HCA reaches 59% of payments as Value-based Purchasing in 2019

In 2019, the Washington State Health Care Authority (HCA) reached 59 percent of payments across all Public Employees Benefits Board (PEBB) and Medicaid managed care programs in a Value-based purchasing (VBP) arrangement. 


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As the largest health care purchaser in Washington, the HCA says their goal is to continue to move the health care system towards VBP. Although the original goal for 2019 was to have 75 percent of payments be VBP, the HCA says they remain optimistic that they can reach their goals. 


Image: Health Care Authority


“Washington will use its position in the marketplace to drive transformation as both a first mover and market convener,” says the HCA website. “We will use purchasing power to lead by example and accelerate the adoption of value-based reimbursement and alternative payment strategies in the commercial market.”

The HCA also issues an annual survey to address the statewide health plan and provider experience with VBP. In 2019, percentages of VBP adoptions across health care sectors were 64 percent for commercial, 76 percent for Medicare, and 73 percent for Medicaid.

In the same survey included in the HCA VBP roadmap, both plans and providers cited that the enablers for adoption of VBP models were centered around trusted partnerships, aligned incentives, and aligned quality measurements.


Image: Health Care Authority


However, the responses to barriers to adoption ranged. Providers cited lack of cost data and insufficient patient volume. Health plans cited payment model uncertainty and disparate quality measures and incentives. Both plans and providers cited the lack of data systems as a key barrier to success. 


Image: Health Care Authority


Earlier this year the HCA revised their roadmap to reflect the challenges that the COVID-19 pandemic was causing for providers. This roadmap outlines the agency’s plans and strategies to increase VBP contracting in the state’s health care system.

The HCA said when they revised this roadmap, the pandemic created the awareness of an urgent need for a shift to VBP because of the strain felt by providers still in a “fee-for-service” payment model. At the start of the pandemic, non-essential procedures and appointments were put on hold for the state to save personal protective equipment (PPE) and beds for COVID-19 patients. For providers still in this model, the loss of patients seen caused financial strains. 

However due to the pandemic, about 40% of providers said they were experiencing reduced willingness to adopt additional risk and/or VBP contracts, and almost 60% suggested the pausing of VBP expansion and instead focusing on maintained access to telehealth services.

The HCA acknowledged that telehealth and the provision of virtual care should continue to be a mode of care after the COVID-19 pandemic. They also acknowledged that future VBP arrangements will consider the impact of virtual care on utilization, quality, outcomes, access, equity, and patient experience.

“[We] will continue driving VBP adoption through multisector, system-wide collaboration—ensuring equitable care and care that focuses on the whole person and supports healthier and engaged communities,” said the HCA.