Washington Health Alliance Quality Improvement Committee February 13, 2014 MEETING SUMMARY Committee Members Present: Lydia Bartholomew, Aetna Christopher Dale, Swedish Health Services Nancy Fisher, Centers for Medicare & Medicaid Services Bob Herr, Molina of Washington Veronica Hooper, MultiCare Health System (phone) Dan Kent, Premera Blue Cross (phone) Pat Kulpa, Regence Blue Shield Dan Lessler, WA State Health Care Authority Peter McGough, UW Medicine (Chair) Bob Mecklenburg, Virginia Mason Medical Center Francis Mercado, Franciscan Health System Jonathan Sugarman, Qualis Health Michael Tronolone, The Polyclinic Ed Wagner, MacColl Institute Committee Members Absent: Terry Rogers, Foundation for Health Care Quality Hugh Straley, Emeritus Matt Handley, Group Health Cooperative Scott Kronlund, Northwest Physicians Network Staff and Guests Present: Susie Dade, Washington Health Alliance Teresa Litton, Washington Health Alliance Theresa Helle, Boeing (PAG Member) Kerry Schaefer, King County (PAG Member) Louis McDermott, HCA/PEBB (PAG Member) Ginny Weir, Bree Collaborative David McGaughey, Sanofi US Maggie Noonan, Merck Megan Ashbaugh, American Cancer Society INTRODUCTIONS   Dr. McGough asked for the January 2014 QIC meeting summary to be approved. The members approved the summary as presented. Welcomed new member, Dr. Christopher Dale, to replace Dr. Brian Livingston as the Swedish Health System representative. Quality Improvement Committee Meeting Summary, February 13, 2014 ACTION: Approval of January 2014 meeting summary Page 1 of 4 ACO Guidelines  Ms. Dade presented the Purchaser Affinity Group’s ACO Guidelines for discussion and feedback from the QIC members. PAG members noted that the needs of purchasers may vary but the document provides an excellent starting point.  QIC members discussed missing/desired elements: o Emphasis on Quality – The guidelines/expectations for providers should more strongly emphasize quality as a critical element of total value. o Financial competency—ACO implementation is complex; the successful ACO will have sophisticated financial competency and maturity with the ability to effectively use financial data to continually track performance (risk/gain) and create internal incentives for providers and other members of the team that drive behavior supportive of ACO goals. o Routine use of data and analytics – ACO must have reliable data analytic tools and resources to “push out” data/information to care teams and management to shape programs and modify performance on an ongoing, continual basis. Tie EHR implementation into Meaningful Use and Patient-centered Medical Home criteria. ACO’s will need timely data from health plans/claims information to help them identify patterns and cost of care. o Strong, organized care coordination systems—This function works best when it’s embedded within the practice where care is provided, rather than through external programs such as those housed or sponsored by health plans. Specific systems, programs and tools for identifying/coordinating/addressing high utilizers are very important. o Population health perspective—ACO must have a strong stewardship role in building the “health of the community,” in addition to a laser-like focus on managing their own ACO population of patients. Market dominance of one health care organization in a community can have a significant negative impact on other health care providers and their ability to perform at optimal levels – all of whom may be needed to fill the health care needs of an entire community. ACO’s shouldn’t limit access to community health centers, the uninsured, etc.  Other discussion points included: o The QIC discussed how purchasers might develop benefit designs that support the ACO and align efforts. Purchasers may need a more specific guide on how to support in the most effective manner. o The QIC questioned whether national research and ACO readiness guides were used in the development of the document. Ms. Dade commented that several sources were referenced, such as CMS, Catalyst for Payment Reform, and the work done by Intel. o The QIC also discussed having more specificity in the guidelines over time Quality Improvement Committee Meeting Summary, February 13, 2014 Page 2 of 4 as ACOs develop and are better understood. This is likely to be an evolutionary progression from the current list of principles. o The QIC and PAG members discussed both the importance and challenge of prospective selection of the ACO, also known as “hard enrollment” (versus retrospective enrollment commonly done now). This is key for ACOs to know who they are responsible for. Aligned effort between purchasers, plans, and providers will be needed for successful prospective enrollment. The guidelines are written to reflect that member enrollment needs to be at least to the ACO, but there is an understanding that it is better if the assignment is to a specific clinic and optimal if it’s to a specific primary care team. Discussion centered around how this is a PPOdominated market and people are accustomed to choice, making this element more challenging. o Purchasers indicated they want information on quality, functional outcomes and patient experience. Cost reduction isn’t enough; purchasers need healthy employees who can return to work sooner. Outcome measures, instead of process measures, are wanted. Purchasers want to be treated as a partner. o Discussion continued about the role of purchasers in promoting participation in ACO’s. There will likely need to be a critical mass of patients selecting ACO options before provider organizations are willing to dramatically change their business models. Are purchasers willing to incentivize their employees to move in this direction and support this shift? o Many of the providers saw the ACO guidelines as a valuable document and how this could create a market standard. Some providers quickly indicated that they will want to align their efforts to these guidelines. o Purchasers were encouraged by the provider’s response to include more, not less, items in the guidelines over time. Own Your Health  Mr. Gallagher presented the “Own Your Health” consumer campaign that works with employers and union trusts to provide targeted materials and resources for employees. The Own Your Health website is embedded in the Community Checkup website. The QIC was asked if “Own Your Own Health” may be 1) hitting the mark, 2) missing anything, and 3) if things should be emphasized more. The members discussed how providers could be a potential user of the website and whether providers can recommend patients to go to the site for vetted resources from a neutral and trusted source. The QIC offered multiple suggestions regarding additional key messages that could be incorporated into the Own Your Health campaign. Quality Improvement Committee Meeting Summary, February 13, 2014 Page 3 of 4 o What patients should expect in terms of “patient experience” o Reliable patient education materials and resources, e.g., AHRQ’s “Next Steps After You Diagnosis” o Template for problem list and medication tracker o List of “common things to avoid” (relate to Choosing Wisely) o Emphasize high quality preventive care o Be clear about when we (re) direct users to their health plan and/or provider website for specific information related to their benefits or care Next Steps  The next QIC meeting will be April 10, 2014 from 2:00 – 4:00 pm at the Alliance. Adjourn Quality Improvement Committee Meeting Summary, February 13, 2014 Page 4 of 4