Washington State Medicaid and MACRA

1. Washington State Medicaid and MACRA MaryAnne Lindeblad Medicaid Director NAMD Fall Conference November 7, 2016

2. Washington State Medicaid Program Purchases health care for close to 2 million people through Medicaid (Apple Health) through 5 MCOs $8 billion annual spend Federal program participation: - State Innovation Model (SIM) Round 2 • Health Homes/Dual Eligible • Medicaid Transformation Demonstration Project (agreement in principle)

3. HCA purchasing goals (Medicaid and Public Employees Benefits Program) By 2021: • 90 percent of state-financed health care and 50 percent of commercial health care will be in value-based payment arrangements (measured at the provider/practice level) (2c-4b in CMS Learning Action Network APM Framework) • Washington’s annual health care cost growth will be below the national health expenditure trend.

4. HCA and Medicare’s VBP goals 2021 90% state-financed 50% commercial In 2016, at least 30% of Medicare payments are linked to quality and value through APMs 2016 30% In 2021, at least 90% of state-financed health care payments and 50% of commercial health care payments are linked to quality and value through APMs (Categories 2c-4b) 2021 90% 50% In 2018, at least 50% of Medicare payments are linked to quality and value through APMs 2018 50%

5. Defining Value-Based Payments using HCP-LAN Alternative Payment Model Framework https://hcp-lan.org/groups/apm-fpt/apm-framework/

6. HCA Value-based Roadmap • Reward patient-centered, high quality care • Reward health plan and system performance • Align payment and reforms with CMS • Improve outcomes • Drive standardization • Increase sustainability of state health programs • Achieve Triple Aim 2021: 90% VBP 2019: 80% VBP Medicaid PEBB 2016: 20% VBP

8. MACRA Alignment Efforts, 2017 - 2019 • Made decision to utilize CMS LAN framework for VBP attainment and provider incentives in 2014 • Align VBP efforts under Wavier with provider incentives under Advanced APM track • Seek ‘other Advanced APM’ designation for WA Medicaid and other HCA APMs, for 2019 • Align other Medicaid transformation efforts (waiver, SIM) with MIPS efforts, i.e., harmonize WA common measure set with MACRA • Assist providers with the transition to VBP payments (through WA Practice Transformation Hub)

9. Questions? For more information: www.hca.wa.gov/hw MaryAnne Lindeblad HCA Medicaid Director Maryanne.lindeblad@hca.wa.gov Tel: 360-725-1863