1. The Bree Collaborative: One Year Later Update & Future Planning Discussion Bree Collaborative Meeting October 1, 2012

2. Purpose of Presentation Review “A Year in Review” Review the current landscape Start to discuss Bree Collaborative members’ expectations/outcomes for Year 2 (fall 2012-2013) 2

3. Outcome of Presentation Gain a shared understanding of the path Bree Collaborative has traveled and basic agreement on the path ahead (next few months) Spur Bree Collaborative members to start thinking about goals and expected outcomes for Year 2 3

4. First Bree Collaborative meeting held on 9/30/11…366 days ago Expected outcome/goal set by Governor Gregoire: By July 2012 develop at least one impactful state-wide solution to a significant health care problem in our state. 4

5. Accomplishments – many! 24 clinical and quality experts agreed to come and work together to decrease variation and improve quality in WA State Exceeded legislative mandate - Selected 4 topics Achieved expected outcome/goal - Completion of OB report & COAP transparency agreement Movement towards transparency of inappropriate PCI cardiac procedures Work underway to improve Potentially Avoidable Readmissions Agreement to start work on acute low back pain and readmission payment reform 5

6. The Evolution of the Bree Collaborative Bree legislation provided a foundation - a “roadmap” Bree voted on topics/priorities last September 2011 to position Bree to have many wins (see handout in packet) Along with its achievements the Bree Collaborative has grown, and is no longer a new organization… Policies and procedures (bylaws) needed Work and strategic plans needed so work matches resources and priorities …while acknowledging huge uncertainties with CMMI grant and change in Governor leadership 6

7. Bree Collaborative: Next 7 Months Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013 OB Implementation PAR Readmissions workgroup Readmissions Payment Reform Subgroup Spine/low Back Pain Workgroup Cardiology (PCI measure publically reported) Red denotes high resource intensity; Orange denotes medium resource intensity; Yellow denotes low resource intensity (monitoring)

8. New Topic Selection/Development Solicited Bree Collaborative members’ input on new topics via email 9/4/12 Sent Bree member survey results from Sept 2011 Low response rate Some Bree members question taking on new topics now Right now Recap 4 active topics (including OB implementation activities) 3 active or soon-to-be active subgroups Resources (1 FTE) at maximum capacity Idea : Hold off new topic selection discussion until November 30 th or January meeting 8

9. What’s next? What’s our vision for Bree? What are Bree Collaborative members’ expectations? Y2 Goal ideas for the Bree Collaborative? Strawman goal: By July 2013 develop at least two impactful state-wide solutions to significant health care problems in our state. Continue this discussion and vote on goal/expected outcomes for YR 2 at November or January Bree meetings 9

10. Preparation for New Topic Selection & Strategic Planning Discussion in November or January What type of information do Collaborative members need in advance? Hire a facilitator? Topic Selection Discussion Use last year survey results as starting point? Select or prioritize a mix of topics that address all or one QI strategies – transparency, public reporting, payment reform? Leverage existing efforts – COAP? Choosing Wisely? What guidance or criteria is needed beyond current topic selection criteria (next slide)? Other Ideas for Strategic Planning Discussion? 10

11. Current Topic Selection Criteria (from Bree legislation) Substantial variation in practice patterns High utilization and/or cost growth trends in Washington State without better outcomes A source of waste and inefficiency in care delivery Patient Safety issues In addition, consider the following questions about the topic: What data are available to support that there is waste, variation, high utilization, excess costs? Are the waste and quality aspects of this topic avoidable? Are there proven means/strategies to address this topic? 11