AWHP Health Care Goals
Health plans have a responsibility to their members to keep health care costs as affordable as possible. We assist in accomplishing this through monitoring legislative and regulatory proposals for their impact on premiums and health care costs. We constructively engage with policy-makers to mitigate those impacts where possible.
Health plans also negotiate with providers and facilities for the lowest reasonable payments for services. This helps their members pay less out of pocket and helps minimize premium rate increases.
Access to Care
Carriers form high-performing networks of quality providers and facilities. These networks of providers and facilities are selected for their ability, the health outcomes of their patients, and their ability to deliver the services covered by a member’s health plan.
Quality of Care
All providers and facilities in a health plan's network are credentialed. This means the health plan confirms a provider’s Washington state license to practice is active, and that their history qualifies them to deliver services to health plan members.
Health plans employ medical directors and case managers to help their network of providers identify the best course of treatment for their members, especially members with complex or chronic health conditions. Health plans also ensure their drug formulary includes drugs in every therapeutic category identified by the Food & Drug Administration.
Health Plans also provide information to providers and facilities about the health of their members that they treat. Providers and facilities then use this information to understand what approaches to care are working, and to identify trends and gaps in patient care. This improves the quality of care for all Washingtonians.
Keeping Coverage Affordable
- Federal Changes to the Affordable Care Act
- Individual & Small Group Market Stability
- Administrative Cost Management & Minimum Loss Ratios
- State Health Benefit Exchange
- Behavioral Health Integration
- Medicaid Rate Reasonableness
Solving Health Care Problems
- Opioid Crisis
- High-Cost Drugs
- Balance Billing
- Access to Care
- All Payer Claims Database
New Laws & Regulations
- 2018 Legislature
- Recently Adopted Regulations