Health Affairs’ blog recently published America’s “NICE”? discussing whether the Institute for Clinical and Economic Review (ICER) is becoming our country’s National Institute for Health and Care Excellence (NICE). ICER was founded in 2006 as “an independent and non-partisan research organization that objectively evaluates the clinical and economic value of prescription drugs, medical tests, and other health care and health care delivery innovations” based in Boston, MA. NICE was founded in 1999 in the United Kingdom as “a special health authority, to reduce variation in the availability and quality of National Health Service treatments and care” and in 2013 was “established in primary legislation, becoming a Non Departmental Public Body.” ”I look to both NICE and ICER as we develop our recommendations and value their contribution to the health improvement space.

I believe that as a public/private Collaborative we bridge the strengths of both NICE and ICER through increased flexibility, greater transparency, and clear accountability. U.S. Supreme Court Justice Louis Brandeis popularized the phrase “laboratories of democracy” reflecting on the ability of our 50 states to engage in regional experimentation. Our Bree Collaborative is the result of such experimentation, a truly American phenomenon working to improve health care.

Like NICE, our Collaborative was created by legislation (ESHB 1311) and we are publicly funded by the Health Care Authority. Like ICER, NICE, and many others such as the Institute for Clinical Systems Improvement in Minnesota and the Integrated Healthcare Association in California we undertake clinical reviews of health care services with the goal of improving health care quality, outcomes, and affordability. Our recommendations have spanned obstetrics care including standards for cesarean section to increasing uptake of advance care planning to align end-of-life care with patient wishes. We have developed bundled payment models and warranties for common surgical procedures such as knee and hip replacements and worked to strengthen the appropriateness of lumbar fusion and bariatric surgery. Recent work has focused on opioid prescribing and integrating behavioral health into primary care including treatment for opioid use disorder as the opioid epidemic has been a priority for our state and region.

We are proud to be a part of this national and international effort to improve health care.

Ginny Weir, MPH
Program Director, Bree Collaborative