and community partners to reach the highest quality of care.”
Patients will benefit most from the initiative, Basket said, particularly those who continue to experience structural barriers accessing quality care.
“The less time our providers spend navigating different standards of models, the more time our providers can spend supporting coordination and whole-person care. When all these standards are aligned, we can become more accurate about what improvements we are seeing. The resources we spend today on navigating administrative and operational inefficiencies can instead be dedicated to expanding services to improve access to care for underserved populations.”
— Basket
MOU signers include Community Health Plan of Washington, Coordinated Care, Kaiser Permanente Washington, Molina Healthcare of Washington, Regence BlueShield, UnitedHealthcare, Premera Blue Cross, Wellpoint Washington, and the HCA.
The MOU includes a commitment to align on program onboarding, quality measure reporting, a common definition of primary care, and coordinated communications to stakeholders and providers.
Brenda Suiter, Seattle regional administrator at the Centers for Medicare & Medicaid Services (CMS), discussed the new Making Care Primary (MCP) model, which launched in eight states—including Washington—on July 1, and will be operating for the next decade.
“MCP provides an on-ramp for primary care organizations who are new to value-based care with three participation tracks with an explicit focus on smaller, independent practices and safety net organizations, including FQHCs,” Suiter said. “The goal is to equip primary care clinicians with tools to improve care management and coordination, form partnerships with specialists, improve behavioral health integration, and leverage community-based connections to address patients’ health needs, as well as their health-related social needs.”
Suiter said 133 primary care organizations representing 770 sites of care have voluntarily signed up to participate in MCP, including 21 organizations in Washington. Over 50 payers across the eight states—including 11 in Washington—are MCP payer partners, and share a vision of improving alignment on payer design, quality measures, data provision, and learning systems, she said.
“MCP augments payments from Medicare fee-for-service. We understand that, for many providers, we’re just one small part of their overall payer mix. That is why CMS seeks to formally partner with public and private payers to implement payment models that align with MCP [goals]. Through multi-payer partnership and alignment, we want to reduce payer fragmentation that holds practices back from achieving shared goals. We want to accelerate innovation by aligning incentives to improve patient outcomes while reducing clinical and administrative burden. Which will increase the likelihood of provider and payer success.”
— Suiter
Sen. June Robinson (D-Everett) discussed her experience working as a Peace Corps volunteer in rural Jamaica in the 1980s.
“It wasn’t a primary care system like what we would expect in the U.S.,” Robinson said. “But the country put a real emphasis on access to primary care. So every small village had a primary care clinic. Everyone in that country had access to primary care. The way that elevated the livelihoods of women and children really made an impact on me. That is a primary reason I champion primary care.”
Robinson sponsored Senate Bill 5589—which went into effect in June 2022—which directed the state’s Health Care Cost Transparency Board to begin measuring how much Washington spends on primary care as a percentage of its overall healthcare spend.
“[It had] a target of (getting) to 12 percent of our healthcare spend being primary care,” Robinson said. “We may change that 12 percent [goal] in the future, but it is now a stretch goal for us to get to 12 percent. It is a major initiative that will ultimately bring down the total cost of care in our state, which is something we’ve worked so hard on in many different ways.”
Those interested in learning more about healthcare in Washington can register to attend the 2024 Inland Northwest State of Reform Health Policy Conference on Oct. 17 at the Spokane Convention Center.