Washington's Medicaid Transformation Project: Engaging the health care and social service sectors to improve health care delivery and address the social determinants of health

Across the US, states have initiated reforms to improve population health by coordinating efforts among health care stakeholders and addressing health-related social needs. Washington State's Medicaid Transformation Project (MTP), launched in 2017, seeks to achieve these goals by supporting the state's Accountable Communities of Health, independent organizations that convene and coordinate the health care and social service sectors in nine regions of the state. MTP places Medicaid funds in the hands of ACHs for the purpose of building health system capacity and carrying out health improvement projects. It includes new supports for aging, housing and employment, and substance use disorder treatment. Early lessons from MTP are emerging that can inform health system transformation efforts in other states. MTP demonstrates the advantages of creating new organizations to serve as regional conveners and coordinators. However, the introduction of new entities will require states to clearly articulate the varying roles of these entities and existing managed care organizations and state agencies. States will need to balance the tradeoffs of local control versus centralization. For example, it may be optimal to standardize electronic health information exchanges but allow organizations flexibility to adopt other interventions that match their local context. In addition, states should build treatment and comparison groups into their program designs in order to generate high-quality evidence about the impact of new health care delivery and payment models.