1. New Topic Selection Bree Collaborative Meeting July 18, 2013

2. Today’s Goal Prioritize topic areas the Bree will focus on over the next 3 – 5 years Prioritization will help inform the State Health Care Implementation and Transformation Effort 2

3. Outline of Presentation Status of current projects/timing of new topics Description of new topic areas & suggested foci Description of criteria used to prioritize new topics Recommendations Roles of workgroups and Bree after new topic areas selected 3

4. Project Dashboard as of 7/18/13 Active TopicsStatus Avoidable Readmissions workgroupCurrently under construction; will be reconvened Fall 2013 Accountable Payment Model subgroup (subgroup of Readmissions workgroup) Target date for final product adoption by Bree: November Spine/low back pain workgroupTarget date for final product adoption by Bree: November Implementation TeamTarget date: Fall 2013 New topicTarget date: December/January 4 GOAL = 3 active workgroups

5. Genesis of Topic Areas & Prioritization Criteria Topic areas: Bree Retreat Priorities of WA Agency Medical Director’s Group (AMDG) Medicaid/PEBB, L&I, Dept of Corrections, DOH, Veterans Affairs Last topic selection exercise Criteria: Bree Statute Bree Retreat 2 Categories: 1) Primary, and 2) Secondary 5

6. Selection Criteria Substantial variation in practice patterns - high utilization and/or cost growth trends in WA – source of waste and inefficiency in care delivery Patient safety issues Significant direct and indirect costs Proven means/strategies to address topic & Implement-ability Not addressed elsewhere/Bree fills unique role Is it a priority of the state? Other criteria (in second table) Data/evidence of waste; Choosing Wisely available; Shared Decision-Making available; Health Technology Assessment Topic; and equity issue 6

7. Process Once Resources Available for New Topic 7 Workgroup members identified, selected, and finalized 1 or 2 months before workgroup convened Workgroup adopted by Bree Workgroup Formed During the first 1-2 meetings Makes recommendation to Bree Bree adopts focus area(s) Workgroup Refines Focus Area(s)

8. 7 Proposed Topic Areas Rec:Proposed TopicsSuggested Focus/foci 1 Addiction/dependence treatment Management of chronic pain/opioids; treatment of dependence and addiction 1 End of Life/Advanced Planning Intensity of services at end of life 3Elective surgeries Standards across all surgeries; perioperative opioid use in opiate tolerant patients 4 Inappropriate ER Use/Potentially Avoidable ER use Strengthen care coordination 5Oncology Proton beam therapy; biologics 6Colonoscopy Appropriateness of standards of care 7Obesity Role of delivery system in management 8

9. Timeline of Next New Topic Target start date for new topic: December/January 2014 Proposed slate of workgroup members will be presented at September or November meeting Bree review/update topic list annually, in July 9