Topic Updates

Bree Collaborative MeetingJanuary 31, 2013

Potentially Avoidable Readmissions (PAR) Workgroup Update

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Summary of ProgressHave met twice since the last Bree Collaborative

meeting (6 meetings total)

Progress made in each of the 3 general areas:1. Alignment/support local readmission opportunities

2. Measurement, transparency, and reporting

3. New accountable payment models

Refined both of its recommendations, as requested by the Bree Collaborative (discussed in next slides)

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1. Alignment/support local readmission

opportunitiesRECAP – WSHA has worked with community partners to

develop a care transitions tool kit Includes best practices in both the inpatient and

community settings. Examples include:PCP notified of admission or immediately following ER visit (if

patient is moderate/high risk)Ensure PCP receives Discharge summary before appointmentHospital/PCP follow up call after dischargePrimary care visit checklistMedication reconciliation x 2

Tool kit will be modified based on findings from qualitative evaluations at pilot sites in Pierce and Spokane counties

PAR Workgroup is not recommending endorsement of specific components of the tool kit at this time, which are still a work in progress

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Recommended: Endorse “concept” of WSHA tool kit

The PAR Workgroup recommends that the Bree Collaborative formally endorse the concept that preventing avoidable readmissions requires:

1. A community-wide approach Hospitals cannot solve this problem alone Requires active engagement from primary care, home

health, hospice, community organizations, etc.

2. Standardization Every one doing it their own way has led to the chaos

that exists today; patients are the ones that suffer Providers have patients in multiple hospitals Variation in practice makes it very difficult for

community-based providers to engage w/ hospitals

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2. Measurement, transparency, and

reportingRECAP – WSHA and Qualis currently partner to

provide reports on all-cause readmission rates based on data from CHARS and CMSAggregate reports are shared, but not the

performance of individual hospitals Exception: WSHA publicly reports some hospital-

specific readmission rates, but they are disease-specific and limited to Medicare FFS patients

Two NQF-endorsed 30-day, all-cause measures will be released in 2013 from un-blinded sourcesPuget Sound Health Alliance: 3rd or 4th Qtr. 2013CMS: “During 2013”

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The PAR Workgroup recommends that the Bree Collaborative approve sending a letter to Qualis & WSHA that makes the following request:

Publish your 30-day, all-cause readmissions results, by hospital, in a semi-public manner,* starting with the next Hospital Readmission Report. Specifically:

Publish results in each Hospital Readmission Report & post results in a user-friendly way on your organization’s website

Publish results until all-cause data becomes available from the Puget Sound Health Alliance and CMS in 2013

*Publish data on public website but do not advertise or market the publication in an aggressive manner.

Proposal: Send letter to Qualis and WSHA

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3. New accountable payment models

PAR Workgroup plans to review APM subgroup products at its February meeting

Overlapping membership between PAR and APM groups maintains strong connection despite high level of autonomy granted to the APM group

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Other Plans for the Next Few Months

Review scope of the PAR report at March meetingStaff will work on interviewing stakeholders to

develop a proposal in advance of this meeting

Recruit a chair (no chair since August)

After refining its scope and deliverables, may add additional members to the groupFront line staff, such as case managersMore providers (strong sense of urgency in that

group)

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Questions? Comments?

Accountable Payment Model

(APM) Workgroup Update

Bree Collaborative MeetingJanuary 31, 2013

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Outline of PresentationOverview

Four Areas of Work

Work Completed to Date

Work in Progress

Next Steps & Looking Ahead

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OverviewHave met three times since the last Bree

Collaborative meeting (4 meetings total)

RECAP – Tasked with recommending a “common reimbursement model” for one episode of focusTotal Knee and Total Hip Replacement warranty

and bundle

Have reviewed national and local definitions and data from the Dartmouth High Value Healthcare Collaborative and bundle payment pilots in California (IHA) and Wisconsin (Meriter)

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Four Areas of Work to Define

Appropriateness Criteria (Pre-Op) BundleWarranty Quality

Outcomes

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Foundational Work Completed

Established criteria for selecting and creating accountable payment models

Adopted broad warranty definition (definition of warranty components almost completed)

Adopted broad bundle definition

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Criteria for Selecting & Creating Accountable Payment Model

ModelsAddresses overall goal: reduces costly avoidable

readmissions

Simple to implement and administer

Built on evidence/consensus-based best practices

Field tested (preferred)

Aligned with proven national metrics & programs

Performance-based reimbursement

Includes quality metrics

Aligned with reducing the cost of care

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Warranty Definition Adopted by the Group

Contract between provider and purchaser/payer

Provider will correct failure of their product at no additional cost to purchaser

Note: Purchaser/payer includes the following: individuals, health plans, self-funded employers, government purchasers (Medicare, Medicaid), small and large employers.

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Bundled Payment Definition Adopted by the

Group

Contract between provider and purchaser/payer to deliver a product for a fixed transparent price

Product contains only value-added elements specified by purchaser and no elements that are non-value added

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Progress in Developing Necessary Components

Direction from the PAR Workgroup

Progress of the APM Workgroup

Recommend episodes of focus

Completed – Selected total hip and knee replacement surgeries. PAR workgroup and Bree Collaborative both approved this focus.

Recommend warranty definition

Almost completed

Recommend bundle definition & quality measures

In progress

Recommend a price structure (but not actual prices)

Not started

Recommend bundle payment contracting• Prospective vs.

retrospective• Unbundling guidelines

Not started

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Warranty Components Under Discussion

Complications (no additional payment under the warranty)Working list: Mechanical, bledding, infection,

death, pulmonary, stroke, cardiac

Post-operative period (of warranty)Tentative agreement to use 60 day coverage

periodPursuing additional analyses

Need to decide whether begins on date of admission from surgery or discharge date

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Bundle Components Under Discussion

Bundle definitionMember eligibilityCovered services and exclusionsEpisode time window

Appropriateness criteriaExample criteria reviewed

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Next Steps & Looking Ahead

Identify context experts physicians who are familiar with the evidence base to give input on draft materials

On track to complete bundle design by end of Q2 2013

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Questions? Comments?

Obstetrics Implementation

Update

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Actions Taken Since Last Meeting

Contacted Executive Director at Association of Washington Healthcare Plans (AWHP) about giving a presentation at an upcoming meeting 15 health plans are AWHP members, including all of the

Basic Health plans

Working with HCA staff on the implementation of the HCA Administrator’s decision to adopt the recommendations Promote widespread adoption of clinical data to capture

labor and delivery practices Add Bree goals to Medicaid Quality Incentive Program Increase patient education (PEBB, Maternity Support

Services)

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Questions? Comments?