Rising health insurance rates are driven in part by more people getting care and the increasing cost of that care. Helping people stay healthy starts with reliable access to primary care. Yet the way we pay for primary care today makes it harder for providers to deliver the services people need. Commissioner Kuderer is proposing to develop a new model for financing and paying for primary care.

It’s the foundation of a high-performing, affordable health care system 

Primary care helps prevent illness, manage chronic conditions, and reduce avoidable emergencies and hospital care. Yet, many Washingtonians currently struggle to access routine primary care, even with insurance. 
A shortage of primary care providers, long wait times, and administrative burdens are making it harder for people to access the primary care they need. 

Lack of access leads to higher costs and worse outcomes

When people cannot access primary care, they delay treatment, rely on urgent care or emergency rooms, and their chronic conditions worsen. About 40% of ER visits could be avoided with better access to primary care (PDF, 910 KB).

How it’s financed and paid for today is not working

Currently, most primary care providers are paid for each individual test or visit they provide. This creates extra paperwork for coding, billing, and getting insurance approval. 

There are already examples in our state of innovative ways of delivering primary care with simpler payment models, such as a set monthly enrollment fee. These models create steady, predictable income for providers, reduce burnout, and allow them to spend more time on patient care. However, they’re not available for most Washingtonians. 

We need a new way to finance and pay for primary care

Commissioner Kuderer will request legislation during the 2027 legislative session to start the work to design a new model for financing and paying for primary care.

The model would: 

  • Pool existing primary care funding across payers into a shared fund.
  • Pay providers through predictable monthly payments, instead of through fee-for-service billing.
  • Reduce administrative burden and overhead. 
  • Strengthen access to preventive, coordinated, comprehensive care. 

Benefits include: 

  • Long term savings from reduced emergency department care and administrative burden. 
  • Improved workforce stability and recruitment.
  • Improved access to primary care, including routine preventive care and screenings, chronic care management, and connection to behavioral health services.
  • Reduce avoidable emergency room and hospital visits, and potentially lower overall healthcare costs.