SENATE BILL REPORT

SB 6413

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

As Reported by Senate Committee On:

Health & Long Term Care, February 3, 2020

Title: An act relating to establishing the primary care collaborative.

Brief Description: Establishing the primary care collaborative.

Sponsors: Senators Cleveland, O'Ban, Keiser, Rivers and Hasegawa.

Brief History:

Committee Activity: Health & Long Term Care: 1/27/20, 2/03/20 [DPS-WM].

Brief Summary of First Substitute Bill

  • Requires the Health Care Authority to administer a Primary Care Collaborative to develop various primary care spending recommendations and report its recommendations to the legislature.

SENATE COMMITTEE ON HEALTH & LONG TERM CARE

Majority Report: That Substitute Senate Bill No. 6413 be substituted therefor, and the substitute bill do pass and be referred to Committee on Ways & Means.

Signed by Senators Cleveland, Chair; Randall, Vice Chair; O'Ban, Ranking Member; Becker, Conway, Dhingra, Frockt, Muzzall, Rivers and Van De Wege.

Staff: Evan Klein (786-7483)

Background: The National Academies of Sciences, Engineering, and Medicine define primary care as the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. Primary care providers generally include internists, family physicians, pediatricians, nurse practitioners, and physician assistants.

In the 2019 Omnibus Operating Budget, the Office of Financial Management (OFM) was provided funding to conduct a study to determine annual primary care medical expenditures in Washington, by insurance carrier, in total and as a percentage of total medical expenditure. In its December 2019 report to the Legislature, OFM found that primary care expenditures as a percentage of total medical expenditures ranged from 4.4 percent to 5.6 percent based on either a narrow or broad definition of primary care. Primary care spending as a percentage of total spending was found to be highest for people under 18 years old and lowest for people 65 years and older. OFM further found that similar percentages of primary care spending were seen in public employee, Medicaid, and commercial coverage.

Summary of Bill (First Substitute): A Primary Care Collaborative (Collaborative) is established, and to be administered by the Health Care Authority (Authority). The Authority must invite representatives of:

The Collaborative must develop recommendations and report its findings to the Legislature by December 1, 2020. The recommendations must address:

In developing its report, the Collaborative must be informed by existing work in Washington and other states regarding primary care.

EFFECT OF CHANGES MADE BY HEALTH & LONG TERM CARE COMMITTEE (First Substitute):

Appropriation: None.

Fiscal Note: Available.

Creates Committee/Commission/Task Force that includes Legislative members: No.

Effective Date: Ninety days after adjournment of session in which bill is passed.

Staff Summary of Public Testimony on Original Bill: The committee recommended a different version of the bill than what was heard. PRO: Washington has long been a leader in health care reform, and one of the main goals in achieving health care reform is access to primary care. Not everyone has adequate access to primary care. This bill establishes the Collaborative to continue the work of the state and to strengthen the state's primary care backbone. Strong primary care systems decrease costs and increase health outcomes. States that invest in primary care have seen these outcomes. Various entities in the state are all working towards increasing access to primary care. Highly performing health care systems should be spending two or three times the amount of money on primary care. This is not about putting more money in primary care provider's pockets, but providing more patient supports, better tracking systems, and working as part of collaborative teams. This is an issue that transcends urban and rural settings. Primary care providers want the time to listen to their patients, want to be able to establish life long relationships with their patients, and to have a team beside them to support all of the health care needs of the patient. The bill mentions spending but there is hope to strengthen the language around enforcement of spending to ensure there are improved health outcomes.

OTHER: The hope is to refocus the Collaborative from the appropriate levels of primary care spending, to focusing on what the model of primary care should look like. The state should not want to drive more money into a system that is not spending that money in the best way. Chiropractors are direct access providers in Washington and are trained in diagnosis. Placement of a chiropractor on the panel will help provide key education, provide better mainstream care, and will ensure the Collaborative reviews the musculoskeletal needs of patients.

Persons Testifying: PRO: Senator Annette Cleveland, Prime Sponsor; Russell Maier, Washington Academy of Family Physicians; Tony Butrielle, Washington Academy of Family Physicians; Annika Lavole, Pacific Northwest University, Washington Academy of Family Physicians; Cindi Laws, citizen; Brad Tower, Washington Association of Naturopathic Physicians. OTHER: Lisa Thatcher, On Behalf of Dr. Garrison Bliss; Lori Grassi, Washington State Chiropractic Association.

Persons Signed In To Testify But Not Testifying: No one.