Washington State Medical Home and Health Care Transformation Activities

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

Healthier Washington – Transforming Health Care in Washington State

  • Healthier Washington  is designed to 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.
  • 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:
    • Builds healthier communities and people through prevention and early attention to disease
    • Integrates care and social supports for individuals who have both behavioral and physical health needs
    • Rewards quality health care over quantity, with state government leading by example as Washington’s largest purchaser of health care
  • 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.

Accountable Communities of Health

Accountable Communities of Health (ACHs) are a critical strategy for health care transformation in in Washington State.  The ACHs bring together leaders from multiple health sectors around the state with a common interest in improving health and health equity. As ACHs better align resources and activities, they support wellness and a system that delivers care for the whole person. See the video.

There are nine ACHs. Their boundaries align with Washington’s Medicaid regional service areas. View the ACH regions map. You can learn more about the work of your ACH by going to its website.  Sign up for the newsletter as an easy way to keep up.  ACH Contact List  and Health Care Authority webpage.

WA State Practice Transformation Support Hub

Healthier Washington supports transformation of the health delivery system through investment in knowledge, training, and tools, that effectively coordinate care, promote clinical-community linkages, and transition to value-based care.

Resources available through the Hub include:

  • WAportal.org: Web-based Resource Portal that provides a clearinghouse of curated resources and training.
  • A regional Health Connector network.
  • Coaching, facilitation and training services.

US Centers for Medicare and Medicaid Services (CMS) Transforming Clinical Practice Initiative

The Transforming Clinical Practice Initiative is a national effort by CMS to engage 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 has four PTNs funded in our state. The Pediatric Transforming Clinical Practice Initiative (P-TCPi) is one of only two PTNs nationally supporting pediatric providers to improve child health.  In addition, the University of Washington, the Rural Health Accountable Care Consortium and PeaceHealth PTNs are engaging adult and family care providers to transform the care they provide.

Pediatric Transforming Clinical Practice Initiative (P-TCPI)

P-TCPI is a unique partnership between the Washington Chapter of the American Academy of Pediatrics, Molina Healthcare, and the Washington State Department of Health. Together, we are advancing child health priorities in statewide transformation efforts and helping providers prepare for the new payment paradigm while leveraging the patient-centered medical home model to improve the health of children.  Over 2000 primary care providers, behavioral health clinicians and licensed specialty health care providers are enrolled.


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

There are nine P-TCPI teams on the ground to support practice transformation. Teams typically include a Practice Facilitator, a Pediatrician Champion and a Behavioral Health Champion from a community mental health center.  For one year (2017-18) each team also included a public health nurse Regional Care Facilitator who identified key care coordinators and other resources for children and their families, gaps in the care coordination system, and how to address key gaps.

See the WA P-TCPI website for great resources for primary care providers and behavioral health clinicians who see children or contact Melissa Thoemke, P-TCPI Program Manager melissa.thoemke@doh.wa.gov 

Medicaid Managed Care Quality Improvement Projects

The Health System Unit (HSU) at Washington State Department of Health supports the Medicaid managed care organizations (MCOs) to:

  • Work collectively and collaboratively to promote positive health outcomes for WA residents.
  • Address the needs for systemic change to achieve health equity.

HSU provides accurate, relevant, timely data/info to support the collaborative MCO quality improvement projects.

As of early 2019 the focus of this work is two-fold:

  • Raising the rate of annual checkups for children 0-20 years of age
  • Increasing health equity for Spanish-speaking adults by  reducing stigma associated with depression and use of antidepressant medication, and improving availability and access to culturally and linguistically appropriate care.

National Summaries of Washington State Activities