Dr. Robert Bree Collaborative Meeting Minutes Wednesday, March 22, 2017 12:30-4:30 Puget Sound Regional Council 1101 Western Ave Seattle, WA 98104 Members Present Susie Dade, MS, Washington Health Alliance Gary Franklin, MD, Labor and Industries Dan Lessler, MD, Health Care Authority Rick Ludwig, MD, Providence Health Accountable Care Rick Goss,* MD, Harborview Medical Center Robert Mecklenburg, MD, Virginia Mason Medical Center Kim Moore, MD, Franciscan Health System Randy Moseley, MD, (for Stu Freed), Confluence Health Members Absent Phil Colmenares, MD (for John Espinola, MD, MPH,) Premera Blue Cross Christopher Kodama, MD, MBA, MultiCare Paula Lozano, MD, MPH, Group Health Cooperative Staff and Guests Jackie Barry, PTWA Lydia Bartholomew, AETNA Trish Blanchard, Consultant Selena Bolotin, LCISW, Qualis Health Danica Boyle, UW Medicine Ed Cardoza, Novo Nordisk Cathy Gibb, WSHA Paul Gruen, Bree Collaborative Carl Olden, MD, Pacific Crest Family Medicine Mary Kay O Neill, MD, MBA, Partner, Mercer Terry Rogers, MD, Vice Chair Jeanne Rupert, DO, PhD Kerry Schaefer, MS, King County Bruce Smith, MD, Regence Blue Shield Lani Spencer, RN, Amerigroup Hugh Straley, MD, Chair Shawn West, MD, Edmonds Family Medicine Greg Marchand, the Boeing Company John Robinson, MD, SM, First Choice Health Carol Wagner, RN, MBA, Washington State Hospital Association Ethan Norris, AEM Healthcare Bob Perna, WSMA Kathy Shoenrock, Qualis Health Lisa Silvestre, Premera Blue Cross Tina Turner, Premera Blue Cross Kelly Veit, Washington Patient Safety Coalition Ginny Weir, Bree Collaborative Emily Wittenhagen, Bree Collaborative * By phone/web conference Agenda and all meeting materials are posted on the Bree Collaborative s website, here, under 2017, March 22 nd materials. Page 1 of 5
CHAIR REPORT & APPROVAL OF JANUARY 18 TH MEETING MINUTES Hugh Straley, MD, Chair, opened the meeting and all present introduced themselves. Dr. Straley gave a brief update on the recent activities of the Bree Collaborative, including attendance at recent events: the Disparities in Care Conference, the Accountable Communities of Health Leadership Meeting, and the Washington Alliance Purchaser Affinity Group, where the Bree Collaborative presented pertinent topics. He also spoke about Group Health s recent acquisition by Kaiser Permanente, and advertised for the Cambia Grove Episodes of Care Summit coming up on March 31, 2017. Motion: Approve the January 18 th Meeting Minutes. Outcome: Passed with unanimous support. HEALTHIER WASHINGTON AND PRACTICE TRANSFORMATION Selena Bolotin, LCISW, Qualis Health presented on the Practice Transformation Support Hub in the context of Healthier Washington, a program of the Health Care Authority. The Hub supports Healthier Washington goals of whole-person care, integrating physical and behavioral health, and encouraging providers to move toward value-based care to improve population health through contracting with Qualis Health to provide practice transformation support. Practice transformation is also supported by a web resource portal that launched in February 2017 with high-quality vetted resources, regionally based coaching and training opportunities, educational tools and resources, personalized practice assessment, quarterly webinars, and a help desk. The group discussed medication-assisted treatment within the hub-and-spoke model and whether there is a relationship between those efforts and the Hub (at the moment, there is no clear relationship), alignment between Bree Collaborative activity and the work of Healthier Washington s Accountable Communities of Health (ACHs), the Hub s clinical integration and behavioral health integration efforts, and the focus on collaborative care models. EPISODES OF CARE: ACCOUNTABLE COMMUNITIES OF HEALTH Dan Lessler, MD, MHA, Washington State Health Care Authority (HCA), spoke about an upcoming request from the HCA for information on bundled payments, particularly asking for information about provider interest in moving toward more bundled payments, any clinical episodes of care that providers are planning to offer, and what kind of work has gone on in response to the Bree Collaborative s bundled payment model recommendations and similar efforts from other organizations. Dr. Lessler also spoke about the work of ACHs in Washington, their localized efforts to build healthier communities, and their role in coordinating regional projects aimed at improving care for Medicaid patients, gathering community feedback, developing project plans, and distributing funds to providers to incentivize goals. The group discussed the three required focuses of ACHs through the Medicaid Transformation Project behavioral health integration, the opioid epidemic, and value-based payment. Dr. Lessler explained other focuses like collaborative care models and spoke about how value-based payment runs through all the goals, particularly those concerning the new payment models, which includes bundled payments. Page 2 of 5
IMPLEMENTATION OF BREE RECOMMENDATIONS Lisa Silvestre, Vice President, National Accounts; Tina Turner, Senior Internal Consultant; and Shawn West, MD, Medical Director, Provider Engagement, all of Premera Blue Cross, presented on the Health Care Authority s Total Joint Replacement Center of Excellence Program. Dr. West gave some background on Premera, their mission and vision, and the key customer issues they aim to address. Ms. Turner spoke about how payment arrangements are moving toward paying for improved quality, how Premera is working to improve quality with a provider partnership model utilizing a continuous provider feedback loop, and shared Premera s past and current work implementing Bree Collaborative recommendations. Ms. Silvestre spoke about the Center of Excellence Program and gave an example of how Premera has implemented new benefits for total joint replacement in collaboration with the HCA, Virginia Mason, and also a data-sharing partnership with Regence, how customer needs were considered, their process of mapping out the various touch points of the customer experience, the resulting journey map, customer facing materials, and an outreach program. She also spoke about the addition of travel and lodging for customers traveling to Centers of Excellence, including car services and hotel stays, to bundled payment models. The group discussed the role of appropriateness and safety standards patients must meet to qualify for surgery and qualify for bundled payment models, which are built into the Bree s recommendations. Paul Gruen, MHA, Implementation Consultant for the Bree Collaborative, gave a brief overview of the responses received for the implementation surveys from health plans, including quality bonus criteria among health plans, topic specific recommendations, the lowest scoring recommendations (prostate cancer screening, low back pain, oncology), more successful recommendations, enablers such as internal awareness, sufficient market shares, contract partner interest in value-based purchasing, and barriers such as insufficient market shares and burden of collecting data. He also shared the outline of the implementation roadmap, including standardization of definitions, use of incentives, collaboration to smooth out fragmentation in the market, and the range of options for value-based purchasing, which are also incentives, such as bundled payments and capitated contracts. The group discussed the state s work on the common measure set and opportunities for aligning plans with this set. FINAL ADOPTION: BEHAVIORAL HEALTH INTEGRATION Mary Kay O Neill, MD, MBA, Partner, Mercer, presented on the results of the Behavioral Health Integration Report and Recommendations, covering the eight key elements of care, the remarkably high participation the public comment period generated, and changes made as a result of the public comments. The group discussed bi-directional care and the need to provide care in the setting in which patients are most comfortable and moving the stakeholder-specific recommendations earlier in the report for those who may not read the entire report. The group also discussed new HEDIS measures on p. 37 of the report concerning screening, which being new lack benchmark and clinical data, and the WHA Purchaser Affinity Group and Healthier Washington s upcoming push to measure these data being somewhat far down the road (about two years), as well as the AIMS Center s encouragement to use these measures as they are more evidence-based. Ms. Weir also shared the addition of language on Patient Involvement in Care (p. 26) added by Marc Avery, MD, of the University of Washington Page 3 of 5
Motion: Adopt Behavioral Health Integration Report and Recommendations. Outcome: Adopted with unanimous support. The Report and Recommendations will now go to the HCA for review and implementation. Ms. Weir thanked Dr. O Neill for her work chairing the workgroup. NEW TOPIC: HYSTERECTOMY Jeanne Rupert, DO, PhD presented on the initial meeting of this new workgroup, reviewing the charter with its aim to align care delivery with existing evidence-based indications, and use of robotics for benign hysterectomy across Washington State, and decrease inappropriate use. Dr. Rupert shared the enthusiasm of the workgroup members to focus on this topic and the proposed work plan, which will involve engaging with experts and talking through barriers, and the aim of generating a product by winter 2017/2018. She also took recommendations for potential member additions to the workgroup. The group discussed the plan to include a focus on the pre-operative stage and appropriateness assessment, as well as the potential for this group to move toward generating a bundled payment model. Motion: Adopt Draft Hysterectomy Charter and Roster. Outcome: Adopted with unanimous support. TOPIC UPDATE: AMDG OPIOID PRESCRIBING GUIDELINES IMPLEMENTATION Gary Franklin, MD, MPH, Medical Director, Washington State Labor and Industries, presented an update on the efforts of this workgroup, including the development of metrics, alignment with the Health Care Authority, and work on reducing inappropriate acute prescribing in dentistry. He reviewed the recent Opioid Prescribing in Dentistry Summit held on March 9, which included participation from several state agencies and dental representatives, including members of the Dental Association. The meeting involved going over a draft of recommendations and a subgroup from this summit will be meeting shortly to work on developing the language for these recommendations. The group discussed the possibility of presenting the resulting draft at the May meeting and made a suggestion to add the word draft prominently on the existing recommendations developed by Dr. Madden to avoid any confusion. Dr. Franklin spoke about a recent morbidity/mortality report that shows that the probability of addiction goes up 1% every day after three days of use and an Annals of Surgery report about how many pills go unused after surgery. TOPIC UPDATE: TOTAL KNEE AND TOTAL HIP REPLACEMENT RE-REVIEW Bob Mecklenburg, MD, Medical Director, Center for Health Care Solutions, Virginia Mason Medical Center shared an update on the progress of this re-review, covering the four components of the original 2013 bundle and inviting feedback on substantive changes to Cycle II of the bundle. The group discussed moving shared decision making closer to the front of the bundle recommendations and asked about situations where non-surgical therapy would not be indicated, such as when there is severe disability or cartilage is completely absent. The group also discussed high-risk patients for example, a patient who has real need for the surgery but may not meet the criteria for post-operative care and what flexibility Page 4 of 5
exists to address their needs and help them meet criteria when appropriate, without removing the necessary checks and balances. Dr. Mecklenburg also went over recent changes to Cycle I and further changes to Cycle II regarding patient engagement with respect to designating care partners and participation in post-operative care, posing to the group whether the designation of a care partner must be mandatory for the patient, or whether the care team could supply an equivalent. TOPIC UPDATE: ALZHEIMER S DISEASE AND OTHER DEMENTIAS Ms. Weir gave an update on the work of this new workgroup, which began meeting in January and the charter and roster approved at the previous Bree meeting in January. She shared one of the group s aims to focus on instilling hope into the topic and the group reiterated the importance of this, particularly within the elderly population. The group also discussed the need for education in the community. TOPIC UPDATE: OPIOID USE DISORDER TREATMENT Ms. Weir gave an update on the work of this group, which began meeting in December, covering the previous work done in the Addiction and Dependence Workgroup and how it relates to this topic, as well as alignments with ACHs in the state. Dr. Franklin spoke about convening a thought leader conference on collaborative care for the treatment of pain on June 14, 2017, and invited anyone interested in participating to reach out to him. GOOD OF THE ORDER/OPPORTUNITY FOR PUBLIC COMMENT Dr. Straley and Ms. Weir thanked all for attending and asked for public comments and final comments. The meeting was adjourned. Next Bree Collaborative Meeting: May 24, 2017 12:30-4:30 Puget Sound Regional Council Page 5 of 5