(a) Washington is best served by a health care system that provides the highest outcomes for the most people at the least cost. Sustaining broad access to quality care while also addressing other critical needs within the state requires the wise investment of available health care dollars.

(b) Among the wisest ways to invest health care dollars is on robust primary care, especially where it integrates behavioral health services. There is consistent and growing evidence that a strong primary care orientation achieves better health outcomes, more health equity, and lower overall costs. It is the essential backbone of any health care system, allowing other medical specialists to focus where they too bring the most value.

(c) Based on nationwide estimates, only five to seven percent of health care spending goes to primary care. A 2019 study by Washington's office of financial management indicates the proportion in Washington is no different. In high-performing health care systems of other countries it is double or triple this amount.

(d) Acknowledging the dearth of spending on primary care as both a problem and opportunity, Oregon, Colorado, Rhode Island, and Vermont are among the states proactively addressing it. Each is engaged in a legislatively directed, collaborative process to systematically strengthen primary care, substantially increasing the proportion of health care spending devoted to it by both public and private payers through deliberate reprioritization and innovations in how such care is provided.

(e) Learning from and following the lead of these states, Washington has begun taking steps of its own to advance primary care. The office of financial management study, directed by the legislature, helps identify a starting point. The health care authority is actively engaged with stakeholders in considering how to further this goal within state purchased health care, with the integration of behavioral health services into primary care already a key component of its transformation initiative. Primary care is among the topics on which the Bree collaborative has chosen to focus in 2020.

(2) The legislature intends to build on what is already being done in this state and others to strengthen primary care by establishing a formal process to set statewide primary care spending targets and identify and direct the implementation of strategies to achieve them.

NEW SECTION. Sec. 2. (1) There is established a primary care collaborative to be administered by the health care authority. The authority shall invite representatives from at least the following to participate:

(2) By December 1, 2020, the collaborative shall report findings and recommendations, including any recommended statutory changes, to the governor and appropriate committees of the legislature regarding statewide spending on primary care, addressing:

(a) How to define "primary care" for purposes of determining current and desired levels of primary care spending by public and private payers as a proportion of overall health care spending;

(b) 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;

(c) What the desired level of primary care spending is in this state, and the annual progress needed to achieve that level of spending in a reasonable period of time;

(d) How and by whom it should annually be determined whether desired levels of primary care spending are being achieved;

(f)(i) Specific practices and methods of reimbursement to achieve and sustain desired levels of primary care spending, including but not limited to: (A) Supporting advanced, integrated primary care involving a multidisciplinary team of health and social service professionals; (B) addressing social determinants of health within the primary care setting; (C) leveraging innovative uses of efficient, interoperable health information technology; (D) increasing the primary care workforce; and (E) reinforcing to patients the value of primary care, and eliminating any barriers to access.

(ii) As much as possible, the practices and methods specified must hold primary care providers accountable for improved health outcomes, not increase the administrative burden on primary care providers or overall health care spending in the state, allow for uniform implementation across payers, and take into account differences in urban and rural delivery settings;

(g) 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.

(3) In developing its report, the collaborative shall be informed by existing work in this state and others regarding primary care, including but not limited to the December 2019 report by the office of financial management, the work of the Bree collaborative, the work of the AIMS center and the center for health workforce studies at the University of Washington, and the work of the health care authority to strengthen primary care within state purchased health care.