Topic UpdatesPresentation to the Bree Collaborative

November 30, 2012

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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

Overview

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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

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

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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

Obstetrics – Next few months

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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?

Obstetrics - Challenges

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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:1. How to support/endorse existing readmission

efforts2. Measurement, Reporting, and Transparency3. Accountable Payment Models and Reforms

Potentially Avoidable Readmissions (PAR)

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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, semi-publicly

Agreed on initial directions for the APM subgroup (next slide)

PAR workgroup meeting #3 held on 10/17

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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

Guidance informed by 10/12 Payment Reform webinar by Harold Miller & Francois de Brantes

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

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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

Agreed upon the importance of establishing common metrics for all-cause PAR

PAR workgroup meeting #4 held on 11/14

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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

Potentially Avoidable Readmissions – Proposed Action Items

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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

Quality measures & appropriateness of care should be considered throughout

Accountable Payment Model (APM) Subgroup

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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

Next APM Meeting 12/4

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Questions or comments about the APM subgroup?

Questions? Feedback?

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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

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

Spine/Low Back Pain Workgroup

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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?

Spine/Low Back Pain Workgroup, Con’t