1. Bringing Transparency to Quality Outcomes 2015 Washington State of Reform Policy Conference January 8, 2015

2. Presenters Susie Dade, Deputy Director, Washington Health Alliance Ginny Weir, Program Director, Bree Collaborative, Foundation for Health Care Quality Carol Wagner, Senior Vice President for Patient Safety, Washington State Hospital Association Rick Rubin, CEO, OneHealthPort

3. State of Reform Conference, January 8, 2015 Health Care Transparency and the Value Equation

4. Understanding VALUE in Health Care - Six Key Variables 4 VARIABLEIs the Health Care Service... AppropriatenessReally Needed? Process Quality Provided in the most effective and safe manner? PriceProduced at a fair price for the buyer? Outcomes Producing the best possible results for the patient? Intensity/ Utilization Provided in the most efficient manner? ExperienceProvided in a patient-centered way? © 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

5. Washington Health Alliance Current Transparency Initiatives Community Checkup  Quality, Patient Experience – Medical Groups, Hospitals, Counties Value Portfolio  Quality, Intensity, Experience, Price – High volume, high cost hospitalizations Disparities in Care Rates of Procedure Use and Diagnostic Testing Choosing Wisely ® Potentially Avoidable ER Visits 30-day All Cause Hospital Readmissions Washington State legislation: FULL price transparency 5 By Hospital and Medical Group © 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

6. Washington One of Only Two States with an ‘A’ 6 This report grades states on the percentage of clinicians with publicly available quality information, the type of measurement reported, and how accessible and useful the information is to consumers. Fifteen years after the publication of ‘To Err Is Human’ by the Institute of Medicine, there is still little, if any, useful and meaningful information on the quality of health care across the country. HCI3 State Report Card on Transparency of Physician Quality Information Released December 16, 2014

7. Washington’s New Common Measure Set for Health Care Quality and Cost 7 © 2015 Washington Health Alliance. All rights reserved. This material may not be reproduced or modified without the prior permission of the Alliance.

8. Unlike in quality, Washington is not differentiating itself as a leader in health care price transparency 8 HCI3/CPR Report Released March 2014 F HCI3 and Catalyst for Payment Reform 2014 Report Card on State Price Transparency Laws F

9. Health Care Performance, Transparency, Improvement 1.Focus on all six variables of health care value 2.Harmonization of measures – converge around common signals 3.Transparency for: – Purchasers – Consumers – Providers with continuous feedback loop 4.Support for performance improvement, especially for smaller provider organizations 5.Strongly link incentives to performance (not volume) 9

10. Bottom Line Transparency is a key tool for identifying, understanding, and ultimately reducing, unwarranted variation in health care quality, utilization and price. 10

11. The Dr. Robert Bree Collaborative Using Transparency to Improve Quality

12. Background Slide 12 House Bill 1311 Health Plans Public Purchasers QI Organizations Hospitals Employers Others Identify health care services with high: Variation Utilization Without producing better outcomes 22 Stakeholders

13. Process Slide 13 Data Transparency Provider Feedback Reports Shared Decision Aids Financial Incentives Evidence-Based Guidelines Centers of Excellence Public Reporting Public Comment Recommendations to improve health care quality, outcomes, and affordability in Washington State Clinical Committee

14. Our Topics Slide 14

15. Cardiology  Recommendation: COAP publicly disclose hospitals’ insufficient information reports and the appropriateness of PCI procedures Slide 15

16. Insufficient Information for Determining Appropriateness in Non-Acute PCI – 2011-2013 Slide 16

18. Total Knee and Total Hip Replacement  High volume of procedures  Variation in way procedures are done  Readmission Rates by hospital on website: www.breecollaborative.org/topic-areas/apm/ Slide 18 Source: Readmission Rates for TKR/THR Procedures in Washington State: Summary of Findings from 2011 CHARS Data Bree Collaborative – Accountable Payment Model Subgroup October 2013. Available: http://www.breecollaborative.org/wp- content/uploads/bree_summary_CHARS_Analysis.pdf

19. Transparent Quality Standards  Appropriateness  Evidence-based surgery  Rapid and durable return to function  Patient care experience  Patient safety and affordability Slide 19

20. More Information Ginny Weir, Program Director GWeir@qualityhealth.org (206) 204-7377 www.breecollaborative.org Recommendations available here: www.breecollaborative.org/about/reports www.breecollaborative.org/about/reports Slide 20

21. Quality and Transparency The Provider Commitment Carol Wagner Senior Vice President Patient Safety CarolW@wsha.org January 8, 2015 21

22. www.WAHospitalQuality.org Washington Hospital Quality 22

23. www.WAHospitalQuality.org Collaborative Learning 23

24. Healthy Competition “The Washington State Hospital Association has come out fully in favor of transparency. We’re finding that if you share results, you’re really allowing the patient, family and consumer to understand, ‘How good is this care, really?’ “By nature, we’re competitive. By nature, if you’re in health care, you want to improve. It’s motivating to find areas and say ‘Whoa, we aren't quite as good as we should be and in fact, most of our colleague institutions are doing better.’ It’s a very motivating thing within our membership.” --Scott Bond, WSHA CEO www.WAHospitalQuality.org 24

25. Data For Patient Engagement www.WAHospitalQuality.org 25

26. Better Quality 50,000 fewer deaths in hospitals. 1.3 million fewer patients harmed. 17 percent decline in harm. Lower Cost $12 billion reduction in costs. Healthcare price inflation was lower than the GDP for the last four years. Nationally 26 Improving Care

27. Better Quality 2010: 145 harms/1000 discharges 2011: 142 harms/1000 discharges 2012: 132 harms/1000 discharges 2013: 121/1000 discharges preliminary results ever! Partnership for Patients Nationally 2013 fewest harm ever! Improving Care 27

28. Better Quality 23,000 fewer patients harmed. Lower Cost $235 million reduction in costs. Partnership for Patients Washington 28 Making a Difference for Washingtonians

29. 29 Improving Care for all Washingtonians

30. 30 Improving Care for all Washingtonians

31. 31 Improving Care for all Washingtonians

33. Question & Answer