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May 12, 2017

Clinics agree to new Medicaid payment model to expand access, improve care

Washington State continues to make progress in its goal to accelerate adoption of value-based reimbursement and alternative payment strategies. Starting July 1, 16 federally qualified health centers (FQHCs) and one rural health clinic (RHC) will begin using a new payment model for Medicaid managed care enrollees that will have additional flexibility in delivering primary care services, and incentivizes financial rewards for quality while still meeting federal requirements.

The payment model converts fee-for-service to a per-member per-month amount, allowing innovation in care delivery and increasing access for members needing care.

The participating RHC is Fidalgo Medical Associates. Participating FQHCs are:

• Columbia Basin Health Association
• Columbia Valley Community Health
• Community Health Association of Spokane
• Community Health Care
• Community Health of Central Washington
• Country Doctor Community Clinic
• Family Health Centers
• HealthPoint
• Moses Lake Community Health Center
• NE Washington Health Programs
• North Olympic Healthcare Network
• Peninsula Community Health Services
• Tri-Cities Community Health Inc.
• Valley View Health Center
• Yakima Neighborhood Health Services
• Yakima Valley Farm Workers Clinic

Currently, FQHCs and RHCs are reimbursed per encounter (face-to-face visits with providers) and are limited in the number of encounters per 24-hour period. This payment arrangement does not incentivize quality or efficiency of care.

 This flexibility will:

• Create additional clinical capacity for primary care teams to take care of their patient population.
• Improve access to care by focusing on how to most efficiently deliver the services.
• Encourage team-based care with doctors, mid-level practitioners, pharmacists and patient navigators working efficiently together to provide personalized care for their population of patients.
• Enable expansion of the primary care team to provide for Medicaid clients.
• Encourage closer care coordination across providers. 

FQHCs and RHCs will receive financial incentives based on performance measures selected from the Washington State Common Measure Set. These measures include:

• Chronic care management of patients with diabetes
• Well-child visits and immunizations
• Evidence-based medication management for patients with asthma
• Appropriate use of antidepressant medication.

The transformation under this payment model will continue the state's trend to redesign the system with enhanced patient engagement, innovative health care interventions and population health strategies.

The project described was supported by Funding Opportunity Number CMS-1G1-14-001 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies.