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Topic Updates. Bree Collaborative Meeting January 31, 2013. Potentially Avoidable Readmissions (PAR) Workgroup Update. Summary of Progress. Have met twice since the last Bree Collaborative meeting (6 meetings total) Progress made in each of the 3 general areas:

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Topic updates

Topic Updates

Bree Collaborative Meeting

January 31, 2013


Potentially avoidable readmissions par workgroup update

Potentially Avoidable Readmissions (PAR) Workgroup Update


Summary of progress

Summary of Progress

  • Have met twice since the last Bree Collaborative meeting (6 meetings total)

  • Progress made in each of the 3 general areas:

    • Alignment/support local readmission opportunities

    • Measurement, transparency, and reporting

    • New accountable payment models

  • Refined both of its recommendations, as requested by the Bree Collaborative (discussed in next slides)


1 alignment support local readmission opportunities

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


Recommended endorse concept of wsha tool kit

Recommended: Endorse “concept” of WSHA tool kit

The PAR Workgroup recommends that the Bree Collaborative formally endorse the concept that preventing avoidable readmissions requires:

  • A community-wide approach

    • Hospitals cannot solve this problem alone

    • Requires active engagement from primary care, home health, hospice, community organizations, etc.

  • 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


2 measurement transparency and reporting

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: 3rd or 4th Qtr. 2013

    • CMS: “During 2013”


Topic updates

Proposal: Send letter to Qualis and WSHA

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.


3 new accountable payment models

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


Other plans for the next few months

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)


Questions comments

Questions? Comments?


Accountable payment model apm workgroup update

Accountable Payment Model (APM) Workgroup Update

Bree Collaborative Meeting

January 31, 2013


Outline of presentation

Outline of Presentation

  • Overview

  • Four Areas of Work

  • Work Completed to Date

  • Work in Progress

  • Next Steps & Looking Ahead


Overview

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)


Four areas of work to define

Four Areas of Work to Define


Foundational work completed

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


Criteria for selecting creating accountable payment model models

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


Warranty definition adopted by the group

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.


Bundled payment definition adopted by the group

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


Progress in developing necessary components

Progress in Developing Necessary Components


Warranty components under discussion

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


Bundle components under discussion

Bundle Components Under Discussion

  • Bundle definition

    • Member eligibility

    • Covered services and exclusions

    • Episode time window

  • Appropriateness criteria

    • Example criteria reviewed


  • Next steps looking ahead

    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


    Questions comments1

    Questions? Comments?


    Obstetrics implementation update

    Obstetrics ImplementationUpdate


    Actions taken since last meeting

    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)


    Questions comments2

    Questions? Comments?


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