PETER J. DUNBAR, MB CHB, MBA CEO

Transcription

1 PETER J. DUNBAR, MB CHB, MBA CEO

2 Penetration in Washington State Port Angeles Mt Vernon Port Townsend Seattle Kirkland Wenatchee Spokane Aberdeen Tacoma Olympia Longview Sunnyside Yakima Richland Portland

3 Registries Cardiac Surgery registry built 1997 (COAP) 100% Participation in Washington State for 20 years Same dataset as STS + ACC registries combined Gen Surgery registry (SCOAP) 2002 (135k cases) Bariatric, Colectomy, Appendectomy, Small Bowel Obstruction Spine surgery registry 75% of inpatient Spine surgery in WA Obstetric registry (OB-COAP) 2008 Currently 18 hospitals + home + birth center 35,000 deliveries/year

4 SCOAP Before After

5 SCOAP Data Perioperative Glucose Levels and Insulin Use Diabetic pts 4098 (35%) Hyperglycemic 2369 (58%) Nondiabetic pts 7532 (65%) Hyperglycemic 1014 (13%) 30% of all hyperglycemic patients were not diabetic! Kwon. Ann Surg. 2013; 257: 8-14

6 Used with permission of MultiCare Heath System

7 What is VALUE? Value = ( "#$%&'&( ) )*+& Value = ( "#$-'&( "#$%&'&( )*+& ) Value = Appropriatness ( "#$-'&( "#$%&'&( )*+& )

8 What is APPROPRIATE? Since Value = Appropriateness ( "#$-'&( "#$%&'&( ) )*+& It follows that if Appropriateness = ZERO Then Value = ZERO

9 The Literature Multidisciplinary Evaluation Leads to the Decreased Utilization of Lumbar Spine Fusion RESULTS: A total of 137 consecutive patients were reviewed at our multidisciplinary conference during the ten month period. Of these, 100 patients had been recommended for lumbar spine fusion by an outside surgeon. Consensus opinion of the multidisciplinary conference advocated for non-operative management in 58 patients (58%) who had been previously recommended for spinal fusion by another institution (χ2 = 26.6; p <0.01). Furthermore, the surgical treatment plan was revised as a product of the conference in 28% (16) of the patients who ultimately underwent surgery (χ2 = 43.6; p < 0.01). We had zero 30-day complications in surgical patients. Spine (Phila Pa 1976) Sep 1;42(17):E1016-E1023

10 Relax Its not just surgery that is being done unnecessarily: o o o o More than 45% of mostly primary care health care services examined were determined to be of low value. Approximately 1.3 million individuals received one of these 47 services; among these individuals, almost one-half (47.9%) received a low-value service. 36% of spending on the health care services examined went to low-value treatments and procedures. This amounts to an estimated $282 million in unnecessary spending. NOT including Medicare (1m) and Medicaid (2m) populations

11 First, Do No Harm media impact National coverage Nearly 30 unique stories in national outlets NPR/ProPublica story ran on dozens of NPR stations Featured in USA Today column Major outlets mentioned the report: Washington Post, Salon.com, Vox, Axios, Kaiser Health News 11

12 Who decides what is appropriate?

13 Bree Collaborative Ordained by statute 2010 Multi-stakeholder Board appointed by Governor Funded by Health Care Authority Create 3-4 reports per annum that are sent to the HCA for consideration e.g. Hip and Knee Joint Replacements Lumbar Spine Fusion Labor and Delivery Reports designed to be used as contracting language by purchasers

14 Mission: To identify health care services with high: o Variation o Utilization Without producing better outcomes Governor appoints Bi-Monthly Meetings Managed by the FHCQ 22 Members of the Collaborative Physicians Public Purchasers QI Orgs Groups Represented at Bree Health Plans Employers Hospitals

15 Inefficiency High Use Increased Use Waste Proven Strategies for Change Topic Variation

16 Recommendations formed in Clinical Committees Financial Incentives Provider Feedback Reports Shared Decision Aids Evidence-Based Guidelines Data Transparency Centers of Excellence Clinical Committee Meeting Monthly for 9-12 Months Public Comment Recommendations to improve health care quality, outcomes, and affordability in Washington State Public Reporting The Health Care Authority Broader Health Care Community

17 BreeCollaborative.org Obstetrics Cardiology Elective Total Knee and Total Hip Replacement Bundle and Warranty Elective Lumbar Fusion Bundle and Warranty Elective Coronary Artery Bypass Surgery Bundle and Warranty Bariatric Surgical Bundled Payment Model and Warranty Low Back Pain and Spine SCOAP Hospital Readmissions End-of-Life Care Addiction and Dependence Treatment Prostate Cancer Screening Oncology Care Pediatric Psychotropic Drug Use Behavioral Health Integration Guidelines for Prescribing Opioids for Pain Opioid Use Disorder Treatment Alzheimer s Disease and Other Dementias Hysterectomy

18 Warranty Valid at hospital performing surgery o o o o Represent significant complications attributable to the TKR/THR procedure Identifiable in administrative claims data Fair to hospitals and physicians Valid only at the hospital performing the surgery. Acute myocardial infarction 7 days 30 days 90 days Pulmonary embolism Infection involving implant Pneumonia Surgical site bleeding Mechanical complications Sepsis/septicemia Wound infection

19 Peter J Dunbar pdunbar@qualityhealth.org Used with permission of MultiCare Heath System