Topic Updates Bree Collaborative Meeting January 31, 2013.
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Transcript of Topic Updates Bree Collaborative Meeting January 31, 2013.
Topic Updates
Bree Collaborative MeetingJanuary 31, 2013
Potentially Avoidable Readmissions (PAR) Workgroup Update
3
Summary of ProgressHave 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)
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1. Alignment/support local readmission
opportunitiesRECAP – 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 appointmentHospital/PCP follow up call after dischargePrimary care visit checklistMedication 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
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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
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2. Measurement, transparency, and
reportingRECAP – WSHA and Qualis currently partner to
provide reports on all-cause readmission rates based on data from CHARS and CMSAggregate 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 sourcesPuget Sound Health Alliance: 3rd or 4th Qtr. 2013CMS: “During 2013”
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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
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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
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Other Plans for the Next Few Months
Review scope of the PAR report at March meetingStaff 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 groupFront line staff, such as case managersMore providers (strong sense of urgency in that
group)
10
Questions? Comments?
Accountable Payment Model
(APM) Workgroup Update
Bree Collaborative MeetingJanuary 31, 2013
12
Outline of PresentationOverview
Four Areas of Work
Work Completed to Date
Work in Progress
Next Steps & Looking Ahead
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OverviewHave met three times since the last Bree
Collaborative meeting (4 meetings total)
RECAP – Tasked with recommending a “common reimbursement model” for one episode of focusTotal 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)
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Four Areas of Work to Define
Appropriateness Criteria (Pre-Op) BundleWarranty Quality
Outcomes
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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
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Criteria for Selecting & Creating Accountable Payment Model
ModelsAddresses 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
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.
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
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Progress in Developing Necessary Components
Direction from the PAR Workgroup
Progress of the APM Workgroup
Recommend episodes of focus
Completed – Selected total hip and knee replacement surgeries. PAR workgroup and Bree Collaborative both approved this focus.
Recommend warranty definition
Almost 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
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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
periodPursuing additional analyses
Need to decide whether begins on date of admission from surgery or discharge date
21
Bundle Components Under Discussion
Bundle definitionMember eligibilityCovered services and exclusionsEpisode time window
Appropriateness criteriaExample criteria reviewed
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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
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Questions? Comments?
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)
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Questions? Comments?