Presentation to the Bree Collaborative November 30, 2012

 Obstetrics – Informational/discussion ◦ Implementation Plan  Potentially Avoidable Readmissions (PAR) Workgroup & Accountable Payment Model (APM) Subgroup – Proposed Action  Spine/Low Back Pain – Informational/discussion * COAP presentation will address Cardiology topic after the break 2

 HCA administrator announced 10/24 OB recommendations will be applied to state purchased programs  Extensive outreach to hospitals ◦ WSHA sent to leadership, obstetrics providers, & public policy leads at all hospitals in WA that provide OB care ◦ Sent to OB COAP Contacts (9 hospitals) ◦ Sent to Boards of 13 Hospitals  Moderate outreach to health plans ◦ Sent to leadership of 15 plans, including every AWHP member and all of the Medicaid plans ◦ Sent to WA State Perinatal Collaborative and Perinatal Advisory Committee  Thank you to Bree members for sending the report to your contacts (& keeping me posted)! See Handout 3

 HCA staff is working on implementing OB recommendations  Idea – Invite HCA staff to February 1 st meeting to discuss their implementation plans and progress, offer input  Continue outreach 4

 Limited resources for outreach to employers ◦ Any thoughts about how to target this group?  Limited resources for evaluation ◦ Ideas to measure “reach”?  Adapting to a changing environment ◦ Should we revisit the OB report in the future? ◦ If so, when?  Questions? Feedback? 5

 PAR met twice since last Collaborative meeting, 4 meetings total ◦ Meeting #3 on 10/17 ◦ Meeting #4 on 11/14  RECAP - Developing recommendations in 3 general areas: 1.How to support/endorse existing readmission efforts 2.Measurement, Reporting, and Transparency 3.Accountable Payment Models and Reforms 6

 Proposed the adoption of an all-cause PAR approach rather than focusing on a specific disease  Proposed asking Qualis and WSHA to publish 30-day all-cause readmission data, semi- publicly  Agreed on initial directions for the APM subgroup (next slide) 7

 APM group should make recommendations on the following topics: ◦ Episodes of focus ◦ Bundle definition ◦ Price structure (but not actual prices) ◦ Bundle payment contracting (prospective vs. retrospective) ◦ Implementation timeline  Guidance informed by 10/12 Payment Reform webinar by Harold Miller & Francois de Brantes 8

 WSHA presented their care transitions tool kit ◦ Lots of work has gone into creating tool kit; many stakeholders participated in development ◦ Piloting in Pierce County now; Spokane County, early next year ◦ Pilot Results Expected Spring 2013 ◦ Supporting and reinforcing the great work done to date is needed to drum up enthusiasm for the tool kit  Agreed upon the importance of establishing common metrics for all-cause PAR 9

PAR proposes these actions now:  Send letter to Qualis and WSHA asking them to publish 30-day all-cause readmission data, semi-publicly  Endorse “concept” of the WSHA tool kit, but wait to endorse components or entire tool kit until pilot results are known ◦ Send letters to pilot communities & other stakeholders recognizing the work of WSHA and its partners 10

 First APM subgroup meeting held on 11/6 ◦ Identified the following scope:  Initial work = defining components for warranty pricing and bundled payments  Focus: total hip and knee replacement surgeries  At some point, APM group or another entity of the Collaborative should identify strategies for shifting towards a total cost of care model ◦ Goal = produce warranty pricing and bundled payments recommendation within 6 months  Quality measures & appropriateness of care should be considered throughout 11

 Next steps ◦ Define warranty (with or separate from TKR and TNR) ◦ Start defining TKR and THR bundles ◦ Gather information from other bundling efforts including Regence/Premera ◦ Identify other financial incentives/levers that meet criteria below  Criteria for Selecting APM models: ◦ Addresses overall goal: reduces avoidable readmissions ◦ Simple to implement and administer ◦ Field tested ◦ Aligned with national metrics & programs ◦ Includes quality metrics 12

Questions or comments about the APM subgroup? 13

 RECAP - Direction from the BC: form workgroup to recommend appropriate management strategies for acute low back pain  First APM subgroup meeting held on 11/8 ◦ Roundtable discussion of the biggest barriers to improvement and areas of opportunity for the Collaborative  Good guidelines exist, but lack of standardization  Patient expectations/patient education needed  More attention needed to function, less to pain  Focus on Acute low back pain vs. disabling low back pain ◦ Identified initial focus: recommendations about the management of back pain in the first 4 weeks; need for patient education and operationalizing what we already know 14

 Next meeting: December 7 th  Start identifying assessment instruments and evidence-based best practices for acute low back pain Questions? Feedback for the Spine workgroup? 15