March 4, 2019

Moving Apple Health to Value

The Health Care Authority's (HCA) Value-based Roadmap sets a target for 90 percent of provider payments under the state financed health care to be linked to quality and value by 2021. This includes both the state's public employees benefits program and Washington Apple Health (Medicaid). 

HCA pays managed care organizations (MCOs) a per-member-per-month (PMPM) premium rate that covers all of a client's care. The MCOs pay providers with the premiums to perform services for Apple Health clients. To connect payment to quality of care and to value, as of January 2018 HCA is withholding 1.5 percent of a MCO's monthly premium to be returned based on performance.