|Initiative Spotlight: Implementing the Affordable Care Act: Washington’s Approach|
Washington Health Benefit Exchange
Medicaid Expansion. The application processing time through September 30, 2013 was up to 45 days. Beginning October 1, 2013 the processing time was reduced to between 30-60 minutes.
Washington Health Benefit Exchange ("Exchange") created as a public-private partnership in 2011. The Governor appoints 11 member bipartisan board with exchange benefits beginning operations in 2012.
Exchange Key Elements: Individuals >138% of FPL and small groups (2-50), tax credits available for individuals 138%-400% of FPL, cost sharing reductions available for <250% FPL, qualified health plan" (QHP) offerings approved by Office of Insurance Commissioner amd certified by the Exchange Board, Apples-to-apples comparisons for consumers, one stop shop, and navigators and call center assistance.
The Exchange will:
- Set standards for Qualified Health Plans (QHPs)
- Certify participating plans
- Provide “Essential Health Benefits” (EHBs)
- Ensure sufficient choice of providers
- Be accountable for performance on clinical quality measures and patient satisfaction
- Implement a quality improvement strategy
- Provide accurate and standardized consumer information
- Be a private health insurance plan
OPEN ENROLLMENT: October 1, 2013 to March 31, 2014.
CHANGING LIFE CIRCUMSTANCES & different Medicaid eligibility levels for children, parents & pregnant women result in: 1. Mixed coverage from different plans, 2. Disruption, 3. Unnecessary duplication of tests and treatment, 4. Increased administrative expense, 5. Decreased incentive for health plans/providers to invest in care activities, 6. DAdministrative difficulties managing benefits while m3easuring quality.
Survey of primary care physicians in WA state show that:
~ 90% of PCPs provide care for some patients covered by Medicaid
~ 80% of PCPs accepting new patients
Reports available include:
Characteristics and distribution of current primary care physicians
Availability of Primary Care Physicians to Serve the Medicaid Expansion
Washington State Primary Care Nurse Practitioner Survey
COST: In Washington State, personal health care expenditures have grown from $3.8 billion in 1980 (7.3% GDP) to $45.4 billion in 2009 (13.6% GDP). Nationally, 30% of expenditures attributed to wasteful spending, poor care delivery, excess administrative costs, unnecessarily high prices and fraud. 85% of Washington’s uninsured adults will have access to coverage under the ACA. Assuring quality care that is affordable requires fundamental change in how health care is delivered. Extending access without such changes will not be financially sustainable.
State Health Care Innovation Planning "SHCIP":
State Innovation Models: Grant program of Center for Medicare and Medicaid Innovation (CMMI) to identify and spread health practices that result in better health and better care at lower cost.
Washington received a $1 million planning grant to fund collaborative development of a 5-year innovation plan.
For information about the Medicaid expansion:
For information about the Health Benefit Exchange:
To contact the HCA concerning the Medicaid expansion:
Source:Daniel Lessler, MD, MHA, FACP, Chief Medical Officer, Seattle Children's Hospital
Seattle Children’s Hospital Grand Rounds – Implementing the Affordable Care Act: Washington’s Approach. http://www.hca.wa.gov/hcr/me/Documents/082913_Seattle_Children%27s_Grand_Rounds.pdf. August 29, 2013