Washington

In 2010, Chapter 220, Laws of 2010 RCW 70.54.420 directed the Washington Health Care Authority to “appoint a lead organization by January 1, 2011, to support at least one integrated health care delivery system and one network of nonintegrated community health care providers in establishing two distinct accountable care organization (ACO) pilot projects.” The Health Care Authority released a Request for Information but was unable to find a suitable lead organization. As described in a January 1, 2013 Report to the Legislature on Accountable Care Organization Pilot Projects, further efforts to designate a lead organization or implement the pilots have been discontinued.
 
In the Washington State Health Care Innovation Plan, the state “proposes to develop local ACOs around 50 hospitals with ~250 practices over 3 years and with a staggered implementation that may potentially affect ~91,200 deliveries over the first three years (WA has ~84,000 births per year).” The state will pay for integrated services for births starting with a global budget negotiated with a set of professionals and their associated hospital(s), with professionals and hospitals that achieve a lower target cost receiving a portion of the savings.
 
In February 2013, the state was awarded a CMS Innovation Center State Innovation Model pre-testing grant to prepare for payment and delivery system reforms, including accountable care models. In its project narrative, the state proposes to test an “Alternative Quality Contract” that can function as a virtual ACO that aligns incentives among independently operating facilities in the state. This model will rely on:
 
  1. gain sharing to provide incentives for best practices and to contain costs;
  2. sharing data to reduce variation;
  3. integration of systems across the continuum of care (e.g., primary care physician, facility and medications); and
  4. additional savings for providers achieving quality improvements.
 
Two existing statewide multi-payer collaboratives in Washington, the Robert Bree Collaborative and the Puget Sound Health Alliance, will support the implementation of Washington’s model.
 
Last updated: November 2013.