Meeting May 20 th , 2015| Seattle Central Library Agenda Chair - PowerPoint PPT Presentation

Bree Collaborative Meeting May 20 th , 2015| Seattle Central Library

Agenda  Chair Report and March 18 th Meeting Minutes  Implementation Discussion  Current Topic Update : Coronary Artery Bypass Surgery Bundled Payment Model  Current Topic Update : Prostate Cancer Screening Workgroup  New Topic Introduction: Oncology Care  Current Topic Update : Washington State Agency Medical Director’s Group Opiate Prescribing Guidelines  Membership Spotlight : MultiCare Health System  Implementation Update : Bree Implementation Team and The Plan for a Healthier Washington  Next Steps and Close Slide 2

March 18 th Meeting Minutes Slide 3

Next Bree Collaborative Meeting Wednesday, July 22 nd Cambia Grove 1800 9th Ave., Suite 250 Seattle, WA 98101 Slide 4

Implementation Discussion Ed Wagner, MD, MPH Group Health Research Institute Senior Investigator Director (Emeritus), MacColl Center May 20 th , 2015

BREE IMPLEMENTATION Wednesday, May 20 th , TEAM UPDATE 2015 Dan Lessler, MD Chief Medical Officer, WA Health Care Authority Chair, Bree Implementation Team

HEALTHIER WASHINGTON GRANT TIMELINE Year 4: Evaluation Year 3: Learning and Refinement Year 2: Launch Year 1: Design Work February 1, 2015 – January 31, 2019

SHARED DECISION-MAKING  2014: Opportunity to develop and implement process to certify decision aids  Healthier Washington Initiative  Gordon and Betty Moore Foundation  March 2015: Identify and test draft certification criteria, from IPDAS checklist  April 2015: Outline process for ongoing certification  May 2015: Engage stakeholders to provide input  Mid-2015: Finalize and begin certifying maternity decision aids  2016: Begin implementation of certified decision aids and begin certifying joint replacement/spine care aids

CORONARY ARTERY BYPASS GRAFT SURGERY BUNDLE AND WARRANTY UPDATE BREE COLLABORATIVE ACCOUNTABLE PAYMENT MODELS: CABG WARRANTY AND BUNDLED PAYMENT MODEL MAY 20 TH , 2015

DESIGN TEAM  Providers Bob Mecklenburg, MD, Virginia Mason, Co-Chair 1. Drew Baldwin, MD, FACC, Virginia Mason (Cardiologist, COAP) 2. Bob Herr, MD, US HealthWorks 3. Vinay Malhotra, MD, Cardiac Study Center (Cardiologist, WSMA) 4. 5. Glenn Barnhart, MD, Swedish Medical Center (Cardiac Surgeon, WSHA) Gregory Eberhart, MD, FACC, CHI Franciscan Health (Cardiologist, WSHA) 6. Jay Pal, MD, University of Washington, (Cardiac Surgeon, WSMA) 7.  Purchasers Kerry Schaefer, King County, Co-Chair 1. Marissa Brooks, SEIU Healthcare NW Benefits 2. Greg Marchand/Theresa Helle, The Boeing Company 3. Thomas Richards, Alaska Airlines 4.  Health Plans Dan Kent, MD, Premera Blue Cross 1. Gregg Shibata, Regence Blue Shield 2.  Quality Organizations Susie Dade, Washington Health Alliance 1. 2 Jeff Hummel, MD, Qualis Health 2. Shilpen Patel, MD, FACRO, COAP 3.

OVERVIEW  WARRANTY : Aligning payment with safety  BUNDLED PAYMENT MODEL: Aligning payment with quality  PROCESS: Brings overall transparency to providers, purchasers, and patients 3

BUNDLE: FOUR COMPONENTS EACH SEQUENTIAL COMPONENT IS REQUIRED 1. Document disability despite non-surgical therapy 2. Ensure fitness for surgery 3. Provide all elements of high-quality surgery 4. Facilitate rapid return to function 4

CYCLE I: DISABILITY AN APPROPRIATENESS STANDARD Document disability despite non-surgical therapy Document disability: Canadian Cardiovascular Society 1. grade of angina pectoris, Seattle Angina Questionnaire-7, PROMIS-10 Document myocardial ischemia with appropriate non- 2. invasive stress testing: 2012 ACCF, et.al. Guidelines Begin risk factor modification unless need for urgent 3. intervention: 2012 ACCF, et.al. Guidelines – e.g., cardiac diet, statins, blood pressure, smoking cessation Stratify prior to determining appropriate intervention: e.g., 4. 5 heart team/multi-disciplinary conference

CYCLE II: FIT FOR SURGERY AN APPROPRIATENESS STANDARD Physical preparation and patient engagement Document requirements related to patient safety 1. • E.g., BMI <40, Hemoglobin A1c <8%, screen for untreated depression Document patient engagement 2. • E.g., shared decision-making, care partner Document optimal preparation for surgery 3. • E.g., perform pre-operative history, relevant consultations, collect patient-reported measures 6

CYCLE III: CABG PROCEDURE MEASURES TO IMPROVE OUTCOMES 1. General standards for a surgical team performing surgery E.g., hospital annual volume of 100-125 open heart procedures, • inpatient facility 2. Elements of optimal surgical process E.g., anesthesia management, L&I standards for opioids • 3. Participation in COAP 7

CYCLE IV: RECOVERY RAPID RETURN TO FUNCTION Standard processes in place at facility where surgery performed Standard process for post-operative care 1. E.g., outpatient prescriptive exercise training, education, post-discharge • phone call Use standardized hospital discharge process aligned with 2. Washington State Hospital Association toolkit E.g., reconcile medications, plan of care • Arrange home care 3. E.g., work with Care Partner • Arrange for post-operative care 4. E.g., post-discharge summary to PCP , cardiac rehab, follow-up • 8 appointments

NEXT STEPS 1. Quality Measures • Align with COAP 2. Warranty 9

PROPOSED ELEMENTS OF WARRANTY Periods of accountability are complication-specific and apply to readmission to the hospital where surgery was performed. 7 days Acute myocardial infarction a. Pneumonia b. Sepsis/septicemia c. 30 days Death a. Pulmonary embolism b. Surgical site bleeding c. Wound infection d. 90 days Infection involving implant a. 10 Mechanical complications related to surgical procedure b.

Prostate Cancer Screening Workgroup Update May 20 th , 2015

Members  Providers  Rick Ludwig, MD (Chair), Accountable Care Organization, Providence Health & Services  Eric Wall, MD, MPH, UnitedHealthcare  Shawn West, MD, Edmonds Family Medicine  Bruce Montgomery, MD, Seattle Cancer Care Alliance  Urology  John Gore, MD, MS, University of Washington Medicine  Jonathan Wright, MD, MS, FACS, University of Washington/Fred Hutchinson Cancer Research Center  Patient Advocates  Steve Lovell, Patient and Family Advisory Council  State Agencies  Leah Hole-Marshall, JD, Department of Labor & Industries  Insurers  Matt Handley, MD, Group Health Cooperative Slide 2

Timeline  March  Introductions, defining scope and focus  April  Discussed the USPSTF PSA testing recommendations in detail with USPSTF Vice-Chairperson Dr. David Grossman  May  Reviewed other PSA testing guidelines and shared decision making Slide 3

Definition: The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Slide 4 Source: U.S. Preventive Services Task Force. Prostate Cancer: Screening. May 2012. Available: www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/prostate-cancer-screening

Other Guidelines Shared Invitation to screening Based on Life Expectancy Decision Making American Academy of No PSA testing for screening regardless of age Family Physicians American Cancer Yes 50 (average risk) No screening if ≤10 Society 45 (high risk) years 40 (higher risk) American College of Yes 50-69 No screening if ≤10 -15 Physicians years American Society of Yes Screening if life expectancy exceeds 10 years Clinical Oncology American Urological Yes 55-69 No screening if ≤10 -15 Association (<55 individualized decision for higher risk years men) National Yes Baseline testing 45-50 No screening if ≤10 Comprehensive Testing every 1-2 years thereafter years Cancer Network depending on PSA ng/ml, Slide 5 Individualized >70 years