Like many of you, we are finding it hard to believe that 2017 is almost over. This has been a busy year for us – we convened five workgroups and brought our number of completed recommendations to twenty! Read our 2017 End-Of-Year Report.

– Ongoing Work: Evidence-Based Prescribing of Opioids for Pain
Our members adopted the Washington State Agency Medical Directors Guideline on Prescribing Opioids for Pain in June 2015 and we have convened an implementation workgroup since December 2015. This past year we developed comprehensive opioid prescribing metrics (July 2017), a guideline on prescribing opioids in dentistry (September 2017), and in partnership with the Washington Health Alliance, we released fact sheets for providers and for patients (January 2017). Read more:

– Completed: Refreshing our Total Joint Replacement Bundle
Our Accountable Payment Models workgroup met to review new evidence around total knee and total hip replacement, learnings from hospital and health system adoption, and refresh the previous bundle and warranty. The bundled payment model includes appropriateness standards (i.e., impairment despite non-surgical therapy, patient fitness for surgery), best practices for the repair of the osteoarthritic joint, and a pathway to return to function. The bundle is supported by a warranty and quality metrics. Read more:

– Completed: Opioid Use Disorder Treatment
Opioid overdose is a leading cause of death in our community. Our workgroup met to develop recommendations to build a health care system that identifies people with opioid use disorder and facilitates access to comprehensive, evidence-based treatment with the patient at the center of care. Focus areas include: access to evidence-based treatment (e.g., medication-assisted treatment, reduce stigma); referral information (e.g., inventory of medication treatment prescribers, supportive referrals and infrastructure); and integrated behavioral and physical health to support whole-person care (e.g., treatment of comorbid conditions). Read more:

– Completed: Alzheimer’s Disease and Other Dementias
Alzheimer’s disease and other dementias are a growing concern in Washington State and around the country. Our workgroup met to develop six focus areas around how a patient experiences disease progression: diagnosis, ongoing care and support, advance care planning and palliative care, need for increased support and/or higher levels of care, preparing for potential hospitalization, and screening for delirium risk. Read more:

– In Progress: Hysterectomy
Hysterectomy is one of the most frequently performed surgical procedure in the United States. Our workgroup met to address variation in populations who undergo the procedures and in outcomes. Focus areas include: assessment and medical management, by indication; uterine sparing procedures, by indication; surgical procedure including follow-up care, emphasizing the enhanced recovery after surgery protocol and use of a minimally invasive approach. These recommendations are currently out for public comment until December 22nd. Read more:

We have also been published in the International Journal of Health Governance and featured in a Washington Post article on warranties in health care. The International Journal of Health Governance published a profile of our Collaborative “A regional collaborative working to improve health care quality, outcomes, and affordability” November, 2017. Read it here: We have developed four warranties on common surgical procedures – an innovative step for our heath care community. In the recently published article, Your Plumber Offers A Money-Back Guarantee. Should Your Doctor? from the Washington Post, author Michelle Andrews with Kaiser Health News says, “You wouldn’t pay a mechanic for a faulty muffler or a restaurant for spoiled food. If you did, you would expect a refund. But the same arrangement between buyer and seller hasn’t historically existed in medical care. Some argue that maybe it should….”I think the warranty is something that really resonates with patients,” said Ginny Weir, program director for the Bree Collaborative. “They think, ‘If something goes wrong in the hospital, I know that I’d be taken care of financially if any of these things happened.” Read more here:

Thank you to our dedicated Bree Collaborative members and our many workgroup members who have donated countless hours to identify evidence-based solutions to pressing health care issues.

From all of us:

Hugh Straley, MD

Ginny Weir, MPH
Program Director

Emily Wittenhagen
Program Assistant