Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 2615

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.

Background:

Primary care involves the provision of routine health care services, including screening, assessment, diagnosis, and treatment for the purpose of promotion of health, and detection and management of disease or injury. These services are generally provided under the practice specialties of family medicine, general internal medicine, and general pediatrics.

In 2019 the Office of Financial Management found that, for 2018, primary care expenditures in Washington ranged from 4.4 percent to 5.6 percent of total medical expenditures (depending on the broadness of the definition used for "primary care").

Multiple groups have already begun to analyze Washington's primary care policy and its implementation by health care workforces, including the Bree Collaborative, the Advancing Integrated Mental Health Solutions (AIMS) Center, and the Center for Health Workforce Studies at the University of Washington.

The Bree Collaborative annually identifies up to three health care services for which there are substantial variations in practice patterns or high utilization trends in Washington, without producing better care outcomes for patients, that are indicators of poor quality and potential waste in the health care system. This year, the Bree Collaborative has begun to work on the topic of primary care.

The AIMS Center focuses on collaborative mental health care service and, to this end, supports organizations interested in collaborative care by providing research collaborations, clinical consultations, and implementation support, training, and workforce development.

The Center for Health Workforce Studies at the University of Washington acts to include the voices of workers in policy discussions on the provision of health care, predominantly through conducting research, providing consultation, and developing and refining analytical methods to support health workforce planning.

Summary of Bill:

The Primary Care Collaborative (Collaborative) is established. It is administered by the Health Care Authority, and will include representatives from:

health care consumers;
behavioral health treatment providers;
employers that offer self-insured health benefit plans;
the Office of the Insurance Commissioner;
Medicaid-managed care organizations;
commercial health insurance carriers;
the University of Washington School of Medicine;
the Elson S. Floyd College of Medicine;
the Pacific Northwest University of Health Sciences;
statewide organizations representing federally qualified health centers, hospitals and health systems, local public health districts, family physicians, pediatricians, physicians, and nurses; and
the Centers for Medicare and Medicaid Services.

The Collaborative is directed to create a report addressing at least:

how to define "primary care" for the purposes of determining current and desired levels of primary care spending as a proportion of overall health care spending;
barriers to the access and use of all the data needed to determine current and desired levels of primary care spending, and how to overcome them;
the desired level of primary care spending in Washington and the annual progress needed to achieve that level of spending in a reasonable period of time;
how and by whom it should annually be determined whether the desired levels of primary care spending are being achieved;
methods to incentivize the achievement of desired levels of primary care spending;
specific practices and methods of reimbursement to achieve and sustain desired levels of primary care spending; and
the ongoing role of the Collaborative in guiding and overseeing the development and application of primary care spending targets, and the implementation and evaluation of strategies to achieve them.

The Collaborative must be informed by existing work and studies performed by the Office of Financial Management, the Bree Collaborative, the AIMS Center, and the Center for Health Workforce Studies at the University of Washington. The Collaborative's findings and recommendations regarding statewide spending on primary care must be delivered to the Governor and the appropriate committees of the Legislature by December 1, 2020.