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Washington State Medicaid and MACRA

Learn about Washington State Medicaid's innovative approach to purchasing healthcare for nearly 2 million people through value-based payment arrangements. Explore the goals, initiatives, and alignment efforts with MACRA to achieve better outcomes and sustainability in state health programs.

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Washington State Medicaid and MACRA

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  1. Washington State Medicaid and MACRA MaryAnne Lindeblad Medicaid Director NAMD Fall Conference November 7, 2016

  2. Washington State Medicaid Program Purchases health care for close to 2 million people through Medicaid (Apple Health) through 5 MCOs $8 billion annual spend Federal program participation: - State Innovation Model (SIM) Round 2 • Health Homes/Dual Eligible • Medicaid Transformation Demonstration Project (agreement in principle)

  3. HCA purchasing goals (Medicaid and Public Employees Benefits Program) By 2021: • 90 percent of state-financed health care and 50 percent of commercial health care will be in value-based payment arrangements (measured at the provider/practice level) (2c-4b in CMS Learning Action Network APM Framework) • Washington’s annual health care cost growth will be below the national health expenditure trend.

  4. HCA and Medicare’s VBP goals 2021 90% state-financed 50% commercial In 2016, at least 30% of Medicare payments are linked to quality and value through APMs 2016 30% In 2021, at least 90% of state-financed health care payments and 50% of commercial health care payments are linked to quality and value through APMs (Categories 2c-4b) 2021 90% 50% In 2018, at least 50% of Medicare payments are linked to quality and value through APMs 2018 50%

  5. Defining Value-Based Payments using HCP-LAN Alternative Payment Model Framework https://hcp-lan.org/groups/apm-fpt/apm-framework/

  6. HCA Value-based Roadmap • Reward patient-centered, high quality care • Reward health plan and system performance • Align payment and reforms with CMS • Improve outcomes • Drive standardization • Increase sustainability of state health programs • Achieve Triple Aim 2021: 90% VBP 2019: 80% VBP Medicaid PEBB 2016: 20% VBP

  7. MACRA Alignment Efforts, 2017 - 2019 • Made decision to utilize CMS LAN framework for VBP attainment and provider incentives in 2014 • Align VBP efforts under Wavier with provider incentives under Advanced APM track • Seek ‘other Advanced APM’ designation for WA Medicaid and other HCA APMs, for 2019 • Align other Medicaid transformation efforts (waiver, SIM) with MIPS efforts, i.e., harmonize WA common measure set with MACRA • Assist providers with the transition to VBP payments (through WA Practice Transformation Hub)

  8. Questions? For more information: www.hca.wa.gov/hw MaryAnne Lindeblad HCA Medicaid Director Maryanne.lindeblad@hca.wa.gov Tel: 360-725-1863

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