Accountable Payment Models

Upcoming meetings:

Date Time Agenda
 Wednesday, April 1  4:00-5:30pm Agenda April 1
 Wednesday, May 6  4:00-5:30pm TBD
 Wednesday, June 3  4:00-5:30pm TBD
 Wednesday, July 1  4:00-5:30pm TBD

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Read our reports:

Lumbar Fusion Surgical Bundle (Adopted September 2014)
Lumbar Fusion Warranty (Adopted September 2014)
Total Knee and Total Hip Replacement Surgical Bundle (Adopted November 2013)
Total Knee and Total Hip Replacement Warranty (Adopted July 2013)

The current model of health care pays physicians and other providers for the number of services provided rather than the quality of care.  This workgroup grew out of the Potentially Avoidable Hospital Readmissions workgroup and looks at how physicians and hospitals are paid for health care services. The workgroup develops recommendations to tie provider payment to an entire episode of care including potential complications resulting from poor care and has focused on total knee and total hip replacement, lumbar fusion, and coronary artery bypass surgery.

The workgroup chose to first focus on knee and hip replacements due to the high volume of these procedures and the high variability in how the procedures are performed. To see this high variation, read the readmissions rates by hospital for Washington State:

Total Knee and Total Hip Replacement Readmission Rates Washington State – Overall and By Hospital (Adopted October 2013)

The total knee and total hip replacement workgroup met from November 2012 to October 2013. The lumbar fusion workgroup met from January 2014 to August 2014. The coronary artery bypass surgery workgroup started meeting in February 2015.

 

Supporting Materials

Letter from Health Care Authority Accepting Lumbar Fusion Bundle and Warranty
Letter from Health Care Authority Accepting TKR/THR Bundle, Warranty, and Spine Report
Lumbar Fusion Evidence Table

Public Comments Summary: Lumbar Fusion Surgical Bundle and Warranty

Total Knee and Total Hip Replacement Evidence TablePublic Comments Summary: Total Knee Replacement and Total Hip Replacement Warranty
Public Comments Summary: Total Knee Replacement and Total Hip Replacement Bundle

Workgroup Charter

Coronary Artery Bypass Surgery Workgroup Members

Member Title Organization
Drew Baldwin MD, FACC Cardiologist Virginia Mason Medical Center
Glenn Barnhart MD Cardiac Surgeon Swedish Medical Center
Marissa Brooks Director of Health Improvement Programs SEUI Healthcare Northwest Benefits
Susie Dade MS Deputy Director Washington Health Alliance
Gregory Eberhart MD, FACC Medical Director, Cardiology CHI Franciscan Health
Theresa Helle Manager of Health Care Quality and Efficiency Initiatives The Boeing Company
Bob Herr MD Physician US HealthWorks
Jeff Hummel MD Medical Director, Health Care Informatics Qualis Health
Dan Kent MD Medical Director, Quality & Medical Management Premera Blue Cross
Robert Mecklenburg MD (Co-Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Vinay Malhotra MD Cardiologist Cardiac Study Center
Kerry Schaefer (Co-Chair) Strategic Planner for Employee Health King County
Gregg Shibata Manager, Accountable Health Implementation Regence Blue Shield
Shilpen Patel, MD, FACRO Medical Director Clinical Outcomes Assessment Program
Thomas Richards Managing Director, Employee Benefits Alaska Airlines

Lumbar Fusion Workgroup Members

Member Title Organization
Susie Dade MS Deputy Director Washington Health Alliance
Gary Franklin MD, MPH Medical Director Washington State Department of Labor and Industries
April Gibson Administrator Puget Sound Orthopaedics
Dan Kent MD Medical Director, Quality & Medical Management Premera Blue Cross
Bob Manley MD Surgeon Regence Blue Shield
Gary McLaughlin Vice President of Finance, Chief Financial Officer Overlake Hospital
Robert Mecklenburg MD (Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Peter Nora MD Chief of Neurological Surgery Swedish Medical Center
Charissa Raynor Executive Director SEIU Healthcare NW Benefits
Kerry Schaefer Strategic Planner for Employee Health King County
Julie Sylvester Vice President of Quality and Safety Initiatives Qualis Health
Jay Tihinen Assistant Vice President Benefits Costco Wholesale

 

Total Knee and Total Hip Replacement Workgroup Members

Member Title Organization
Susie Dade MS Deputy Director Washington Health Alliance
Joe Gifford MD Chief Strategy and Innovation Officer for Western Washington Providence Health and Services
Bob Herr, MD Medical Director, Government Programs Regence Blue Shield
Tom Hutchinson Practice Administrator PeaceHealth
Rich Maturi Senior Vice President, Health Care Delivery Systems Premera Blue Cross
Gary McLaughlin Vice President of Finance Overlake Hospital
Robert Mecklenburg, MD (Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Kerry Schaefer Strategic Planner For Employee Health King County
Julie Sylvester Vice President of Quality and Safety Initiatives Qualis Health
Jay Tihinen Assistant Vice President, Benefits Costco