Bree Collaborative Readmissions Joe Gifford, MD Executive Medical Director Regence January 2012

Readmissions Mission Statement Drive accountability by reducing unnecessary readmissions Strategy Gather, track, & review data Financial incentives: agree on common definitions for all-payer approach to warranty pricing, evolve toward bundled warranty pricing

Readmission Data All-in readmission rate according to an agreed- upon method (CMS? NCQA?) –By hospital –By medical group? –With and without risk adjustment? Specific diagnoses with “pure” method –CMS PPR method CHF, AMI, pneumonia –Add our own COPD, hip fx, spines, knee & hip replacement

Warranty pricing Bundled payments with warranty Incentives

Warranty Pricing Agree on specs for all-payer implementation –30- or 60-day –List of 5 – 10 DRGs –Technical spec: what readmits are in (same dx) and what are out (hit by bus) –Rate structure: is readmit a “never event” or should the warranty come with a cost? Professional fees part of the warranty!!

Bundled Warranty Pricing Agree on specs for optional all-payer implementation –3 day before to 30 or 60 day post –Services are all in (esp professional) List of exceptions –Treatment of co-morbidities, etc –Price of bundle is private negotiation, but structure of it (rules) are arrived at by community