In 2014 the Performance Measures Coordinating Committee was established to identify and recommend standard statewide measures of health performance to inform health care purchasers and set benchmarks. The measures must include dimensions of prevention and screening, effective management of chronic conditions, key health outcomes, care coordination and patient safety, and use of the lowest cost, highest quality care for preventive care and acute and chronic conditions. The Washington State Common Measure Set for 2021 includes 46 measures that are appropriate for Population Health Monitoring and Value-Based Contracting for Payment and another 17 measures that are only appropriate for Population Health Monitoring.
The Health Care Authority (HCA) has also implemented certain value-based purchasing (VBP) provisions into contracts for Medicaid managed care, plans offered to public employees, and other programs. The goal of VBP is to improve the quality and value of health care services, while ensuring that health plans and providers are accountable for providing high-quality, high-value care. This type of purchasing uses value-based payment, which rewards providers for the quality of health care, rather than the volume of patients seen.
The HCA contracts with managed care organizations and behavioral health administrative services organizations to provide integrated medical care services, including behavioral health care services, to Medicaid clients. The HCA and the Department of Social and Health Services (DSHS) must employ performance-based contracts with these entities, known as service contracting entities. These contracts must include performance measures targeting the following outcomes:
The HCA and DSHS were required to establish performance measures to be integrated into the statewide common measure set that tracks integration practices of behavioral health services in primary care settings. The HCA and DSHS were also required to adopt performance measures to determine whether service contracting agencies are achieving these outcomes for those enrolled in Medicaid managed care and receiving mental health, long-term care, or chemical dependency services.
The Performance Measures Coordinating Committee (Committee) must establish:
By July 1, 2022, the Committee must report to the Governor and the appropriate committees of the Legislature on the implementation of these requirements.
By October 1, 2022, the Health Care Authority (HCA) must report to the Governor and the appropriate committees of the Legislature on options and recommendations for integrating value-based purchasing terms and a performance improvement project into managed health care contracts relating to specified criminal justice outcomes.
The HCA must adopt performance measures to determine whether service contracting agencies are achieving these outcomes for those receiving mental health, long-term care, or chemical dependency services.
The stated intent of the bill is to focus the HCA's purchasing efforts on providing incentives to its contractors to reduce criminal justice system involvement for public health system clients with behavioral disorders.