Accountable Payment Models

Read the Lumbar Fusion Bundle and Warranty
(Adopted January 2019)
Read our Summary 

Read the Total Knee and Total Hip Replacement Bundle and Warranty
(Adopted November 2017, Revised July 2018)
Read our Summary 

Read the Bariatric Surgical Bundle
Read the Bariatric Surgical Warranty
(Adopted November 2016)
Read our Summary

Read the Coronary Artery Bypass Graft Surgical Bundle
Read the Coronary Artery Bypass Graft Surgical Warranty
(Adopted September 2015)
Read our Summary

The majority of health care payments are for number of services provided rather than quality of care or per person or per unit of time. This 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.

This 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 graft surgery workgroup met from February 2015 – September 2015. The bariatric surgical workgroup met from February to November 2016. The re-review of the total knee and total hip replacement workgroup met from December 2016 to November 2017.The workgroup to re-review the lumbar fusion bundle and warranty met from January 2018 to January 2019.

Previous Meeting Materials

Date Materials
January 23 Agenda January 23
Accountable Payment Models: Lumbar Fusion Charter and Roster
Bree Collaborative Process
Lumbar Fusion Surgical Bundle
Lumbar Fusion Warranty
February 27 Agenda February 27
Minutes January 23
Draft Bundle and Warranty
March 27 Agenda March 27
Minutes February 27
Lumbar Fusion Bundle and Warranty Draft
April 24 Agenda April 24
Minutes March 27
Draft Lumbar Fusion Bundle and Warranty
Draft Lumbar Fusion Evidence Table
May 22 Agenda May 22
Minutes April 24
Draft Lumbar Fusion Bundle and Warranty
Lumbar Fusion Evidence Table
June 26 Agenda June 26
Minutes May 22
Draft Lumbar Fusion Bundle and Warranty
July 24 Agenda July 24
Minutes June 26
Draft Lumbar Fusion Bundle and Warranty
August 28 Agenda August 28
Minutes July 24
Lumbar Fusion Bundle and Warranty Draft
Draft Lumbar Fusion Evidence Table
ASA Basic Standards for Preanesthesia Care
Volume Standards Talking Points
September 25 Agenda September 25
Minutes August 28
Lumbar Fusion Bundle and Warranty Draft
Draft Lumbar Fusion Evidence Table
October 23  Agenda October 23
Minutes September 25
Draft Lumbar Fusion Bundle and Warranty
Draft Evidence Table
December 18 Agenda December 18
Minutes October 23
Lumbar Fusion Bundle and Warranty Draft
Lumbar Fusion Evidence Table
Public Comments

Supporting Materials:

Letter from HCA Accepting Lumbar Fusion Bundle
Lumbar Fusion Evidence Table
Accountable Payment Models: Lumbar Fusion Re-Review Workgroup Charter and Roster
Letter from the Health Care Authority Accepting the Total Knee and Total Hip Replacement Bundle and Warranty and the Opioid Use Disorder Treatment and Alzheimer’s Disease and Other Dementias Report and Recommendations
Total Joint Replacement ICD-9/10 Crosswalk (November 2017)

Total Knee and Total Hip Replacement Evidence Table (November 2017)
Letter from Health Care Authority Accepting Bariatric Surgical Bundle and Warranty
Accountable Payment Models: TKR/THR Re-Review Charter and Roster
Evidence Table for Bariatric Surgical Bundle
Accountable Payment Models: Bariatric Surgery Charter
Letter from Health Care Authority Accepting Coronary Artery Bypass Graft Surgical Bundle and Warranty
CABG Bundle Public Comment
Coronary Artery Bypass Graft Surgery Evidence Table
CABG Bundle Public Comment
Letter from Health Care Authority Accepting Lumbar Fusion Bundle and Warranty
Lumbar Fusion Evidence Table
Public Comments Summary: Lumbar Fusion Surgical Bundle and Warranty
Evidence Table for Total Knee and Total Hip Replacement Surgery Bundle
Public Comments Summary: Total Knee Replacement and Total Hip Replacement Bundle
Public Comments Summary: Total Knee Replacement and Total Hip Replacement Warranty
Accountable Payment Models Workgroup Charter

Lumbar Fusion Re-Review Workgroup Members

Name Title Organization
Robert Mecklenburg, MD (Co-Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Kerry Schaefer, MS (Co-Chair) Strategic Planner for Employee Health King County
Lydia Bartholomew, MD Senior Medical Director, Pacific Northwest Aetna
Arman Dagal, MD Medical Director Spine SCOAP
Sharon Eloranta, MD Division Director, Clinical Excellence and Quality CHI Franciscan Health
Farrokh Farrokhi, MD Neurosurgeon Virginia Mason Medical Center
Gary Franklin MD, MPH Medical Director Washington State Department of Labor and Industries
Andrew Friedman, MD Physical Medicine and Rehabilitation Virginia Mason Medical Center
Michael Hatzakis, MD Physiatrist Overlake Medical Center
Sara Groves-Rupp Asst Administrator, Performance Improvement University of Washington Medicine
Marcia Peterson Manager of Benefits Strategy and Design Washington State Health Care Authority
Linda Radach Patient Advocate

Mia Wise, DO

 

Medical Director, Provider & Customer Engagement Premera Blue Cross
Jason Thompson, MD Spine Surgeon Proliance Surgeons

 

Total Knee and Total Hip Replacement Re-Review Workgroup Members

Member Title Organization
Lydia Bartholomew, MD Senior Medical Director, Pacific Northwest Aetna
Shawn Boice, RN, BSN, MHA Nurse Navigator, MSK Administration Evergreen Health Care
Greg Brown, MD, PhD Orthopedic Surgeon CHI Franciscan
Sharon Eloranta, MD Medical Director, Quality and Safety Initiatives Qualis Health
Andrew Friedman, MD  Physiatrist Virginia Mason Medical Center
Fred Huang, MD Orthopedic Surgeon Proliance Orthopedic Associates
Kevin Macdonald, MD Orthopedic Oncology, Adult Reconstruction Virginia Mason Medical Center
Robert Mecklenburg, MD (Co-Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Linda Radach  Patient Advocate
Kerry Schaefer, MS (Co-Chair) Strategic Planner for Employee Health King County
Jacqui Sinatra, MPA, FACHE Service Line Director of Sports, Spine, & Ortho Health Svc University of Washington Medical Center
Gaelon Spradley Chief of Clinic Operations Mason General Hospital
Theresa Sullivan CEO Samaritan Healthcare, Moses Lake

.

Bariatric Surgery Workgroup Members

Member Title Organization
Sharon Eloranta, MD Medical Director, Quality and Safety Initiatives Qualis Health
Kristin Helton, PhD Consumer
Jeff Hooper, MD Medical Director, Weight Loss Program MultiCare Health System
Dan Kent, MD Chief Medical Officer United Health Care
Saurabh Khandelwal, MD Bariatric Surgeon University of Washington
Robert Mecklenburg, MD (Co-Chair) Medical Director, Center for Health Care Solutions Virginia Mason Medical Center
Robert Michaelson, MD, PhD, FACS, FASMBS President Washington State Chapter, American Society for Metabolic and Bariatric Surgery
Thien Nguyen, MD Bariatric Program Medical Director Overlake Medical Center
Tom Richards Consumer
Kerry Schaefer (Co-Chair) Strategic Planner for Employee Health King County
Jonathan Stoehr, MD/Jeff Hunter, MD Endocrinologist/ Bariatric Surgeon Virginia Mason Medical Center
Brian Sung, MD Bariatric Surgery Director Swedish Medical Center
Tina Turner Senior Internal Consultant Premera Blue Cross
Richard Thirlby, MD Medical Director Surgical Care and Outcomes Assessment Program (SCOAP)

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, MS (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, MS 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

 

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, MS 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