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He says the process, which includes risk adjustment and quality metrics, allows all Premera patients to be part of the payment system. "There's no change in product and nothing needs to be rolled out member by member." That means no new contract negotiations. To keep things simple, Premera adopted the quality metrics used in the state's medical home program.

An added plus: physicians can simply add their Premera patients to existing programs. There's no need to develop special programs exclusive to Premera members. Maturi explains that one clinic already had in place a program to manage high-risk, multi-chronic disease patients, which included a team of primary care physicians, nurse care managers, pharmacists, and behavioral health specialists. As part of the global outcomes contracting the clinic wants to include Premera's high risk patients in the existing program.

Premera began signing up physicians for the payment model in 2010. Acceptance is building in a state that is not well known for its acceptance of managed care or capitated payments. To date, 100,000 Premera members, about a quarter of its membership, are provided care under the global outcomes contracting model. Twelve physician groups, including The Everett Clinic, and one IPA are part of the program.