The Health Care Authority. The Health Care Authority (HCA) is a state government agency that purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and other programs. HCA has undertaken numerous health care transformation projects in pursuit of its stated mission to provide equitable, high-quality health care through innovative health policies and purchasing strategies.
The Multi-Payer Primary Care Transformation Model. The Multi-Payer Primary Care Transformation Model (Model) is an initiative proposed by HCA in 2020, with the stated purpose to create better health and better care through multi-payer payment reform and care delivery transformation. Primary care clinics certified as ready would accept a value-based payment, based on the number of enrolled clients served, to replace patient billing systems that incentivize volume of patient services over outcomes and quality. In exchange, the clinic would agree to provide a range of services falling under the umbrella of whole-person integrated healthcare, report data, and be evaluated under a centralized evaluation and quality measurement system. The Model has undergone a public comment period and two stakeholder surveys, with the last survey completed in December 2021.
HCA must work with stakeholders to complete development of its Model and begin phasing in value-based payments and accountability requirements for top-tier readiness certification clinics for clients of the Medicaid program, PEBB, and SEBB by January 1, 2023. The Model must to the extent practicable be designed to achieve cost neutrality when fully phased in for participating clinics. The Model must include the following components:
Medicaid managed care organizations must make reimbursement for care coordination services performed by non-licensed staff acting in the role of a health navigator available to primary care clinics by January 1, 2023, excluding clinics that have fully transitioned to the Model, using funding provided for Medicaid administrative services.
HCA must report to the Governor and appropriate committees of the Legislature by December 1, 2023, describing the Model, its progress with implementation, and a strategy and timeline to complete implementation in primary care clinics across the state.
A health navigator is defined as an unlicensed member of a health care team who helps individuals overcome barriers and facilitates access to services by increasing health knowledge and self-sufficiency through a range of evidence-based activities, and who is typically a trusted member of the community with an unusually close understanding of the community served.
The Department of Health must contract with an organization that represents pediatric primary care needs to convene community-based organizations dedicated to children's mental health to establish and implement an equity-focused curriculum to prepare health navigators to meet the unique needs of children, adolescents, and their families by January 1, 2023.
PRO: The purpose of this bill is to create a health navigator to help clients of primary care practices. We should limit this to pediatric practices. Community health workers perform the same role as health navigators with a different title. Many evidence-based programs can be implemented by community health workers. They can address social needs which are important but are not a good use of psychiatrist time. I have seen the benefit non-licensed staff have in family's lives. We can build a bridge of trust and catch kids who would otherwise fall through the cracks. Families are struggling with social and financial challenges. Mental health is a second pandemic for youth. We need to serve kids in the places where families turn for help, like primary care. Complete implementation of a transformation model is not necessary before integrating community health workers into care. Kids can't wait. Collaborative care complements the work of health navigators but involves licensed mental health therapists. This workforce can be stood up quickly. Our health systems are exponentially more difficult to navigate where there is a linguistic or cultural barrier. Important health issues are sidelined by pressing mental health concerns. Making a referral doesn't help families when they don't have extra time or transportation. Team care is much more efficient. We want to not just screen for but address the social determinants of health. One community health worker costs about $70,000. Most clinics should have two. The two clinics in the state who provide this service support it through private philanthropy. We don't have the overall financial system in place to underwrite the services we need. More should be invested in primary care. This bill will move the needed Multi-Payer Primary Care Transformation Model forward more quickly by proving the funding and support for implementation.
CON: We should not limit our problem solving to psychiatric solutions. Parents need information about alternatives that do not emphasize drugs and coercive treatment.
OTHER: Using the existing infrastructure of community health workers makes more sense than creating health navigators. Please do not restrict Medicaid administrative dollars; care coordination should be funded differently. Please do not lock in requirements for the Multi-Payer Primary Care Transformation Model because they could be changed following input from stakeholders.