Washington

Washington has long embraced the PCMH model of care delivery through both private and public sector initiatives. Beginning in the 1990's, partnerships between pediatricians, families, and the Washington State Department of Health Children with Special Health Care Needs Program were established to build the concepts of the medical home into primary care pediatric practices. In 2008, the Substitute House Bill 2549 authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults. Substitute Senate Bill 5891 established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project. State law, Chapter 48.150 RCW, specifies that a direct primary care medical home must be integrated with an issuer’s Qualified Health Plan (QHP). If a QHP filing contains a direct primary care medical home, then the Health Benefit Exchange will recognize the Office of Insurance Commissioner’s approval of the plan to confirm that the medical home is integrated with the QHP.

The HealthPath Washington partnership between the State of Washington and the Centers for Medicare & Medicaid has decided to discontinue implementation of the capitated managed care project. This project was created to integrate medical, behavioral health, and long term services so that benefits could be delivered through managed care organizations.

The Washington Healthcare Improvement Network (WHIN) offers services to primary care clinicians and practice teams to develop health/medical homes, manage care for patients with multiple chronic conditions and improve care transitions. WHIN also serves:

Behavioral health teams that plan to collaborate with primary care.
Care/case managers or coordinators who are part of a health/medical home team.
Pharmacists that plan to collaborate with primary care.
Naturopathic doctors and consultant specialty providers on a case-by-case basis.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Multi-Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program	Outcomes
Washington State Multi-Payer Medical Home Reimbursement Pilot	Multi-Payer	Statewide

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
CMS State Innovation Model (SIM) Test Award - Washington	Grant	Statewide	CMS State Innovation Model (SIM)
Group Health Cooperative Learning to Integrate Neighborhoods and Clinical Care Program	Grant	Statewide	Patient-Centered Outcomes Research Institute (PCORI) Programs
Health Homes for Washington State	Medicaid	Pierce, Clark, Cowlitz, Klickitat, Skamania, Wahkiakum, Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Walla Walla, and Yakima counties	ACA Section 2703 Health Homes
Kitsap Mental Health Services	Grant	Kitsap County	CMS Health Care Innovation Award (Round 1)
PTN - Washington Transforming Clinical Practice Initiative – Pediatrics (TCPI-P)	Grant	statewide	Transforming Clinical Practices Initiative (TCPI)
Rainier Health Network Accountable Care Organization (ACO)	Medicare	South Puget Sound area	Medicare Shared Savings Program

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
Boeing Intensive Outpatient Care Program	Commercial	Puget Sound/Seattle area
Cigna Collaborative Accountable Care (CAC) Program - Northwest Physicians Network	Commercial	South Puget Sound area	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care (CAC) Program - The Polyclinic	Commercial	Seattle area	Cigna Collaborative Care Program
Cigna Collaborative Care Program - EvergreenHealth Partners (EHP)	Commercial	Seattle area	Cigna Collaborative Care Program
Group Health Cooperative PCMH Program	Commercial	Washington and Idaho
Premera Blue Cross Global Outcomes Contracting	Commercial	Statewide
Qliance direct primary care	Commercial	Seattle, Kent, Tacoma, Bellevue, Lynnwood
Regence Blue Shield and Everett Clinic Collaborative Care Initiative	Commercial	Seattle

State Legislation

Legislation	Status	Year
Substitute Senate Bill 5891 This bill established several medical home reimbursement pilot projects including a multi-payer medical home demonstration project.	Expired	2009
Substitute House Bill 2549 This bill authorized the creation of the state's first medical home learning collaborative for qualified primary care practices serving children and adults.	Expired	2008
Chapter 415 budget bill $110,000 of the general fund—state appropriation for fiscal year 2020 is provided solely for the office of financial management to determine annual primary care medical expenditures in Washington, by insurance carrier, in total and as a percentage of total medical expenditure. Where feasible, this determination must also be broken down by relevant characteristics such as whether expenditures were B4 for in-patient or out-patient care, physical or mental health, by type of provider, and by payment mechanism	Enacted	2019
SB 5589 Charges the state’s Health Care Cost Transparency Board with measuring and reporting on primary care expenditures and progress toward increasing spending to 12% of total healthcare expenditures.	Enacted	2022