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 the 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 the 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 performance measures which track rates of criminal justice system involvement among public health system clients with an identified behavioral health need, such as rates of arrest and incarceration. The Health Care Authority (HCA) must set improvement targets for these measures.
By July 1, 2022, the Committee must report to the Governor and the appropriate committees of the Legislature on the implementation of these requirements.
The Committee must convene a work group of stakeholders with expertise in criminal justice and behavioral health to review current performance measures adopted in other states or nationally to inform the process of establishing performance measures.
By October 1, 2022, the 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.
(In support) Performance-based contracting works in all kinds of disciplines. However, before performance-based contracting can be used, benchmarks must first be established so that what is being measured can be tracked. This first step allows the state to know that when you invest dollars into something, the state is investing them in the right place. This bill directs the Health Care Authority to establish the benchmarks, which will set up the next step of incorporating those measures into contracts.
(Other) The health plans are neutral on the intention of the bill. However, the Performance Measures Coordinating Committee (Committee) members do not have a lot of institutional experience. Accordingly, the plans would like an amendment that requires the Committee to establish a work group of stakeholders that have the appropriate expertise to identify new measures and examine what other states have done to better inform the Committee.