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Washington State Medical Home / Health Care Transformation Activities

Formal medical home efforts in Washington have expanded in the past several years from an initial focus on improving care for children with special health care needs to improving care for everyone of all ages and abilities.

The Transforming Clinical Practice Initiative is a national effort by the Centers for Medicare and Medicaid Services (CMS) to engage 140,000 clinicians in transformation of their practices to prepare for value-based payment and improve outcomes for their patients. Twenty-nine Practice Transformation Networks (PTN) were selected by CMS to be the agents of change in their regions.  See map here.

Washington is fortunate to have four PTNs funded in our state. The University of Washington, the Rural Health Accountable Care Consortium and PeaceHealth PTNs are actively recruiting and engaging adult and family care providers. P-TCPI is the only initiative in Washington state dedicated to supporting pediatric providers and improving child health.

Pediatric Transforming Clinical Practice Initiative (P-TCPI)

P-TCPI, is uniquely focused on improving child health. In fact, we are one of only two pediatric focused PTNs in the country. Guided by the CMS “Change Package,” we offer support to primary care providers in transforming their practices and improving population health.


  • Increase well child visits
  • Increase immunization rates
  • Improve behavioral health
  • Improve asthma management
  • Decrease avoidable use of the emergency room
  • Increase care coordination

Nine regions or Accountable Communities of Health (ACH) in Washington state will each have a P-TCPI team on the ground to support practice transformation. Each team includes a Practice Facilitator, a Physician Champion (who is a local, practicing primary care provider) and a Behavioral Health Champion from a community mental health center.

To learn more about the project contact: Kathleen Clark at the Washington State Department of Health ( or Sarah Rafton at WCAAP (

Healthier Washington – Transforming Health Care in Washington State

  • Healthier Washington will transform health care in Washington State so that people experience better health during their lives, receive better care when they need it, and care is more affordable and accessible. We are in the early stages of a five-year Health Care Innovation Plan that has brought together hundreds of people from many communities to put the best solutions to work for the people of our state. This work will improve the quality of life for everyone regardless of their income, education or background.
  • The state Health Care Innovation Plan is supported by foundational legislation signed by Governor Jay Inslee in 2014 and a federal grant from the Center for Medicare and Medicaid Innovation.The Healthier Washington initiative will:
    • Build healthier communities and people through prevention and early attention to disease
    • Integrate care and social supports for individuals who have both behavioral and physical health needs
    • Reward quality health care over quantity, with state government leading by example as Washington’s largest purchaser of health care
  • Innovation Plan Documents: (From one page summary to full plan)
  • To receive regular updates on Healthier Washington, sign up to join the Feedback Network and follow Facebook for news and links to our social media announcements.

Washington Chapter of the American Academy of Pediatrics (WCAAP)

The WCAAP partners with communities on a number of active initiatives to improve children’s health.  Current projects include:

 Washington State Medicaid “Health Homes”

Medicaid Health Homes Implementation Update:  Medicaid health homes, made possible through the Affordable Care Act, provide states with a mechanism to support better care management for people with complex health needs with the goal of improving health outcomes and curbing costs. As of September 2015, Washington State and 18 other states and the District of Columbia have 27 approved Medicaid health home models in operation. This fact sheet from the Center for Health Care Strategies describes how states are using the health homes opportunity.

Medical Homes for Patients who are Aged, Blind or Disabled

  • The Department of Social and Health Services (DSHS) was mandated by Section 4 of E2SSB 5930 to work with the Dept. of Health to design and implement Medical Homes for clients who are aged, blind or disabled. This is to be done in conjunction with current chronic care management programs to improve health outcomes, access and cost-effectiveness. DSHS is also mandated to consider expansion of existing Medical Home and chronic care management programs and to build on the WA collaborative initiative.

Washington State Medical Home Leadership Network

  • County-based volunteer teams of pediatricians and other primary care providers, public health nurses, early intervention professionals and parents who work locally to improve medical homes for children and youth, especially those with special health care needs. Technical assistance provided by the Washington State Medical Home Partnerships Project through a contract with the Washington State Department of Health’s Healthy Starts and Transitions Unit.

Washington State  Department of Health, Medical Home-related Grants for CSHCN

  • Washington State LAUNCH II (Linking Actions for Unmet Needs in Children’s Health). Washington State received a second grant in 2015 to build on the original grant and expand the project to new communities.  The purpose of the federal Project LAUNCH is to promote the wellness of young children ages birth to 8 by addressing the physical, social, emotional, cognitive, and behavioral aspects of their development. The long-term goal of Project LAUNCH is to ensure that all children enter school ready to learn and able to succeed. Project LAUNCH seeks to improve coordination across child-serving systems, build infrastructure, and increase access to high-quality prevention and wellness promotion services for children and their families. More information about LAUNCH II.
  • Great LINCS (Links to Integrate and Coordinate Services for CYSHCN) – Great LINCS abstract, Great LINCS fact sheet
  • Great MINDS – Medical Homes Include Developmental Screening – current (2015-2016) version of training project housed at the Washington Chapter of the American Academy of Pediatrics
  • Great MINDS– Medical Homes Include Developmental Screening (July 2011-2015)
    Grantee: Washington State Dept. of Health Funder: US Dept of Health and Human Services

Safety Net Medical Home Initiative

  • Two Washington State not-for-profit health care improvement organizations, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute, have joined with the national Commonwealth Fund to develop the Safety Net Medical Home Initiative. This initiative helps primary care safety net clinics become high-performing patient-centered medical homes. The goal of the Safety Net Medical Home Initiative is to develop a replicable and sustainable implementation model for medical home transformation. Visit the website information about what a medical home is and how to transform your clinic into a medical home.

National Summaries of Washington State Activities

Washington State Medical Home Fact Sheets and Brochures

See Brochures page

National Medical Home Endorsements

The Medical Home Concept has been endorsed as the standard of care by a growing number of health care provider organizations and other groups. The terminology used by organizations can vary slightly and includes “medical home,” “personal medical home,” “pediatric health care home” and “advanced medical home”. National organizations endorsing medical home include:

The American Academy of Family Physicians, American College of Physicians (internists), American Osteopathic Association and American Academy of Pediatrics
Joint Principles of the Patient-Centered Medical Home (March 2007, PDF file: 3 pages). This is an important step forward in promoting medical home throughout the healthcare system.

The American Academy of Pediatrics
Medical Home Policy Statement

National Association of Pediatric Nurse Practitioners

American Academy of Pediatric Dentistry
Policy on the Dental Home (PDF file: 2 pages)

The professional organizations above have joined with over 500 other organizations in the national Patient Centered Primary Care Collaborative to promote medical homes. The PCPCC is a coalition of major employers, consumer groups, patient quality organizations, health plans, labor unions, hospitals, physicians and many others who have joined together to develop and advance the patient centered medical home. Many organizations and businesses have joined from Washington State, including Microsoft, Group Health Cooperative, Puget Sound Health Alliance, and Seattle Children’s.

Medical Home and Health Care Transformation information developed or last updated ….