Transcript Topic Updates

Topic Updates
Bree Collaborative Meeting
January 31, 2013
Potentially Avoidable
Readmissions (PAR)
Workgroup Update
Summary of Progress
 Have 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)
3
1. Alignment/support
local readmission opportunities
 RECAP – 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 appointment
Hospital/PCP follow up call after discharge
Primary care visit checklist
Medication 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
4
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
5
2. Measurement,
transparency, and reporting
 RECAP – WSHA and Qualis currently partner to
provide reports on all-cause readmission rates based
on data from CHARS and CMS
 Aggregate 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 sources
 Puget Sound Health Alliance: 3rd or 4th Qtr. 2013
 CMS: “During 2013”
6
Proposal: Send letter to
Qualis and WSHA
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.
7
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
8
Other Plans for the
Next Few Months
 Review scope of the PAR report at March meeting
 Staff 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 group
 Front line staff, such as case managers
 More providers (strong sense of urgency in that group)
9
Questions? Comments?
10
Accountable Payment
Model (APM)
Workgroup Update
Bree Collaborative Meeting
January 31, 2013
Outline of Presentation
 Overview
 Four Areas of Work
 Work Completed to Date
 Work in Progress
 Next Steps & Looking Ahead
12
Overview
 Have met three times since the last Bree Collaborative
meeting (4 meetings total)
 RECAP – Tasked with recommending a “common
reimbursement model” for one episode of focus
 Total 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)
13
Four Areas of Work to Define
Appropriateness
Criteria (Pre-Op)
Warranty
Bundle
Quality
Outcomes
14
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
15
Criteria for Selecting & Creating
Accountable Payment Model Models
 Addresses 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
16
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.
17
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
18
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
19
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 period
 Pursuing additional analyses
 Need to decide whether begins on date of admission from
surgery or discharge date
20
Bundle Components Under
Discussion
 Bundle definition
 Member eligibility
 Covered services and exclusions
 Episode time window
 Appropriateness criteria
 Example criteria reviewed
21
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
22
Questions? Comments?
23
Obstetrics
Implementation
Update
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)
25
Questions? Comments?
26