State Roles
in Promoting
Accountable Care
Organizations and
Medical Homes
Richard K. Onizuka, PhD
Health Policy Director
Washington State Health Care Authority
The “Why” and “What” for
Washington State
• State budgets – driven by health
purchasing costs
• Health system status quo is unsustainable
• Leveraging state roles as purchaser,
regulator, and licensor
• Facilitator/convener for payment reforms
with multiple payers
• Governor’s 4% challenge
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Key State Roles in ACO
Development*
• Designing and promoting data
• Designing and promoting new payment
models
• Fostering the use of accountability
measures
• Identifying and promoting systems of care
• Supporting a continuum of care and
medical home models
* from NASHP report
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Designing and Promoting Data
• Governor’s five point plan (2005) includes
data transparency
• Puget Sound Health Alliance (PSHA)
Community Checkup
• Medicaid Predictive Risk Intelligence
System (PRISM)
• HITECH coordination, HIE development
• All payer claims database?
4
Designing and Promoting
New Payment Models
• Multiple payer, payment reform pilot
– Public private collaboration
– Performance outcomes (reduction in
avoidable ER use)
– Key challenges
• Consolidated purchasing of Medicaid
and public employees (HCA)
• ACO pilot legislation
• ACA opportunities
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Fostering the Use of
Accountability Measures
• Puget Sound Health Alliance – resource
use measures – Dartmouth Atlas frame
• Multi-payer pilot outcomes
• Consolidated state health purchasing,
and self funded plan third party
administrator (e.g., eValue8)
• Beacon community coordination
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Systems of Care and
Medical Home Models
• Primary care health homes and new
legislation
• Expansion of Boeing IOCP model with
public employees and other purchasers
• ACO pilot legislation
• ACA opportunities, e.g., dual eligibles,
2703 funding
• Regional health authorities
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Other Opportunities/Final Thoughts
• Other HIT activity (e.g., Beacon)
• Leveraging our Health Insurance Exchange
• Needed resources, challenge to health system
status quo (technical, political, etc.)
• Role within state’s overall health system
change strategy
• Private sector opportunities and collaboration
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Additional Resources
• PSHA community checkup:
http://www.wacommunitycheckup.org/
• ACO legislation (ESSB 6522):
http://apps.leg.wa.gov/documents/billdocs/200910/Pdf/Bills/Session%20Law%202010/6522S.SL.pdf
• Multi-payer medical home pilot:
http://www.hca.wa.gov/medical_homes.htm
• Governor Gregoire’s health reform site:
http://www.governor.wa.gov/news/newsview.asp?pressRelease=1469&newsType=1
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Questions?
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