Fireside Chat: Medicaid in the Pacific Northwest
August 31, 2023 · Tom Curtis
It isn’t every day that climate change and Medicaid are discussed in the same sentence. But that’s exactly what you get when you talk to Dr. Christopher Chen, the Medicaid Medical Director in Washington State—and for good reason.
As Dr. Chen puts it, “Health care takes up 20% of the economy and 9% of carbon emissions in the US. We [US health care] have the largest footprint worldwide—larger than the UK’s total carbon emissions.”
Washington is used to juggling multiple, diverse issues simultaneously. Before it became a state, it had to battle “the other Washington” for its name. It was first suggested that Washington State be called “Columbia,” but there were concerns it would be confused with the District of Columbia. “Washington” won out.
Washington’s geography embraces mountain ranges, tropical rain forests, farmland, ocean waters and islands. It is home to the sixth highest population of Indigenous peoples in the country. When Dr. Chen sat down with NCQA President, Peggy O’Kane, their conversation meandered like the Columbia River through the heaviest topics in health care today: payment reform, primary care support, behavioral health, digital quality measurement and—yes—climate change.
It was a refreshing and rejuvenating chat between two like-minded, dedicated advocates. Washington State has tied 90% of Medicaid payments to value-based measures. But, even when the FFS infrastructure supports essential aspects of the health care system like primary care and behavioral health, there remains disparity in payment between Medicaid and commercial insurance. Transparency and close partnerships with Medicaid MCOs are imperative to supporting primary care in value-based models.
Washington State is participating in CMMI’s Making Care Primary initiative to address the payment disparity and burden on primary care. “Good primary care leads to better equity, better outcomes, reduced hospitalizations [and] reduced ED visits, and builds stronger relationships and better decisions” says Dr. Chen.
“Complexity is the name of the game in health care in America. So is fragmentation. It manifests itself in health care organizations across America, and the software it implements.” Dr. Chen’s advice to Peggy on digital quality measurement: that NCQA and others take the provider’s needs into account.
This invigorating discussion included heartfelt admiration and optimism on both sides. When asked to provide counsel for emerging leaders in health care improvement and innovation, as someone who has been a driving force in health care for decades, Peggy said: Continue to grow. Stay committed to people and populations. Fight for human health.
