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.