In July, eight payers, the Washington Multi-Payer Collaborative, signed a memorandum with the Washington State Health Care Authority to promote value-based payment models for primary care in the state.
The agreement helps align and standardize performance measures across payers. The implementation of payment frameworks will vary by payer, but each signee must offer models with incentives for quality and may opt to provide upfront investments in providers’ infrastructure.
Chip Howard, vice president of network innovation and alternative payment models at Regence BlueShield, told Becker’s aligning on standards is helpful for providers who want to participate in value-based care.
A common pain point for providers participating in value-based arrangements with multiple payers is coordinating different metrics and financial parameters, Mr. Howard said.
“While we’re not going to be in a place where it’s entirely uniform, there will be that common framework. It will make it easier for providers to participate in multiple value-based arrangements across payers, because they will be working on mainly the same set of quality metrics,” he said.
In addition to Regence BlueShield, Kaiser Permanente, UnitedHealthcare, Molina Healthcare, Premera Blue Cross, Community Health Plan of Washington, Wellpoint Washington and Coordinated Care signed the agreement.
Angela Dowling, president of Kaiser Permanente Washington, told Becker’s the common framework is critical to the success of the initiative. It took a long time to find a framework that multiple payers and providers could align with, Ms. Dowling said. Her advice to other organizations considering a similar model: Engage early.
“Be mindful about the payment model and the quality model. Make sure you’re leaning on metrics that are consistent within the industry and that organizations can understand,” she said. “Always focus on the patient being the center of everything that we do. If you lose sight of the patient or the member, then we really aren’t solving the problem.”
A few states, including Vermont, Massachusetts and Washington, have developed multipayer models that have successfully addressed local priorities for reform, according to a 2022 report from the Margolis Center for Health Policy at Duke University.
The state initiatives have required “substantial investment by states and participating payers, employers, and organizations,” according to the report.
Executives at the insurers participating in the collaborative said the process comes with far more opportunities than challenges.
Leanne Mangrobang, director of value-based risk contracting at Premera Blue Cross, told Becker’s collaborating with payers operating in different lines of business can present some challenges, but also comes with opportunities to learn and find commonalities.
“One of the unique aspects of the collaborative is bringing in insurance companies that focus on commercial, Medicaid and Medicare,” Ms. Mangrobang said. “We’ve learned what is priority for different lines of business in the market and how we can align and find those commonalities.”
Steve Jacobson, MD, medical director of Premera Blue Cross, told Becker’s any opportunity to learn from other payers, providers and state partners is worthwhile.
“On one hand, the folks we’re working with are our competitors, but I think there’s benefits for collaboration for all of us. Whether it’s with other health plans in the state of Washington – It’s really important, our work with the Healthcare Authority. We learn a lot from them.”
