1. Topic Updates Bree Collaborative Meeting January 31, 2013

2. Potentially Avoidable Readmissions (PAR) Workgroup Update

3. 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

4. 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

5. 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

6. 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: 3 rd or 4 th Qtr. 2013 CMS: “During 2013” 6

7. 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. Proposal: Send letter to Qualis and WSHA 7

8. 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

9. 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

10. Questions? Comments? 10

11. Accountable Payment Model (APM) Workgroup Update Bree Collaborative Meeting January 31, 2013

12. Outline of Presentation Overview Four Areas of Work Work Completed to Date Work in Progress Next Steps & Looking Ahead 12

13. 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

14. Four Areas of Work to Define Appropriateness Criteria (Pre-Op) BundleWarranty Quality Outcomes 14

15. 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

16. 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

17. 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

18. 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

19. Progress in Developing Necessary Components Direction from the PAR WorkgroupProgress of the APM Workgroup Recommend episodes of focusCompleted – Selected total hip and knee replacement surgeries. PAR workgroup and Bree Collaborative both approved this focus. Recommend warranty definitionAlmost 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

20. 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

21. Bundle Components Under Discussion Bundle definition Member eligibility Covered services and exclusions Episode time window Appropriateness criteria Example criteria reviewed 21

22. 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

23. Questions? Comments? 23

24. Obstetrics Implementation Update

25. 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

26. Questions? Comments? 26