Washington State Purchasers Align to Support Primary Care Transformation

Health care purchasers, including employers and health plan sponsors, in Washington State have come together to support the state’s efforts to support the transformation of primary care by moving away from fee-for-service to support comprehensive integrated care.

Purchasing organizations in the Washington Primary Care Purchasing Group include the Washington Cities Employee Benefits Trust Association, King County, the Health Purchasing Business Group, the SEIU 775 Benefits Group, the Washington State Health Care Authority (HCA), the Washington Health Benefits Exchange, and the Washington Health Alliance.

The group formed in May 2022 to support advanced primary care represented by Washington’s Multi-Payer Primary Care Transformation Model (PCTM).

“Primary care is essential to ensuring that all Washingtonians live healthy, productive lives,” Drew Oliveira, MD, MHA, CEO of the Washington Health Alliance, said in a statement. “Aligning our healthcare purchasing to reinforce a comprehensive, comprehensive health care model will alleviate gaps in care and ensure everyone can have a productive, lifelong primary care relationship.”

The commitment from this group, which represents more than 700,000 commercially insured lives in Washington, comes as state and federal efforts move toward implementation. Making Care Primary, a state-run federal effort of the Centers for Medicare & Medicaid Services, will launch in 2024, and health care providers and health plans will show interest in participating this fall. That initiative would incorporate the PCTM.

Recognizing that the impact of any single purchaser is limited, the purchasers of this initiative have collaboratively committed to a good faith effort to coordinate with each other and with the HCA to transform the way primary care is delivered and is financially supported by 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:

• Guide members to use advanced comprehensive primary care and encourage them to choose a primary care practice;

• Work to ensure access to advanced primary care services;

• Modify benefit design to reflect advanced primary care priorities;

• Align your standards and expectations; and

• Apply your health purchasing power by using procurement processes to select the providers best prepared to engage in advanced primary care and using contracting processes to implement advanced primary care practices.

The buyers, 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:

• Develop aligned metrics to provide consistent direction to contracted providers such as insurance companies, TPAs, primary care clinics, and others on contracting, procurement, and payments.

• Meet periodically to discuss purchasing strategies, including participation in joint purchasing.

• Leverage contracting and procurement processes to select providers who can demonstrate effective primary care support strategies and are willing to replace a provider if necessary. Primary care support strategies may include participating in PCTM, providing practice support (financial or technical assistance), and offering alternative payment methodologies with value-based purchasing.

• Support transformative and aligned payment approaches that move away from fee-based payment for primary care services.

• Require contracted providers to be part of the PCTM, delivering a common model and competing on how well they implement it.

• Develop a “case” to help members understand the benefits of advanced primary care.

• Engage in direct contracting with providers when effective in supporting advanced primary care.

• Support the development of a centralized data repository for reporting and evaluation.

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