The United States has seen its approach to health care shift drastically in recent years, with the implementation of the Affordable Care Act, and as Medicare, the nation’s biggest healthcare payer, moves away from traditional volume-based health care payments to payments based on value. This means that consumers can more easily choose providers with high ratings, so that they get the most value out of their health care. Following Medicare’s lead, Washington State has created an initiative called Healthier Washington, to provide better, cheaper, more wholistic health care to its 2.2 million citizens, by integrating physical healthcare, drug and alcohol treatment, and mental healthcare in a system based on value.
According to Washington’s Health Care Authority (HCA), “Healthier Washington will help people experience better health throughout their lives and receive better—and more affordable—care when they need it. A unique multi-agency effort supported by federal funding, Washington’s state agencies are working with the public and private sectors toward building healthier communities through a collaborative regional approach, integrating how we meet physical and behavioral health needs so that health care focuses on the whole person [and] improving how we pay for services by rewarding quality over quantity.” Healthier Washington will also assist its health care providers, especially smaller practices, in the transition to the new system, through a service called Program Transformation Hub (PTH). PTH will “connect health care providers with tools, training and hands-on technical assistance to address the needs of the whole person and assist with the transition from volume to value.”
Its website explains that Healthier Washington’s delivery system partners “have committed to meaningful, extensive care transformation, improved consumer experience and financial accountability tied to quality improvement across a set of performance indicators. This strategy sends one common signal to providers, incentivizes consumer‐centered, high-value care and quality improvement.” For example, a low income person with diabetes might have trouble managing their blood sugar with the food most accessible to them; Healthier Washington does its best to ensure this person gains access to healthful food through government programs to keep their diabetes in check and limit costly medical intervention. Additionally, someone with a mental health issue can access support groups and professionals to give them a well balanced treatment plan.
One major goal of Healthier Washington is to lower its growth in annual health care costs by 2019, lowering it two percent less than the national health expenditure trend. It plans to achieve this by developing a HCA Value-based Road Map that will lay out how HCA will change the way health care is provided by implementing new models of care that are geared towards population-based care. HCA’s website explains that the map will combine “major components of Healthier Washington…the Medicaid transformation waiver and the Bree Collaborative care transformation recommendations and bundled payment models.” The Road Map will be built on the following principles: “Reward the delivery of consumer‐centered, high value care and increased quality improvement; Reward performance of HCA’s Medicaid and Public Employees Benefits Board (PEBB) Program health plans and their contracted health systems; Align payment and delivery reform approaches with U.S. Centers for Medicare and Medicaid Services (CMS) for greatest impact and simplify implementation for providers; Improve outcomes for consumers and populations; Drive standardization based on evidence; Increase long‐term financial sustainability of state health programs; and continually strive for the Triple Aim of better care, smarter spending and healthier people.”
Healthier Washington includes an investment in Analytics, Interoperability, and Measurement (AIM) to strengthen “existing health data systems from multiple sectors to create capacity for analytics and decision support to best serve Washington’s needs.” If Healthier Washington is effective, other states may be able to use this data in creating similar health care policies, to make America as healthy as possible while saving people money. In fact, the Health Care Transformation Task Force already exists to bring “together consumers, payers, providers and purchasers to align private and public sector efforts to clear the way for a sweeping transformation of the U.S. health care system.” The Task Force encourages health care systems to develop a holistic approach such as Healthier Washington.
By prioritizing access to mental and behavioral health care, Healthier Washington illustrates the importance of comprehensive health care. Based on a model by Medicaid, it will increase state access to mental health care by integrating it with physical health care.
The Healthier Washington campaign also creates a place for newer models of delivering behavioral health care, like telepsychiatry. Telepsychiatry is the delivery of psychiatric assessment and care through technology, often videoconferencing. As component of telemedicine, the use of telepsychiatry has been promoted and increased in Washington due to a number of efforts by state legislators. One such effort is the Telemedicine Advancement Law, passed this past March. The new law establishes a collaborative of legislators, healthcare professionals and representatives from universities, hospitals and insurance carriers for the advancement of telemedicine.
Telepsychiatry offers several important benefits to individuals seeking behavioral health care . For people with hard-to-treat concerns who require specialty care, telepsychiatry allows them to connect with providers who specialize in their unique needs without having to spend hours in the car traveling back and forth. For individuals with mobility issues, even a specialist 5 miles away can be difficult to visit and connecting remotely makes getting care less stressful and more likely to be effective.
Washington state has taken other measures to promote the use of telepsychaitry and to increase access to mental health care. In 2014, state legislators banned psychiatric boarding, the involuntary detention of a mentally ill individual in a hospital ED setting while waiting for proper psychiatric treatment. 2016 has seen Washington continue to address issues surrounding psychiatric care in the state, including budget amendments to improve the retention of psychiatric providers and coordination with campaigns to improve mental health state-wide, like the Healthier Washington campaign.
In theory, any state willing to create a health care system can model it after Healthier Washington’s system. This system entails universal screening for mental and physical health, navigators to foster consumer engagement, co-locating centers for both behavioral and physical health to maintain accessibility (having the services offered in the same location), health homes for those with complex and serious mental health conditions and system-level integration of services to ensure holistic health care. By integrating mental and physical health care, Healthier Washington supports its citizens’ access to both, and by normalizing mental health care the state may effectively destigmatize the concept. This alone makes the system revolutionary, especially in the United States, where mental health and health care remain stigmatized and concealed. Watching Healthier Washington unfold is truly an exciting and transformative experience, and will hopefully encourage more states to take this holistic, consumer and cost friendly approach.
 Washington State Health Care Authority (2016). HCA Value‐Based Road Map, 2017-2021. Retrieved from http://www.hca.wa.gov/hw/Documents/vbp_roadmap.pdf
 Healthcare Transformation Task Force. Retrieved from http://www.hcttf.org/aboutus
 The Kaiser Commission on Medicaid and the Uninsured (2014). Integrating Physical and Behavioral Health Care: Promising Medicaid Models. Retrieved from http://www.integration.samhsa.gov/integrated-care-models/Kaiser_brief_on_integrated_health_2014.pdf
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