A health system performance scorecard shows consistent health disparities for Native
Americans in Washington State compared to white residents, reports Oregon Public
Broadcasting. The report from The Commonwealth Fund found that American Indian/Alaska
Native people experienced the lowest health system performance in the state. A separate
regional dataset shows higher rates of death before 75 from preventable and treatable causes,
and higher rates of death from diabetes, cancer, heart disease, and opioid-related issues.
Nearly 20 percent of Native Americans and Alaska Natives in Washington lack supplemental
insurance beyond the Indian Health Service, which is chronically underfunded.

A survey found that many Washington State residents struggle with health care costs, according
to the Economic Opportunity Institute. The survey shows that 57 percent of respondents
avoided seeking medical care in the last year due to cost, one in three lived in a household with
medical debt, and 88 percent are concerns about the cost of health care in the future. It also
found that 63 percent could not pay or would struggle to pay an unexpected $500 medical bill.

Washington has started enrollment for a Medicaid-like program available to undocumented
adults with incomes up to 138 percent of the federal poverty level, reports The Seattle Times.
With coverage starting July 1, 2024, the Apple Health Expansion will cover, with some
limitations, primary and specialty care, emergency visits, dental visits, pediatric care, and
pregnancy and labor services with no out-of-pocket costs or copays. The state Health Care
Authority plans to cap new enrollments at 13,000 people.

Washington will require insurance companies to explain to policyholders why their premiums
have gone up, reports My Northwest. Starting June 1, 2024, insurers will have to include a
disclaimer on the first page of renewal notices and billings statements notifying policyholders
they can request more details about their premium increase, and the insurer must respond
within 20 days. Effective June 1, 2027, insurance companies will have to provide explanations
automatically before renewing a policy with a 10 percent or more increase. The rule from the
Washington State Insurance Commissioner’s office is reportedly the first of its kind in the
country.

Washington State has expanded the authority of its Health Care Cost Transparency Board,
according to Northwest Health Law Advocates. Under its original duties, the Board may require
data collection from payers and providers to annually calculate total health care expenditures
and cost growth, establish a cost growth benchmark, and analyze the impact of cost drivers on
health care spending. Washington passed legislation that expands the categories of data and
cost drivers the Board may use in its analyses, and directs the Board to conduct a study of costs
from nonprofit providers and payers not included in total health care expenditures. The Board
may also require certain providers that frequently exceed the cost growth benchmark without
reasonable justification submit a performance improvement plan or pay a civil fine.

A preliminary report to Washington State legislators outlines the current state of Washington’s
health care system, including recent market consolidation and a process for evaluating changes
that could improve affordability, published by the Office of the Insurance Commissioner. The
report highlights that the cost of care is driven by both rates of utilization and the price of
services, and efforts by private employers and the state to reduce health care costs.

Ambulance passengers in Washington face high costs for ambulance rides despite having no
choice about the service, reports The Columbian. The federal No Surprises Act, which prohibits
balance billing for services in other areas of the health care sector including air ambulances,
does not protect against surprise bills for ground ambulances. The report from the Office of the
Insurance Commissioner states that, on average, patients are responsible for more than $500 in
payment for emergency visits and more than $1,000 for non-emergency visits. The report
examines protections enacted by other states and issues policy recommendations for future
legislation to address the issue.

Washington State is the first state in the country to open its Affordable Care Act Marketplace to
undocumented residents following approval and implementation of a 1332 Medicaid waiver,
reports KUOW. Federal rules have excluded undocumented immigrants from purchasing
coverage on the Marketplace and while other states have created alternative avenues for
undocumented adults to purchase coverage, Washington State’s Marketplace will now make
plans and subsidies available to this population. Still, premiums are often too expensive for
many, even with subsidies, presenting ongoing affordability challenges.

Washington has passed a number of bills intended to lower out-of-pocket costs for routine screenings and equipment, according to The Lund Report. Senate Bill 5729 caps the cost of insulin at $35 for a 30-day supply but without the 2-year expiration date that previous legislation had. Senate Bill 5242 eliminates cost-sharing for abortions in health plans that cover the procedure, which includes all plans that cover maternity care. House Bill 1222 requires large group health plans and plans offered to public employees to include certain hearing-related coverage, including hearing aids and assessments. Senate Bill 5396 eliminates copays for breast examinations used to screen for cancer. Finally, House Bill 1626 requires the Health Care Authority to certain colorectal cancer tests under medical assistance programs, as well as colonoscopies if there is a positive result.

Washington has passed a law eliminating cost-sharing for abortions for state-regulated health plans, reports The Seattle Times. However, this does not apply to private, employer-sponsored health insurance plans, on which a majority of residents rely on for coverage.

Washington State passed legislation requiring the creation of a Prescription Drug Affordability Board by June of 2023, according to NASHP. The Board will conduct affordability reviews of the costliest prescription drugs–brand name drugs costing more than $60,000 per year or with price increases of 15 percent or more in the past year, or 50 percent over the last three years—as well as some biosimilars and generics. Starting January 2027, the Board may then establish upper payment limits for state payers on up to 12 drugs per year. In addition, the legislature lowered the cap on insulin prices from $100 to $35 per month and extended the cap through 2024 while the state’s Total Cost of Insulin Work Group studies long-term cost-lowering strategies.

For years, Ely Bair dealt with migraine headaches, jaw pain and high blood pressure, until a dentist recommended surgery to realign his jaw to get to the root of his health problems, reports Kaiser Health News. Bair had his first of two surgeries in 2018 and his out-of-pocket costs were $3,000. However, before having his second surgery, he switched jobs but retained the same brand of healt insurance. His second surgery at the same hospital went well, but he was billed for $27,119. Even though he retained the same insurance company, his new plan had a $5,000 lifetime limit on coverage for his orthognathic surgery, which is not considered an essential health benefit in Washington. After working with a patient advocare, appealing to his insurer three times and filing a complaint with the state attorney general's office, Bair's bill was reduced to $7,164. 

Though breast cancer screenings dropped sizably among all Washington women, women of color and those living in rural communities experienced the steepest drop-offs, according to a study by researchers at Washington State University Health Sciences Spokane and a not-for-profit healthcare system, MultiCare. The study, published in JAMA Network Open, used medical records data from MultiCare patients who had screening mammograms completed between April and December of 2019 and during the same months in 2020, after the World Health Organization declared COVID-19 a global pandemic. The number of completed screening mammograms across Washington fell by 49 percent, but these results were not consistent across racial groups. Breast cancer screening declined by 64 percent in Hispanic women and 61 percent in American Indian and Alaska Native women. In addition, screenings dropped by almost 59 percent for rural women, versus about 50 percent for urban women. This is the first study to examine racial and socioeconomic differences in missed cancer screenings during the pandemic.

The Washington Health Alliance released its 15th Community Checkup report that comprehensively reviews medical claims data to measure progress toward improving health outcomes for Washington residents. The report summarizes information from 1,869 clinics, 322 medical groups, 105 hospitals, 15 health plans, 39 counties and all nine Accountable Communities of Health on more than 100 performance measures in order to: (1) compare Washington’s performance with national benchmarks; (2) rank providers’ performance on primary care delivery; (3) monitor opioid prescribing and healthcare spending trends; and (4) spur action by health plans, healthcare professionals, and purchasers like employers and union trusts. 

The Washington State Health Care Authority, governor’s office, state medical association and insurance companies signed a memorandum of understanding committing to improve primary care and develop a new payment model in Washington state, according to a press release. The goals of the initiative are to: increase primary care expenditures while decreasing total health spending; align payment and incentives across payers; align quality metrics across both payers and providers; promote and incentivize integrated, whole-person and team-based primary care, physical and behavioral healthcare and preventive services; improve provider capacity and access; and work with interested public and private employers to spread and scale the model throughout the state.

In 2020, Washington State finished a phased, regional process to transition from three fragmented Medicaid systems for physical health, mental health and substance use disorder services into one integrated system to improve care coordination and health outcomes for individuals with physical and behavioral health needs. A webinar hosted by the Center for Health Care Strategies explored Washington’s transition to physical-behavioral health integration, with a focus on how this approach was tailored to the strengths of different regions. Speakers shared lessons for stakeholders interested in integrating care, presented emerging data on resulting outcomes and addressed the evolving role of public regional behavioral health systems.

The Washington Health Alliance released its second Community Checkup report in 2020 on the quality of healthcare in Washington state. In addition to other features, the report includes a new Quality Composite Score that combines up to 29 Community Checkup measures to make it easier to compare the quality of healthcare being delivered across the state and by different provider groups. While the composite score provides a more streamlined and nuanced understanding of care quality on primary care measures endorsed by Alliance members, it does not provide an understanding of other important factors, such as cost, patient experience, and care disparities. As the work of the Alliance continues, the Quality Composite Score may evolve to incorporate and measure these important aspects of healthcare.

Integrating health and social services is increasingly important, particularly as patients with complex needs cope with the COVID-19 pandemic. A case study by the Commonwealth Fund describes how a nonprofit in Snohomish County, Washington, partnered with a Medicare Advantage plan to provide care coordination and social services – like home-delivered meals and medically related transportation – as a cost-saving intervention for the plan’s high-need, high-cost members. The process offers insights about how to integrate health and social services in a financially sustainable way.

Washington State launched a collaborative regional Accountable Communities of Health (ACH) model in 2015 to improve the health of communities across the state. These ACHs have evolved into independent organizations that are integral to the state’s health system transformation efforts. A 2019 evaluation by the Center for Community Health and Evaluation found this ACH model has largely succeeded in building robust regional coalitions to improve the health of their communities. This blog by NASHP highlights the ACHs’ diverse approaches to improving health.  

The Washington Health Care Authority (HCA) has finished a multi-year effort to integrate physical health, mental health and substance use disorder treatment services for nearly two million Apple Health (Washington Medicaid) recipients, according to a press release. Under the transformed system, managed care organizations are responsible for physical and behavioral health services for the Apple Health recipients they serve. Additionally, behavioral health administrative services organizations deliver crisis services that are available to all, and manage regional functions, such as employing an ombudsman and managing a community behavioral health advisory board. This effort is part of Washington’s value-based purchasing roadmap, in which HCA aims to shift 90 percent of state-financed healthcare to value-based payment by 2021.

A 2019 analysis by the Washington Health Alliance found a 10 percent decrease in wasteful spending in the state’s commercially insured population and a 24 percent decrease in wasteful spending in the Medicaid population from 2014-2017, reports State of Reform. Despite significant progress, wasteful spending continues to be an issue, as 51 percent of the 9.5 million services examined were deemed “low-value” and likely representing unnecessary spending. 

Thousands of former patients at Deaconess and Valley hospitals will have medical debts erased as part of a major legal settlement with Community Health Systems (CHS), a struggling for-profit hospital chain, according to The Spokesman-Review. The settlement comes more than two years after the Empire Health Foundation sued CHS, alleging the company failed to provide the levels of charity care that it had promised when buying the hospitals from Empire Health Services in 2008. CHS also agreed to pay the foundation $20 million to create a political lobbying arm, the Empire Health Community Advocacy Fund. 

Insurance premiums for Washington’s individual market are rising less than 1 percent on average in 2020, which may be due to market domination by homegrown insurance companies, according to The Seattle Times. Homegrown insurers are tied to the local community and must succeed in Washington or in the Pacific Northwest region to stay in business. Presumably, this motivates them to try harder to meet their customers’ needs. Other ways that local plans can help stabilize their state-based marketplaces include helping fill geographical market gaps, building better partnerships with local doctors and hospitals and reaching underserved populations more effectively.

Seattle’s City Council adopted the Sweetened Beverage Tax in June 2017 to improve the health of the city’s residents, and address persistent health and education inequities, reports The Seattle Times. Evidence to-date shows the tax is funding programs that increase healthy food access, support child health and aid in early learning. However, its impact on reducing sales of sugary beverages is currently unknown. Nevertheless, evaluations of similar taxes imposed in Berkeley and Philadelphia revealed that sales of taxed beverages dropped substantially — by 9.6% and 38%, respectively. 

The state of Washington is praised for creating the country’s first “public option,” but a closer look at the law reveals tradeoffs that could curb potential savings for consumers, reports The New York Times. Although the law allows the state to regulate some healthcare prices, the prices were set significantly higher than drafters originally hoped in order to gain enough support to pass. As a result, the public option may not deliver the steep premium cuts that supporters want. Estimates suggest that individual market premiums will fall 5-10 percent when the new public plan begins.

Washington state has a history of leading the way on healthcare by seeking innovative approaches to expand coverage and ensure affordability, according to NPR. This includes the establishment of a "public option" health insurance plan that, in theory, will be more affordable for consumers. Public option plans will be available in all 39 counties, eliminating “bare counties” where one or no private insurance carriers provide coverage. Washington is the first state law to authorize the creation of a public insurance plan of this type, although other states are following suit. Colorado lawmakers approved legislation directing state agencies to develop a proposal for a public health coverage option and other states, including Connecticut, are considering public option legislation.

A new Washington law will direct money to tribal healthcare systems and create a council focused on improving health outcomes for members of Washington’s 29 tribes, reports The Seattle Times. The program will dedicate $3-$5 million in the first year (and potentially more in subsequent years) to implement an Indian Health Improvement Advisory Plan, designed by the Governor’s Indian Health Advisory Council. The council, also established by the law, will include a representative from every tribe in the state, CEOs of the state’s two Urban Indian Health Boards, legislators from both parties and a representative from the governor’s office.

The Washington Health Alliance has released several new reports on negotiated reimbursements from commercial payers, reports State of Reform. One report shows that reimbursement for a vaginal delivery at one medical center varies from $7,196 to $19,402, depending on the commercial payer. Another report reveals that overall inpatient utilization from 2015-2016 was down enough ($51.2 million) to offset price growth ($21.7 million). A third report analyzing “how well health plans are meeting the needs of their members and working to improve quality and reduce the cost of healthcare" identified Kaiser's HMO product as the overall top rated insurance plan, with Regence the top rated PPO plan.

Gov. Jay Inslee and Democratic lawmakers will introduce legislation that would provide a public healthcare option in Washington through the state’s Health Benefit Exchange, announced the Governor’s Office. The proposal addresses the challenges of health insurance availability as well as affordability—specifically, the proposal will improve affordability through standardized plan designs that are easier to understand and have lower out-of-pocket costs for consumers. “With volatility and uncertainty at the federal level, the goal of this proposal is to provide a sensible alternative that is affordable and accessible in every county,” said the bill’s sponsor, Rep. Eileen Cody.

This brief by the Washington State Budget & Policy Center describes how policymakers can help build healthy communities and advance equity in Washington by applying a health lens to all state budget and tax decisions. Many policies – including those related to affordable housing, public transportation and high-quality jobs – may not appear health-related on the surface, but are essential to the well-being of the state. Education policies and policies that lift and keep people out of poverty, in particular, significantly impact people’s health. By looking at budget choices through a health-promoting lens, lawmakers can take steps to create a budget that invests in the programs and policies that give everyone a chance to lead a healthy life.

A study by the Washington Health Alliance found that in a single year more than 600,000 patients underwent treatment they didn’t need, at an estimated cost of $282 million, reports Pro Publica. The report calls for overuse to become a focus of “honest discussions” about the value of health care. It also said the system needs to transition from paying for the volume of services to paying for the value of what’s provided. 

The Washington legislature passed legislation in 2016 that requires the state’s insurance commissioner to conduct a Study of the Pharmacy Chain of Supply. The study, published in June 2017, confirmed that retail pharmacies generally profit more when dispensing generic versus brand drugs, according to this study by Brookings. However, profitability was dependent on an individual pharmacy’s cost to dispense.

Gov. Jay Inslee and the Washington State Health Care Authority announced an agreement that ensures the state can continue transforming the Medicaid program to achieve better health, reward high-quality care and curb healthcare costs, according to the Seattle Medium. Officials said the five-year Washington State Medicaid Transformation Project provides up to $1.1 billion of incentives to reward high-quality care. It takes a patient-centered, holistic approach to care and creates partnerships with communities to address social determinants of health. The project also provides $375 million to support critical services for Medicaid clients.

The State of Washington is using its size to improve the quality and affordability of healthcare that their employees and dependents receive, according to Harvard Business Review.  Washington’s Health Care Authority (HCA) is applying supply-chain tools to purchase high-quality surgical “bundles” defined by Washington’s multi-stakeholder collaborative. A bundle is a package of care, offered at a single price, that covers the total cost of treating a specific condition.

The second-largest investor-owned hospital company, CHS, is selling two of its 158 hospitals to MultiCare Health System, according to Modern Healthcare. The move comes after 38 small and rural hospitals were spun off to create an independent company, Quorum Health Corp in April.

The state of Washington will partner with CMS on a five-year Medicaid demonstration waiver to continue implementing the Healthier Washington plan through regional Accountable Communities of Health. The project is part of Washington’s effort to focus on prevention and proactive management of physical and mental health issues and control costs. The waiver will provide $1.1 billion in funding for these reform strategies and $375 million for services, including supportive housing and supported employment services for Medicaid enrollees.

Washington’s Insurance Commissioner released a statement promising to propose similar legislation in 2017 to California’s law that protects consumers from surprise out-of-network medical bills, according to KING 5. The California bill guarantees patients who visit an in-network hospital do not face out-of-network charges and creates a process for doctors and insurance companies to handle price disagreements without involving the consumer.

Washington is the first state in the nation to formally review, certify and advocate the use of aids to help patients make decisions about their care, according to a press release by the Washington State Health Care Authority. The HCA announced the certification of four patient decision aids (PDAs), which help consumers gain access to reliable information so they can talk with their providers before making decisions about their care. In 2007, Washington was the first state to pass legislation regarding shared decision making, which provided that if a provider used a certified PDA as part of the informed consent process, there is a presumption that informed consent has been given and obtained. A Health Affairs study found that PDAs were linked to significantly lower hip and knee surgery rates and costs, since patients have a better sense of the anticipated likelihood of benefit from a procedure and alternative, less invasive options.

The Washington Health Alliance released a report that reveals that a patient’s location can influence the treatment or services he or she receives. The report covers the entire state of Washington and includes results for 22 tests and treatments in five categories (ear/throat, ortho-/neurosurgery, diagnostic tests, obstetrics/gynecology, and special topics). The report also divides results by age range and gender, which can reveal additional variation.

State of Reform reports that the Washington Health Care Authority’s (HCA) new 1115 Medicaid waiver application is seeking to tie 30 percent of its healthcare purchases to value-based arrangements by next year, and 90 percent by 2019. HCA will implement seven performance measures that complement the waiver process. HCA will withhold one percent of a managed care plan’s premiums based on their performance against these measures which can be earned back by producing favorable scores for quality, patient experience, and cost of care.

The Office of Financial Management announced the Center for Health Systems Effectiveness at Oregon Health & Science University will develop and operate Washington’s All-Payer Claims Database, according to Onpoint Health Data. The project will increase transparency and improve quality in healthcare by collecting, integrating and enhancing claims data, benchmarking performance, identifying value in purchasing strategies, and promoting competition based on quality and cost.

The Northwest Health Law Advocates and Washington Community Action Network released a report that discusses how community members can become involved in regional decision making and recommends ways in which regional entities can engage consumers after the creation of Accountable Communities of Health (ACHs) in Washington.

The Office of the Insurance Commissioner revised Washington's network adequacy rules in 2014 and added concrete distance standards, established provider ratios for primary care physicians, and defined allowable wait times, according to Washington Healthcare News. The rules apply to all health insurance plans issued in Washington, not just ACA plans.  The OIC’s 2017-2023 Strategic Plan affirms that it will “monitor how narrow networks affect access” and maintain its network standards.

The Washington State Multi-Payer Medical Home Reimbursement Pilot tested a payment method for the patient-centered medical home (PCMH) model intended to reduce emergency department and hospitalization rates, according to an article published in Population Health Management. The study found that the data reporting and payment methods were insufficient to realize the potential of the PCMH population health approach; specifically, the study found that data for population health interventions must (1) define the population; (2) be accessible to healthcare providers; and (3) have an all-inclusive perspective to describe the health needs of an entire population. Further, payment methods must create incentives that work across the health system and support infrastructure development for population health interventions, including integrated information exchange between primary care, specialty care, EDs and hospitals.

The Washington state legislature passed a bill to establish a fully functional All-Payer Claims Database (APCD). The bill now heads to Gov. Jay Inslee for his signature into law. The bill had strong support among businesses, health-care providers and patient organizations and corrects issues in a 2014 APCD law. Among the problems with the existing law was that it lacked a requirement that all health insurers submit data.

This April 2015 report published by the University of Washington evaluates seven value-based payment reform programs in Washington, Oregon, Pennsylvania, Maine, New Hampshire and Massachusetts. All of these states were pushing to transition to value-based payment. The researchers found that value-based payment reform requires a trusted, widely respected “honest broker” that can convene and maintain the ongoing commitment of health plans, providers and purchasers. Examples of such successful coalitions include the Washington Health Alliance.

Washington released a Common Measure Set, which will create a common way of tracking health and healthcare performance, as well as inform public and private healthcare purchasers. The state approved 52 measures for inclusion in the “starter set”; these measures are divided into three categories: Population, Clinical, and Healthcare Costs. Washington acknowledged that the topics identified were of significant importance, but readily available measurement/public reporting and/or nationally vetted measures did not yet exist. The lack of a robust infrastructure in Washington to enable cost-effective aggregation of clinical data for public reporting was a particularly rate-limiting element of the work.

In December 2014, Gov. Jay Inslees announced that Washington received a $65 million federal grant to fund an effort to deliver more efficient healthcare. The four-year Center for Medicare and Medicaid Innovation grant will help implement the Healthier Washington program. This initiative will create incentives designed to promote price transparency and integrated care as a way to improve health outcomes for consumers in Washington.  Read more

In February 2015, the Washington Health Alliance published a report that found that the state’s hospital readmission rates for patients with commercial insurance is 8.7 percent, which amounts to $446 million in additional health system and hospital costs. Readmissions can lead to more tests and treatment which can increase medical risk for consumers. The researchers suggest that the high readmissions rates in the state could be reduced through better coordination of care by primary care doctors.