Preliminary results from accountable care organizations: Better care coordination, high interest among PEBB Program members

OLYMPIA — A new approach to providing medical benefits for public employees has yielded high-quality care and proven popular among those who selected it, according to results released today at the Health Care Authority’s (HCA) purchaser’s conference.

In 2016, HCA’s Public Employees Benefits Board (PEBB) Program began offering an accountable care organization (ACO) option called Uniform Medical Plan (UMP) Plus in King, Kitsap, Pierce, Snohomish and Thurston counties. In 2017, UMP Plus expanded to four more counties: Grays Harbor, Skagit, Spokane and Yakima.

ACOs are arrangements under which the provider networks contract with HCA and agree to be rewarded based on providing high-quality, coordinated care, rather than volume of health care services and treatments provided. ACOs are part of a national movement away from fee-for-service payment toward value-based purchasing.

PEBB Program members choose from two UMP Plus networks: UW Medicine Accountable Care Network or Puget Sound High Value Network. Those enrolled in UMP Plus get primary care office visits in their network at no cost; lower monthly premiums; lower annual medical deductible; no prescription-drug deductible; access to a coordinated network of providers; and better coordinated care.

Key results from the first two years of UMP Plus:

  • UMP Plus saw a 52 percent increase in enrollment from year one to year two (January 2016 to January 2017), which is the largest increase of any PEBB Program medical plan. In 2016, the first year UMP Plus was offered, enrollment was 10,000 PEBB Program members. UMP Plus enrollment is now at 17,000 members.
  • Of those PEBB Program members who selected UMP Plus in 2016, 89 percent chose to stay in the plan the following year, demonstrating a high level of satisfaction.
  • The networks improved on nearly all of 13 contractually required quality measures.
  • The networks outperformed their goals in managing the delivery of care for UMP Plus members, and UMP Plus was the only medical plan in the PEBB Program to lower premiums for state agency and higher-education employees from calendar year 2017 to 2018.

“The UMP Plus experience so far has indicated that we can transform health care—delivering high-quality, well-coordinated care while curbing costs,” HCA Acting Director Lou McDermott said. “We are well on our way to shifting health care purchasing away from a system that pays for volume to one that rewards quality and outcomes.”

“Together, the Washington State Health Care Authority and Puget Sound High Value Network are moving the health care market to value, showing outstanding health care service and quality can be delivered at an affordable price,” said Gary Kaplan, MD, chairman and chief executive officer of Virginia Mason, a participating organization in the Puget Sound High Value Network. “We are excited to be innovating in the delivery of coordinated care across Washington, with a focus on tailoring care to each individual patient and ensuring flexibility in the choice of providers. We look forward to working with the Health Care Authority to extend the program to as many as possible.”

“Our relationship with HCA complements our ongoing work on evidence-based best practices,” said Paul Ramsey, chief executive officer of UW Medicine. “Through the work of our UW Medicine Accountable Care Network, we place emphasis on preventive health and patient-centered care—all with a focus on impacting population health to improve the overall health of the community.”

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