Transcript Topic Updates

Presentation to the Bree Collaborative
November 30, 2012
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Obstetrics – Informational/discussion
◦ Implementation Plan
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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
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HCA administrator announced 10/24 OB recommendations
will be applied to state purchased programs
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Extensive outreach to hospitals
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Moderate outreach to health plans
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Thank you to Bree members for sending the report to your
contacts (& keeping me posted)! See Handout
◦ 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
◦ 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
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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
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Limited resources for outreach to employers
◦ Any thoughts about how to target this group?
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Limited resources for evaluation
◦ Ideas to measure “reach”?
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Adapting to a changing environment
◦ Should we revisit the OB report in the future?
◦ If so, when?
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Questions? Feedback?
5
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PAR met twice since last Collaborative
meeting, 4 meetings total
◦ Meeting #3 on 10/17
◦ Meeting #4 on 11/14
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RECAP - Developing recommendations in 3
general areas:
1. How to support/endorse existing readmission
efforts
2. Measurement, Reporting, and Transparency
3. Accountable Payment Models and Reforms
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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, semipublicly
Agreed on initial directions for the APM
subgroup (next slide)
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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
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Guidance informed by 10/12 Payment Reform
webinar by Harold Miller & Francois de Brantes
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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
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Agreed upon the importance of establishing
common metrics for all-cause PAR
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PAR proposes these actions now:
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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
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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
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Quality measures & appropriateness of care
should be considered throughout
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Next steps
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Criteria for Selecting APM models:
◦ 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
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Addresses overall goal: reduces avoidable readmissions
Simple to implement and administer
Field tested
Aligned with national metrics & programs
Includes quality metrics
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Questions or comments about the APM
subgroup?
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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
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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
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Next meeting: December 7th
Start identifying assessment instruments and
evidence-based best practices for acute low
back pain
Questions? Feedback for the Spine workgroup?
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