Potentially Avoidable Readmissions Workgroup Update - PowerPoint Presentation

Slide1

Potentially Avoidable Readmissions Workgroup Update

Bree

Collaborative

March 27, 2013Slide2

Outline of Today’s Meeting

Update on Bree Collaborative request to WSHA and Qualis to semi-publicly publish 30-day, all-cause data

Update on activities to promote endorsement of the concept of WSHA and partners’ tool kit

Present summary of stakeholder interviews & Discuss future ideas for Bree role in reducing avoidable readmissions

2Slide3

Background information on Data Request

Qualis

& WSHA partnering to provide reports to hospitals on readmission rates and patterns, approximately every 6 months

Medicare FFS and CHARS (“all-payers”)Description of data and data analytics in meeting packet

Reports intended to support QI efforts by hospitals and others to improve care transitions and reduce hospital admissions

Results are shared with individual hospitals – hospitals see their own performance and how they compare to peers;

aggregate reports available to public (not individual hospitals’ performance)

3Slide4

Request to Publish 30-day, A

ll-Cause Avoidable Readmissions

Part of Strategy #2 - Measurement

, transparency, and reporting (in a semi-public manner)At 1/31 meeting, Bree approved Steve Hill sending a letter to Qualis and WSHA requesting that they publish 30-day, all-cause readmissions results

Bree

Readmissions workgroup collaborated on draft letter; final letter sent February 1

st 4Slide5

Request in Letter

Publish 30-day, all-cause readmission results, by hospital, in a semi-public manner, starting with the next WSHA/

Qualis

Hospital Readmission Report Semi-public = Publish data on public websites but do not advertise or publish data in an aggressive manner

Publish

results until all-cause data becomes available from the Puget Sound Health Alliance and CMS in

2013 – the later two are nationally vetted, more utility to inform benefit design5Slide6

Responses to Request

Qualis response: working with CMS to secure approval and publish these

data; if CMS deems data confidential, each hospital will need to give permission (response letter

sent on 2/8)WSHA response: currently available data is not risk-adjusted and therefore would be inaccurate and misleading – will not publish more data until CMS releases new measure in July (response letter

sent on

3/6)

Opportunity for comments from Qualis and WSHA6Slide7

Endorsement of WSHA Tool Kit

In January 2013, the

Bree

Collaborative formally endorsed the concept of the WSHA tool kit and acknowledged 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.StandardizationEvery one doing it their own way has led to the chaos that exists today; patients are the ones that sufferProviders have patients in multiple hospitals

Variation in practice makes it very difficult for community-based providers to engage w/ hospitals

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Promotion of Bree

Endorsement of Concept of WSHA Tool Kit, Cont’d

Letter to the Editor published in Seattle Times, 2/26 about

the importance of standardization and a community-wide approachNext Steps:Write Op-Ed and/or Letters to the Editor in response to readmission articles published in Washington newspapers (not labor/resource intensive)

Send letters to all hospitals, county medical societies, WAFP, and others

PAR workgroup will develop list and scope out key messages

Other ideas? Does the Bree agree with this approach?8Slide9

Bree

Collaborative & Avoidable Readmissions

Summary of Stakeholder Interviews & Discussion of Bree’s Future

Role

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Outline of Presentation

Review the readmissions problem & efforts in WA state

Recap

the Bree Collaborative’s work in this areaPresent

findings from stakeholder

interviews

Barriers to readmissions problem and potential solutionsPotential role(s) of the Bree in this areaPresent and discuss straw person proposal for next steps10Slide11

Readmissions Problem

Potentially avoidable readmissions (PAR) are common and costly events

Readmission may indicate poor quality of care

Result of our highly fragmented system and inability to coordinate care for patients during times of transitions of care and across the health care continuum – lack of clear roles, responsibilities, accountability Historically, health care system rewards avoidable readmissions (until recently)

Socio-economic factors are a big driver of readmissions

WA readmissions

causes differ by populationMedicare - Diabetes (25%)Medicaid - Psychosis (35%)

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Efforts in WA

WSHA (and many partners: Puget Sound Health Alliance, WSMA)

State- Wide Readmissions Committee

Smooth Transitions Tool KitState (DSHS and HCA)Health homes for Medicaid, persons with public insuranceHome Care Association of WashingtonLeading Age Washington

Olympic Agency on Aging

Qualis

HealthPeaceHealthOthers! Lots!12Slide13

Bree Collaborative Topic Selection, Sept 2011 -

RECAP

Topic: Reducing

preventable hospital readmissions 8 topics presented; each

Bree

members was asked to rank each topic – good first topic; good topic but not first; and not a good topic for the

BreeOut of 17 Bree Collaborative members surveyed:14 voted for readmissions as a good first topic2 voted for readmissions as a good but not first topic

1 voted this is not a good topic for the

Bree

OB and Appropriate ED Use, along with reducing preventable hospital readmissions received the most votes for a good first topic

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PAR Workgroup ‘Charge’ -

RECAP

Formed a workgroup Summer 2012

Recommend strategies to reduce Potentially Avoidable Readmissions (PARs)Expected final work product – Report, to be adopted by the Bree CollaborativeReport to contain strategies in 3 general areas:

Alignment/support local readmission opportunities

Measurement

, transparency, and reporting (in a semi-public manner)New accountable payment models that align payment with quality/value

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PAR Work to Date – RECAP

Held 7 meetings; meets every 4 weeks

Workgroup members:

Susie Dade, Sharon Eloranta, Joe Gifford, Mary Gregg, Tony Haftel, Bob Mecklenburg, Kerry Schaefer, Peter Valenzuela

Narrowed focus: reduce all-cause avoidable readmissions (not disease-specific)

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PAR Work to

Date, Cont’d –

RECAP

Alignment/support local readmission opportunitiesAt 1/31 meeting, Bree Collaborative approved workgroup recommendation to recognize that “WSHA and its community partners are on the right track of developing a standardized tool kit and process that both hospitals and community providers can use to reduce the rate of readmissions”

Letter to the Editor printed in the Seattle Times on 2/26 about the importance of standardization and a community-wide approach

Measurement

, transparency, and reporting (in a semi-public manner)Requested Qualis

and WSHA semi-public 30-day, all-cause readmissions, by hospital

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PAR Work to Date, Cont’d –

RECAP

New

accountable payment models that align payment with quality/value

APM subgroup has met 6 times to develop a total knee and total hip replacement warranty and bundle model

Goal: Bundled payment goes live on January 1, 2014

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Challenges so far…

Has not had a chair since August

Workgroup composition, no ‘clinical’ expert in readmission –additional expertise needed

No clear charter/purpose/scope too broad

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Purpose of Stakeholder Interviews

To help “scope” readmissions work and identify where Bree can make meaningful contributions

ID top 3 barriers to reducing readmissions

ID strategies to reduce readmissionsRole of Bree – how can

Bree

make a meaningful contribution to reducing readmissions

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Diverse Sampling of Stakeholders I

nvited & Interviewed

20 individuals statewide invited

More than 10 interviewedA few members of the PAR workgroup, and additional Bree membersA least one member of each stakeholder group: purchaser, payer, hospital, provider

WSMA and WSHA

State Reps – DSHS and HCA

Medicaid Managed Care organizationMental Health community organizationNote: Long-term care community rep did not respond20Slide21

Top Barriers to Reducing Avoidable Readmissions

Community does not have a shared sense of responsibility

for

the problem – what’s the role of payers? PC? Home health workers? Who is accountable for what?

No business case for hospitals – lack of financial incentives to change

Not

easy to define avoidable vs. unavoidable readmissionsMental health system – diagnoses and lack of care before inpatientLack of organizational capacity

Inter

and intra

-organizational

barriers

– hard to work across systems

A lot of work being done,

but

in individual silos – not one

table with everyone at the table

State’s role unclear – not one point person

Primary care/outpatient providers not engaged in the process, at the table

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Improvement Strategies – What the Evidence says Works

No

silver

bulletEvidence shows multiple interventions, simultaneously can reduce readmissionsMost strategies are

hospital-centric, not

community-wide

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Recommended Roles for Bree

Note: Only a few people had time or ideas

Top idea:

Lead financial and payment reform discussions and recommendations“Follow the Money” – help expose where the incentives areIncentives, preferential contracting, patient-centered medical home, global payment

Top idea:

Augment Advanced Planning – how to inculcate into the process

Convene/facilitate a community conversation, since the Bree is a multi-stakeholder group, on behalf of the stateState needs to lead efforts – work on recommendations for state role in the issue

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Other recommended Roles for Bree

, Cont’d

“Allow payment for pre-discharge appointment”

“Help create a Health Information Exchange”“Recommend discharge standards across the state”“Implement CMS Readmission Penalties

to

WA Medicaid”24Slide25

Questions to Consider

Adding value vs. duplication

Do proven, evidence-based strategies exist?

Can Bree make meaningful contributions in this area?If Bree is going to do anything, is this an appropriate area

given limited resources and attention

? Or is another area more appropriate to switch attention to?

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Straw Person Based on Recommendations

Narrow the scope

: After tool kit pilot results are known, focus on payment reform/financial incentives recommendations to facilitate implementation and standardization

Examples: Discharge checklists, advanced planningSubmit final report by end of summer

PAR workgroup recommend ID additional experts to join workgroup & chair to

Bree

Questions? Other Ideas?

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