Topic Updates

1. Topic Updates Presentation to the Bree Collaborative November 30, 2012

2. Overview • 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

3. Obstetrics – Successes (since last BC meeting 10/1) • 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

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

5. Obstetrics - Challenges • 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?

6. Potentially Avoidable Readmissions (PAR) • 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: • How to support/endorse existing readmission efforts • Measurement, Reporting, and Transparency • Accountable Payment Models and Reforms

7. PAR workgroup meeting #3 held on 10/17 • 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)

8. Guidance from PAR Workgroup to Accountable Payment Model (APM) Subgroup • 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

9. PAR workgroup meeting #4 held on 11/14 • 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

10. Potentially Avoidable Readmissions – Proposed Action Items 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

11. Accountable Payment Model (APM) Subgroup • 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

12. Next APM Meeting 12/4 • 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

13. Questions? Feedback? Questions or comments about the APM subgroup?

14. Spine/Low Back Pain Workgroup • 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

15. Spine/Low Back Pain Workgroup, Con’t • Next meeting: December 7th • Start identifying assessment instruments and evidence-based best practices for acute low back pain Questions? Feedback for the Spine workgroup?