Primary Care Model Comment Period Extended to August 7!

The Washington State Health Care Authority has released its Multi-payer Primary Care Transformation Model for public comment ending August 7, 2020. You can read this briefing paper to learn more about the proposed model:

It is imperative that Washington pediatric primary care providers comment via this survey:

WCAAP has identified a number of concerns and/or omissions in the proposed model and have assessed that improvements need to be made specific to pediatric care.

  1. Population health infrastructure – support on the clinic team for understanding performance and continuously monitoring performance and convening team – is important. Identifying care gaps, pulling in patients for care who have not gotten care.
  2. Behavioral health integration – WCAAP’s nearly highest priority for children on Apple Health is timely access to behavioral health and advancing and spreading behavioral health integration for children in primary care walls. The plan is vague on how this will occur and what financial drivers will allow for the model to be viable within primary care. MCO’s and ACH’s specific role or capacity to drive this transformation is not clear. The plan could be improved to create specific requirements for embedded behavioral health and associated investments. For clinics who cannot have embedded BH due to clinic size or other limitations, financial incentives should be specified for documented behavioral health referral relationships.
  3. Children’s social needs impact the level of management and support they need, which is also the case when caring for the small numbers of kids who have medical complexity. Per Member Per Month is an ideal model to support children but we must identify the social and medical needs of clinics’ assigned patients and provide compensation proportional to the medical and social needs of clinics’ assigned panels. Clinics cannot be expected to provide social and medical risk stratification on their own. Social and medical risk stratification must occur that is specific to children’s needs, like the seminal work done by Rita Mangione-Smith and Oregon Medicaid. This risk stratification needs to be done by the Medicaid agency and uniform across plans, not falling to clinics to provide, which is beyond their capacity and would prohibit necessary uniformity across Medicaid.
  4. Care coordination should be specifically defined and compensated for those clinics who are meeting definitions.

WCAAP representatives on the HCA work group that is developing this model will continue to advocate for strengthening pediatric primary care and WCAAP as an organization will submit a detailed comment, but your voices in the public comments will help us make our case to build a value-based payment model that works for pediatric primary care.