Washington State Health Care Authority (HCA) purchases care for Washington State Apple Health (Medicaid) and public and school employees and retirees, covering over 2.5 million people. HCA’s value-based purchasing goals span across all state-purchased health care and it aims to tie 90 percent of state-financed health care payments to quality and value by the end of 2021, defined by payments in HCP-LAN’s categories 2C and above. HCA’s recently published Long-term Value-based Purchasing Roadmap lays out a vision for paying for health and value and details key priorities for the state’s delivery system through 2025. These include increasing access, affordability, and infusing concepts of health equity into health care purchasing initiatives.
Dr. Judy Zerzan, HCA’s Chief Medical Officer, likens HCA’s payment transformation to “converting from a combustion engine to an electric car.” The transformation has happened in stages, and this year COVID-19 intensified the need to complete the transition.
HCA has focused its efforts heavily on strengthening and shoring up primary care in Washington State. When the COVID-19 pandemic hit, it threatened primary care practices’ solvency and the viability of Washington’s already fragile primary care system, increasing the risk of practice acquisition and consolidation and affordability concerns. Over 60 percent of primary care clinicians in Washington reported in mid-2020 that COVID-19 had moderately or severely impacted their practices. HCA understood that without immediate private and public payer action to stabilize (short-term) and strengthen (long-term) primary care, primary care would not readily survive the next wave of the pandemic.
HCA’s multi-payer primary care transformation – launched in October 2020 – plans to combine lump sum, short-term financial relief for primary care providers with population-based payments that will eventually be placed at risk. While one component of the population based payment, called the Comprehensive Primary Care Payment (CPCP), is designed to provide stability for practices, a separate component, called the Transition of Care Fee, will provide temporary (up to three years if needed) support for practices to transition to the integrated care delivery model and to make changes in infrastructure, staffing and business processes to support the model. Additionally, the model will provide a prospective incentive payment on a quarterly basis to drive performance improvement. The model will go a step further than payment reform to individual practices, by specifying total spend on primary care across all payers, as a proportion of total cost of care. For Dr. Zerzan, while complete alignment of approach between payers and stakeholders is not always possible, the critical action is that all “hold hands and jump” together.
Payers | 
Providers | 
Purchasers | 
Community Organizations
Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
