BILL REQ. #:  H-3324.4 

Read first time 01/21/14.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to a mutual accountability model for clinical practices and healthy behaviors; and adding a new section to chapter 41.05 RCW.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   A new section is added to chapter 41.05 RCW to read as follows:
     (1) The board shall conduct a pilot project for enrollees in the uniform medical plan to test the mutual accountability model in which financial incentives are offered to both health care providers and their patients for declaring or demonstrating to one another adherence to best clinical practices and healthy behaviors. At a minimum, the mutual accountability model must:
     (a) Incorporate evidence-based medicine treatment guidelines and information therapy, defined as providing a patient the right information at the right time to make an informed decision;
     (b) Be voluntary for health care providers and patients on an encounter-by-encounter basis;
     (c) Compensate health care providers for declaring to their patients their adherence or reasons for nonadherence to evidence-based medicine treatment guidelines, and for providing relevant educational material as information therapy to their patients;
     (d) Offer a financial reward to the patient for responding to the delivery of information therapy by demonstrating the patient's understanding of his or her health condition and recommended care, by declaring or demonstrating adherence or providing a reason for nonadherence to recommended care, by agreeing to allow the patient's health care provider to view the patient's responses and acknowledge the patient's health accomplishments, and by rating the quality of care provided to the patient against the treatment guidelines and recommended care; and
     (e) Allow the health care provider and the patient to earn additional financial incentives by applying the mutual accountability model to wellness, prevention, and care management regimens such as health risk assessments and screenings, smoking cessation, weight loss and fitness programs, and disease management.
     (2) To conduct the pilot project, the board shall contract, directly or through an insuring entity, with a vendor that offers a web-based health care cost containment program that incorporates the mutual accountability model. The contract must apply to plan years 2015, 2016, and 2017.
     (3) The board shall determine the number of beneficiaries necessary to participate in the pilot project to achieve a statistical significance, but the number of beneficiaries may not be less than ten percent of the enrollees in the uniform medical plan.
     (4) The board shall contract with an independent entity to collect and analyze the pilot project data. The independent entity shall provide analyses of the progress of the pilot project at least annually. The independent contractor shall submit a final report regarding the financial sustainability of the pilot project, its effectiveness at controlling health care costs, and other relevant objectives identified by the board. The report must include recommendations for improving the program and expanding its use. The independent contractor shall submit the report to the board by September 1, 2018. The board shall submit the report to the governor and the legislature by October 1, 2018.
     (5) The board shall use funds from the uniform medical plan benefits administration account established under RCW 41.05.143 for the cost of the pilot project and may not pass these costs to participating state agencies, other entities participating in the public employees' benefits board, or providers.