Our Background

The Dr. Robert Bree Collaborative (Bree) was established in 2011 by the Washington State Legislature

“…to provide a mechanism through which public and private health care stakeholders can work together to improve quality, health outcomes, and cost effectiveness of care in Washington State.”

Information about our legislative authority can be found in the bill that established the Bree, ESHB 1311. Read the bill

Members are appointed by the Governor and include public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. Meet our members

What We Do

We identify up to three areas of health care services every year that have high variation in the way that care is delivered, that are frequently used but do not lead to better care or patient health, or that have patient safety issues. In choosing a topic, we consider many strategies including:

  • Goals for appropriate utilization rates
  • Peer-to-peer consultation
  • Provider feedback reports
  • Use of patient decision aids
  • Incentives for the appropriate use of health services
  • Centers of Excellence or other provider qualification standards
  • Quality improvement systems
  • Service utilization or outcome reporting

For most topic areas, we organize a workgroup made up of experts, including physicians, specializing in the topic. Workgroups are made up of community experts and Bree members. A list of current and previous workgroup members can be found here. Workgroup members identify and analyze evidence-based best practices to improve quality and reduce variation in practice patterns.  These recommendations take into account existing quality improvement programs and organizations already working to improve care.

Recommendations are then sent to the Washington State Health Care Authority (HCA) for review and approval. The HCA oversees Washington State’s largest health care purchasers, Medicaid and the Public Employees Benefits Board Program, as well as other programs. The HCA uses our recommendations to guide state purchasing for these programs. LEARN MORE ABOUT THE HCA

We also strive to develop recommendations to improve patient health, health care service quality, and the affordability of health care for the private sector. However, we do not have the authority to mandate the implementation of our recommendations or set health care prices.

How We Formed

Our partnership is named in honor of the late Dr. Robert Bree, a pioneer in medical imaging.  Dr. Bree made important contributions to reduce the inappropriate use of advanced imaging (e.g., CT, PET, and MRI) in Washington State.  Dr. Bree was a member of the Washington State Advanced Imaging Management Workgroup, which preceded the Bree Collaborative. Learn more about the Advanced Imaging Management Workgroup

In August 2011, Governor Gregoire appointed 23 health care experts to serve on the Bree in accordance with requirements laid out in the legislation establishing our group. Members are nominated by a variety of community stakeholders such as the Association of Washington Healthcare Plans, the Washington Osteopathic Medical Association, the Washington State Hospital Association, and the Washington State Medical Association. Our members are not allowed to receive compensation and sit for three, four, or five-year terms.

Steve Hill served as the Collaborative’s first Chair. In November 2014 Mr. Hill announced his retirement as Chair of the Collaborative and in March 2015 Governor Inslee appointed Dr. Hugh Straley as chair. Dr. Straley is board certified in both internal medicine and medical oncology and served in many leadership roles at Group Health Cooperative.

We held our first meeting in September 2011. In November 2012, we adopted bylaws to set policies and procedures for the Bree beyond the mandates established by the Bree legislation.

Read our Bylaws

Our Relationships with Other Organizations

Washington State Health Care Authority (HCA)

The HCA is our funding agency. The HCA oversees eight programs, including the two largest health care purchasers in the state: Medicaid and the Public Employee Benefits Board. Learn more about the HCA

Foundation for Health Care Quality (The Foundation)

The HCA contracts with The Foundation to provide project management, administrative support, and healthcare specific expertise. The program director and all other Bree staff are employed by The Foundation. We also have close partnerships with several of the other health care quality improvement programs housed at The Foundation. Learn more about the Foundation

We do not have formal ties to any other organizations