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Healthier Washington: WSMA Guide

The WSMA has prepared a guide for physicians and practices to help them participate in the state's Healthier Washington initiatives to redesign care delivery to Medicaid patients.

Our state’s Healthier Washington initiatives comprise a “transformation project”—not a grant—funded by the federal Centers for Medicare & Medicaid Services (CMS) and intended to transform care delivery in Washington, starting with the state’s Medicaid program.

The project runs from 2017-21. The Washington State Health Care Authority will receive funding from CMS contingent upon achieving specific targets, framed around three core strategies:

  • Improving how health care services are paid (value-based payment).
  • Ensuring that health care focuses on the whole person (care integration).
  • Building healthier communities through a collaborative approach (with the participation of the nine regional Accountable Communities of Health, or ACHs).

Each of the nine ACHs has selected “projects” to address the transformation of care, including two required projects: Integration of Physical and Behavioral Health and Addressing the Opioid Use Public Health Crisis.

The WSMA can help!

Physicians and their practices can consider participating in this dramatic redesign of care delivery to Medicaid patients and the incremental introduction of value-based payment methodologies to replace traditional fee-for-service payments. However, these models of care and payment can be complex and confusing.

To assist you in this process, we have prepared this Healthier Washington: WSMA Guide for Physician Practices. The guide describes in detail the three Healthier Washington initiatives along with the various projects being undertaken regionally by the nine ACHs. The guide also explains the value-based payment models that can be used to reimburse physicians and practices for their participation in the selected projects. These payments are separate and distinct from payments made by managed care organizations for traditional Medicaid services.

We welcome your comments and feedback! Contact Bob Perna (rjp@wsma.org) or Michelle Lott (mml@wsma.org) at the WSMA Practice Resource Center.

Healthier Washington: WSMA Guide for Physician Practices

Download Healthier Washington: WSMA Guide for Physician Practices (revised September 2018).

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