Workers’ Comp Advisory Committee-Health Care Subcommittee: Transition July 25, 2013 Joint Meeting with the Provider Ne

1. Workers’ Comp Advisory Committee-Health Care Subcommittee: TransitionJuly 25, 2013 Joint Meeting with the Provider Network Advisory Group

2. Prior to the restructure… Provider Network Advisory Group WCAC- Health Care Subcommittee • Mandated by SSB 5801 • Role: Advise L&I on implementation of SSB 5801 (not limited to the Medical Provider Network) • 4 medical providers designated by the Industrial Insurance Medical Advisory Committee • 2 chiropractors designated by the Industrial Insurance Medical Chiropractic Committee • 2 business / 2 labor representatives designated by WCAC caucus chairs • Not required by statute • Role: Support creation and oversight of Centers of Occupational Health & Education and related pilots • 4 business / 4 labor representatives designated by WCAC • 4 L&I representatives • 1 BIIA representative

3. Changes approved in June by the Workers’ Compensation Advisory Committee • Add 1 business and 1 labor representative to the Provider Network Advisory Group, designated by WCAC caucus chairs • Discontinue the WCAC-Health Care Subcommittee • Expand scope of the Provider Network Advisory Group to encompass the WCAC-HC’s role

4. ACCOMPLISHMENTS OF THE WCAC-HEALTH CARE SUBCOMMITTEE 1997-2013

5. Occupational Health Services Project Final Report Completed September 1998 Goals / Guiding Principles • Expand capacity for occupational medicine delivery systems. • Increase provider accountability for delivery of efficient and effective care with improved outcomes. • Improve worker and employer satisfaction. • Retain the voluntary nature of the worker’s current ability to select providers. • L&I could use economic incentives to encourage participation.

6. Research-Conducted by the UW • Key informant interviews • Expert panels • Literature searches • Trade journals and newsletters • Web sites

7. InitialWork on Policy Options Policy Options Explored • Develop systems to track worker and employer satisfaction with health care. • Develop an outcome tracking system to monitor provider performance. • Develop and/or select occupational health centers of excellence to promote improved quality of care, timely return to work, and more effective primary injury prevention.

8. Policy Options Explored (continued) • Develop new contracting and payment mechanisms to provide for greater accountability, enhance the overall quality of care, promote access and availability of high quality providers, and activities such as provider-employer communication and primary prevention activities. • Develop new mechanisms for claims processing to improve administrative efficiency and reduce administrative burden for providers. • Develop economic incentives to encourage workers to use selected providers.

9. Finding Sites for Initial COHE Pilots Choosing COHE(s) • Drafting the RFP • Two business and two labor evaluators • Reviewed all proposals • Selected Valley Medical Center as first COHE (2002) • Selected St Luke’s Rehabilitation Institute as second COHE (2003) • Lobbied legislature for funding

10. New Sites Added in 2007 Seed COHEs • Recognized interest in developing “seed” COHEs • Helped draft RFP • Business and labor evaluators • Selected two seed COHEs • The Everett Clinic-testing effectiveness of HSC model • Harborview-testing effectiveness of model in emergency department

11. End of Pilot Phase June 1, 2009 WCAC Meeting • Approved COHE moving from project status to L&I’s standard way of doing business • Approved continuation of WCAC-Health Care Subcommittee in its advisory role • Requested opportunity for business and labor input on a more detailed workplan

12. COHE Results • Through June 2013: ~2,000 providers in four COHEs • COHEs reduce disability and reduce costs • 4.1 day reduction in time-loss per claim • $480 net gross savings per claim in 1st year

13. COHE Future Substitute Senate Bill 5801 (2011) (5)(a) The legislature finds that the department and its business and labor partners have collaboratedin establishing centers for occupational health and education to promote best practices and prevent preventable disability by focusing additional provider-based resources during the first twelve weeks following an injury. The centers for occupational health and education represent innovative accountable care systems in an early stage of development consistent with national health care reform efforts. Many Washington workers do not yet have access to these innovative health care delivery models. (b) To expand evidence-based occupational health best practices, the department shall establish additional centers for occupational health and education, with the goal of extending access to at least fifty percent of injured and ill workers by December 2013 and to all injured workers by December 2015.

14. Timeline for COHE Expansion Public meetings to recruit additional COHE sponsors – Fall 2011 Draft Request for Proposals – Fall 2012 Review proposals and select new COHE sponsors – Spring 2013 New contract period – July 1, 2013 through June 30, 2016

15. WCAC-HC Membership—Labor Caucus

16. WCAC-HC Membership—Business Caucus

17. WCAC-HC Membership—BIIA THANK YOU!!!

18. Discussion: Expanded Role of the Provider Network Advisory Group going forward Draft list (for input): • Provide a venue for business, labor, and providers to advise on L&I health care programs • Continue monitoring and advice on Provider Network implementation • Finalize rules and policies on Top Tier eligibility and incentives • Review “Risk of Harm” criteria for network removal • Support COHE expansion statewide • Advise on development and piloting of new occupational health best practices • Support self-insured participation in COHEs and/or other health care initiatives • Provide updates to WCAC on reform implementation and other issues

19. Discussion: Expanded Role of the Provider Network Advisory Group going forward Opportunity for comments from WCAC-HC members: • What important work from the WCAC-HC needs to be continued? • What emerging issues need to be addressed? • Any advice on ways to make this effort successful?