Washington state carriers agree to support primary care shift
Employer plans are supposed to help pay to move doctors away from the current fee-for-service system.
Washington state is counting on employer-sponsored health plans to help primary care providers move away from the current fee-for-service reimbursement model.
Employers have been part of a major effort to change the state’s primary care delivery system, according to the Washington State Health Care Authority.
The authority announced last week that a group of eight large carriers has signed a “primary care transformation” memorandum of understanding.
The carriers that signed the memorandum are Community Health Plan of Washington, Coordinated Care, Kaiser Permanente Washington, Molina Healthcare of Washington, Regence BlueShield, UnitedHealthcare, Premera Blue Cross and Elevance’s Wellpoint Washington unit.
The participating carriers have agreed to adopt similar primary care benefits packages and quality standards. The carriers have also agreed to pay providers upfront to create the infrastructure needed to support reimbursement arrangements based on the number of patients the providers treat, rather than the amount of care provided.
The goal is to reward providers for providing high-quality care as efficiently as possible, without running into the kinds of provider risk forecasting problems that killed many earlier efforts to move providers to capitated contracts.
Some newer “value-based” reimbursement efforts have also run into trouble.
Medicare, for example, has tried create a performance-based pay system and found that it’s much more popular with doctors when it increases their pay than when it dings them for poor performance.
Related: This summer, rural health clinics get a boost from CMS to improve quality of care
The Washington state effort may benefit from the fact that the state is the home of Microsoft, a company with a longstanding interest in finding ways to use technology to improve health care delivery, and counts Kaiser has one of its members.
Kaiser has been one of the companies that has stuck with running health maintenance organization plans that rely on their own provider networks, and that may give the Washington state effort extra insights into provider capacity and risk forecasting.