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Health Impacts of Extreme Heat and Wildfire Smoke - NEW!

Guideline Information

Guideline title: Health Impacts of Extreme Heat and Wildfire Smoke

Publication Status: January 2025

Date of publication: 2025

Date of last evidence search: 2024

Scope: TBD

Methods: Current guidelines and literature review and expert consensus

Description: This report’s main aim is to reduce morbidity and mortality related to extreme heat and wildfire
smoke. Heat-related illnesses and health impacts due to poor air quality can be prevented or reduced by
implementing evidence-informed, coordinated efforts across sectors, such as early detection and
warning systems, education and communication, and standardized protocols for responding to heat-
related illnesses and exacerbation. Addressing the underlying social and environmental determinants of
health that make certain populations more vulnerable to heat and wildfire smoke can reduce disparities
and promote health equity in the face of our changing climate.

Metrics and Evaluation Tools

Introduction to Evaluation Tools

The Bree has developed multiple tools specific to the Health Impacts of Extreme Heat and Wildfire Smoke report, to support the evaluation projects implemented based on our guidelines.

Evaluation Matrix

The Bree has developed an evaluation matrix to help clarify measurable objectives, goals, and metrics that are relevant to the recommendations made by the work group. The matrix can be use during planning of your implementation project to help identify long-term outcomes or impacts of your project(s). The matrix provides a broad summary of the recommendations by audience for each component or focus area the guideline addresses (for example: education, access, treatment, etc.).

EVALUATION MATRIX

Evaluation Framework

The Evaluation Framework provides further guidance on how organizations can conduct and align their work with other audience actors (example: all health plans in Washington state) or other audience types (example: health plans and providers). It provides specific details for measurement, provides strong and soft recommendations for the types of evaluations each organization may consider conducting, expands on alignment with other initiatives in Washington State, and makes recommendations for ethical and equity considerations.

EVALUATION FRAMEWORK – COMING SOON

Data Matrix

An example of how to fill out this form is available in Appendix B of the Evaluation Framework. The Data Matrix tool can be used in planning your data collection effort for your implementation and evaluation.

Data Matrix Template– fillable form

Theory of Change

The theory of change illustrates how the work group conceptualized changes that would occur throughout the health care ecosystem as a result of their recommendations. The subcommittee for this report has not yet developed a theory of change.

THEORY OF CHANGE – (will be posted when complete)

Score cards

To support health system improvement the Bree Collaborative has created evaluation score cards that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our score cards, find the audience type, or types, that is closest to your organization and download the excel document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Score cards are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards.

Completed score cards can be sent to knicholas@qualityhealth.org

Score cards can be found in the tabs below:

Delivery Site and Health System

Health System Administration Score Card

Urgent Care Score Card

Hospitals and ERs Score Card

Health Care Professionals

Clinician Score Card

Outpatient Staff Score Card

Health Plans

Health Plan Score Card

Washington State Agencies

Washington State Health Care Authority Score Card

Washington State Department of Health Score Card

Washington State Department of Labor and Industries Score Card

Washington State DSHS Score Card

Private and Public Purchasers

Employer/Purchaser Score Cards

Community Based Organizations, Other (schools, LHJ's etc.)

School Score Cards

Local Health Jurisdictions Score Cards

Long Term Care Organizations Score Cards

Emergency Medical Services

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

WorkGroup Members

Name Title Organization
Chris Chen, MD (Chair) Medical Director for Medicaid Washington HealthCare Authority
Brad Kramer, PhD Program Manager Public Health Seattle King County
Kristina Petsas, MD Chief Medical Officer for Employer and Individual Plans United Healthcare
Bre Holt Senior Director Population Health Comagine Health
Jessi Kelley Research Coordinator UW Collaborative for Extreme Event Resilience
Stefan Wheat, MD Emergency Medicine Physician UW
Raj Sundar, MD Family Medicine Physician Kaiser Permanente
Jessica Symank/Amy Anderson Senior Director, Safety Quality and Rural Programs Washington State Hospital Association
Kelly Naismith, MPH Climate Change and Health Epidemiologist Supervisor Washington Department of Health
LuAnn Chen, MD, MHS Medical Director Community Health Plan of Washington
June Spector, MD, MPH Internal Medicine Physician/Scientist Washington Labor & Industries
Mary Beth Bennett, MD Pediatric Resident Seattle Children’s
Seth Doyle, MA Director of Strategic Initiatives/President of WAPH Northwest Regional Primary Care Association/Washington Association for Public Health
Raymond Moeller, MD Thurston County Medical Reserve Corps
Brian Henning, MD Director Gonzaga Institute for Climate, Water, and the Environment
Onora Lien Executive Director Northwest Healthcare Response Network

Award Winners

Add Award Winners here

LGBTQ Care

Guideline Information

Guideline title: LGBTQ Care Report and Guidelines

Publication Status: Active

Date of publication: 2018

Date of last evidence search: 2018

Scope: Communication, language, and inclusive environments; screening; data collection; vaccination; care and services.

Methods: Current guidelines and literature review and expert consensus

Description: The workgroup aims to develop guidelines with a manageable scope that can be adopted by clinics, hospitals, health systems, and health plans. Guidelines are based in a whole–person care framework, taking into consideration an individual’s multiple factors that make up health, wellness, and experience (e.g., behavioral health, past trauma, race/ethnicity) in such a way that is not identity or diagnosis–limiting. We recommend that all health care encounters should occur using non–judgmental, non–stigmatizing language, body language, and tone. Our guidelines are oriented mainly, but not exclusively, to primary care, and include guidelines directed to hospital settings, health plans, health care purchasers, and patients themselves.

Supporting Materials

Department of Health Letter Accepting LGBTQ Health Care Recommendations
Health Care Authority Letter Accepting LGBTQ Health Care Recommendations
LGBTQ Health Care Workgroup Charter and Roster

Metrics and Evaluation Tools

To support health system improvement the Bree Collaborative has created operational measures that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our operational measures, find the audience type, or types, that is closest to your organization and download the measures document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Operational measures are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report on operational measures, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards. Instructions for the self-report submission can be found in the section below.

Delivery Site and Health System

Health System Evaluation Score Card  Health System Score Card _ LGBTQ

Health Care Professionals

Clinician Score Card  Clinician Score Card _ LGBTQ

Health Plans

Health Plan Score Card  Health Plan Score Card _ LGBTQ care

Washington State Agencies

Washington State Agency Score Card WA State Agencies Score Card _ LGBTQ care

Private and Public Purchasers

Employer/ purchaser Score Card  Employer Score Card _ LGBTQ care

Guideline Metrics

The work group recommends tracking the number of patients who identify as lesbian, gay, bisexual, and transgender. Additionally, Healthy People 2020 includes two Lesbian, Gay, Bisexual, and Transgender Health related metrics:

  • Increase the number of population-based data systems used to monitor Healthy People 2020 objectives that include in their core a standardized set of questions that identify lesbian, gay, bisexual, and transgender populations
  • Increase the number of states, territories, and the District of Columbia that include questions that identify sexual orientation and gender identity on state level surveys or data systems.

The Bree, along with Healthy People 2020, acknowledges intersections with other topic areas including: breast cancer screening, bullying among adolescents, cervical cancer screening, condom use, educational achievement, health insurance coverage, HIV testing, illicit drug use, mental health and mental illness, nutrition and weight status, tobacco use, and [having a] usual source of care. To address this intersectional work we have identified LGBTQ care guidelines as part of a set of common measures that support other guidelines the Bree has created.

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

Workgroup members

Name Title Organization
Dan Lessler, MD, MHA (Chair) Chief Medical Officer Washington State Health Care Authority
Olivia Arakawa, MSN, CNM, ARNP, RN Parent Advocate
Scott Bertani Director of Policy Lifelong AIDS Alliance
Kathy Brown, MD Provider Kaiser Permanente
LuAnn Chen, MD, MHA, FAAFP Medical Director Community Health Plan of Washington
Michael Garrett, MS, CCM, CVE, NCP Principal Mercer
Chris Gaynor, MD, MA, FAAFP Family Practice Clinician Capitol Hill Medical
Matt Golden, MD Professor, Director, PHSKC STD Control Program University of Washington
Kevin Hatfield, MD Family Practice Clinician The Polyclinic
Corinne Heinen, MD Physician Lead, UW Transgender Clinical Pathway Department of Internal Medicine, Allergy & Infectious Disease, University of Washington
Tamara Jones End AIDS Washington Policy and Systems Coordinator Department of Health

Primary Care

Guideline Information

Guideline title: Primary Care Report and Guidelines

Publication Status: Active

Date of publication: 2020

Date of last evidence search: 2020

Scope: Management; implementation; patient education, measurement; financing structure

Methods: Current guidelines and literature review and expert consensus

Description:  The Primary Care Report and Guidelines  are designed “to foster a common understanding of primary care to increase primary care accessibility and availability.” This report outlines the benefits of accessing primary care for a population, as well as the issues with current reimbursement models on page 3 and the focus areas for these guidelines on page 5. Pages 6-11 include checklists for primary care, for health plans, for people receiving care, and for employer groups to support the focus areas. Must have infrastructure elements for primary care are listed on page 6 including those around team-based, evidence-informed, and whole-person care; available behavioral health; patient panels; accessible care; and supportive health information technology. Primary care is further defined on pages 13-14 including a philosophical framework of being accountable, first contact, comprehensive, continuous, coordinated, and appropriate. Content of care visits is discussed on page 15 and approaches to reimbursement including measurement on page 18.

Metrics and Evaluation Tools

To support health system improvement the Bree Collaborative has created operational measures that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our operational measures, find the audience type, or types, that is closest to your organization and download the measures document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Operational measures are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report on operational measures, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards. Instructions for the self-report submission can be found in the section below.

Delivery Site and Health System

Health System Evaluation Score Card Health System Score Cards _ Primary Care

Health Plans

Health Plan Score Card Health Plan Score Card _ Primary Care

Private and Public Purchasers

Employer/Purchaser Score Card Employer_Purchaser Score Cards _ Primary Care

Guideline Metrics

No metrics have been identified by the work group, instead the report “recommends that annual primary care spend initially be measured with claims data such that the numerator includes all services delivered in an ambulatory setting by a predefined group of providers and team members and the denominator is the total cost of care including ambulatory and non-ambulatory care services, laboratory tests, drug costs, imaging, and other fees”.

It is recommended that delivery and payor organizations track the condition specific measure proposed by the HCA to ensure quality of care a to address disparities in care. The core set to gauge the clinical quality delivered by an integrated, whole-person care model are listed below. Measurement is aligned with the participation level agreed to by payer and provider (NPI, practice site, etc.) Except where otherwise noted, all measures are recommended using HEDIS measurement standards (metrics). All measures are part of the Washington Common Measure Set.

  • Child and Adolescent Well-Care Visit (WCV)
  • Childhood Immunization Status (CIS) (Combo 10)
  • Breast Cancer Screening (BCS)
  • Cervical Cancer Screening (CCS)
  • Colorectal Cancer Screening (COL)
  • Depression Screening and Follow up for Adolescents and Adults (DSF-E)
  • Controlling High Blood Pressure (CBP)
  • Asthma Medication Ratio (AMR)
  • Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (CDCÑ)
  • Antidepressant Medication Management (AMM)
  • Follow-up after ED visit for Alcohol and Other Drug Abuse of Dependence (FUA)
  • Ambulatory Care – Emergency Department (ED) Visits per 1,000 (AMB) (Medicaid only in HEDIS, but will adapt for use across populations)

The Washington State Health Care Authority is working on the implementation of Bree Guidelines on Primary Care through the design of a certification program associated with their Primary Care Transformation Model. Any organization certified by the HCA is considered to have fully implemented the Bree Collaborative Primary Care Recommendations (need to decide if this is true)

Any organization looking for measures to track their progress on implementing the Primary Care recommendations can refer to the audience specific measures above.

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

Workgroup members

Name Title Organization
Judy Zerzan, MD, MPH (Chair) Chief Medical Officer Washington State Health Care Authority
Patricia Auerbach, MD, MBA Senior Medical Director UnitedHealthcare
Cynthia Burdick, MD Medical Director, Medicare and Medicaid Kaiser Permanente Washington
Tony Butruille, MD Chair, Primary Care Investment Task Force Washington Academy of Family Physicians
Jason Fodeman, MD Associate Medical Director Washington State Department of Labor and Industries
Bianca Frogner, PhD Associate Professor, Family Medicine; Director of Center for Health Workforce Studies University of Washington School of Medicine
Ingrid Gerbino, MD, FACP Chief, Department of Primary Care Virginia Mason
Karen Johnson, PhD, MHSA Director of Performance Improvement and Innovation Washington Health Alliance
Louise Kaplan, PhD, ARNP, FNP-BC, FAANP, FAAN Associate Professor, Associate Academic Director Washington State University Vancouver College of Nursing
Catherine Mazzawy
 Senior Director, Safety and Quality
Washington State Hospital Association
Carl Olden, MD Family Physician Virginia Mason Memorial
Mary Kay O’Neill, MS, MBA Partner Mercer
Ashok Reddy, MD, MS Assistant Professor, Medicine University of Washington School of Medicine, Veterans Administration
Keri Waterland, PhD, MAOB Division Director, Division of Behavioral Health and Recovery Health Care Authority
Laura Kate Zaichkin, MPH Director, Health Plan Performance and Strategy SEIU 775 Benefits Group

SDOH & Health Equity

Guideline Information

Guideline title: Social Determinants of Health and Health Equity Guidelines and Report

Publication Status: Active

Date of publication: 2021

Date of last evidence search: 2021

Scope: Planning, identification, tracking and measurement, follow-up, incentives and investments.

Methods: Current guidelines and literature review and expert consensus

Description:  This report was prepared by the Foundation for Health Care Quality for the Washington Healthcare Forum. This report covers guidelines and best practices for screening and intervening on the social determinants of health as well as a strategy for assessing and addressing population health disparities, especially from racism.

Resources and Tools

General Resources and Tools

Advancing Equity Report by FHCQ

Social Need Screening Report by FHCQ

Social Need Intervention Report by FHCQ

Storing and Sharing Data Report by FHCQ

Bree/FHCQ Health Equity Webinars 

PRAPARE

Social Interventions Research & Evaluation Network (SIREN)

 

DCHQ

Planning

American Academy of Family Physicians: The EveryONE Project

American Hospital Association: Health Equity Snapshot – A Toolkit for Action

Institute for Healthcare Improvement: Advancing Equity Guidelines

National Academies Press: Integrating Social Care into the Delivery of Healthcare

Identification

American Hospital Association: Equity, Diversity & Inclusion Measures for Hospitals and Health Systems

Robert Wood Johnson Foundation: Data for Health – Learning What Works

CMS: Inventory of Resources for Standardized Demographic and Language Data Collection

Kaiser Permanente and SIREN: Systematic Review of Social Risk Screening Tools

Boston Medical Center: The WE CARE Model

CMS: Accountable Community of Health – Health Related Social Needs Screening Tool

Health Leads USA: Screening Toolkit

Kaiser Permanente: Your Current Life Situation Tool

PRAPARE: Implementation and Action Toolkit

Tracking & Measurement

The Gravity Project

AHRQ: Computerized Disease Registries and Selected Disease Registry Resources

Follow-up

Intermountain Healthcare: Social Determinants of Health SBIRT Model

Kaiser Permanente: COVID-19 Social Health Playbook

SIREN: Community Resource Referral Platforms: A Guide for Health Care Organizations

Incentives & Investments

Commonwealth Fund: Review of Evidence for Health-Related Social Needs Interventions

The Improving Social Determinants of Health Act of 2010 (H.R. 6561/S. 4440)

Social Need & Health Equity Summit 2023

Metrics and Evaluation Tools

To support health system improvement the Bree Collaborative has created operational measures that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our operational measures, find the audience type, or types, that is closest to your organization and download the measures document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Operational measures are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report on operational measures, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards. Instructions for the self-report submission can be found in the section below.

Delivery Site and Health System

Health System Evaluation Score Card Health System Score Card _ Equity

Health Care Professionals

Providers Provider score Card _ Equity

Case Managers and Care Coordinators HC Manager score Card _ Equity

Community Based Organizations and Associations

Community Based Organizations CBO Score Card _ Equity

Professional Associations Association Score Card _ Equity

Community Information Exchange

Community Information Exchange CIE Score Card _ Equity

Health Plans

Health Plan Evaluation Score Card Health Plan Score Card _ Equity

Washington State Agencies

Washington State Health Care Authority HCA Score Card _ Equity

Department of health and Local Health Jurisdictions DOH_LHJ Score Card _ Equity

Washington State Legislature WA_Leg Score Card _ Equity

Private and Public Purchasers

Employer/Purchasers Employer Score Card _ Equity

Guideline Metrics

No metrics have been identified by the work group, instead the report “recommends that annual primary care spend initially be measured with claims data such that the numerator includes all services delivered in an ambulatory setting by a predefined group of providers and team members and the denominator is the total cost of care including ambulatory and non-ambulatory care services, laboratory tests, drug costs, imaging, and other fees”.

It is recommended that delivery and payor organizations track the condition specific measure proposed by the HCA to ensure quality of care a to address disparities in care. The core set to gauge the clinical quality delivered by an integrated, whole-person care model are listed below. Measurement is aligned with the participation level agreed to by payer and provider (NPI, practice site, etc.) Except where otherwise noted, all measures are recommended using HEDIS measurement standards (metrics). All measures are part of the Washington Common Measure Set.

  • Child and Adolescent Well-Care Visit (WCV)
  • Childhood Immunization Status (CIS) (Combo 10)
  • Breast Cancer Screening (BCS)
  • Cervical Cancer Screening (CCS)
  • Colorectal Cancer Screening (COL)
  • Depression Screening and Follow up for Adolescents and Adults (DSF-E)
  • Controlling High Blood Pressure (CBP)
  • Asthma Medication Ratio (AMR)
  • Comprehensive Diabetes Care: Hemoglobin A1c (HbA1c) Poor Control (>9.0%) (CDCÑ)
  • Antidepressant Medication Management (AMM)
  • Follow-up after ED visit for Alcohol and Other Drug Abuse of Dependence (FUA)
  • Ambulatory Care – Emergency Department (ED) Visits per 1,000 (AMB) (Medicaid only in HEDIS, but will adapt for use across populations)

The Washington State Health Care Authority is working on the implementation of Bree Guidelines on Primary Care through the design of a certification program associated with their Primary Care Transformation Model. Any organization certified by the HCA is considered to have fully implemented the Bree Collaborative Primary Care Recommendations (need to decide if this is true)

Any organization looking for measures to track their progress on implementing the Primary Care recommendations can refer to the audience specific measures above.

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

Workgroup Members

Name Title Organization
Abigail Berube Director, Safety and Quality Washington State Hospital Association
Alison Bradywood Senior Director, Clinical Quality and Practice Virginia Mason
Angela Chien, MD OBYGN
Becky Fraynt Manager, Health Improvement Program SEIU
Christopher Chen, MD Associate Medical Director Washington Health Care Authority
James Manuel Project Lead Washington Health Benefit Exchange
Janice Tufte Patient Advocate
Jessica Martinson Director, Continuing Professional Education Washington State Medical Association
Jon Ehrenfeld Mobile Integrated Health Program Manager Seattle Fire Department
Julie Stroud Medical Director for Quality and Clinical Services Optum
Karen Curtis Senior Director, National Health and Life Sciences PointB
Karie Nicholas Data Analyst Washington Association fro Community Health
Ashley Lile Director of Training and Technical Assistance Washington Association for Community Health
Kevin Conefrey Vice President, Human Resources First Choice Health
Laurel Lee VP Member and Community Engagement, Interim President Molina Healthcare
Yogini Kulkarni-Sharma AVP of Health Plan Quality Improvement Molina Healthcare
Laurie Bergman Vice President, Care Transition Confluence Health
Maria Courogen Special Assistant, Systems Transformation Washington Department of Health
Meg Jones Director of Government Relations PacificSource Health Plans
Layne Croney Product Development Strategist PacificSource Health Plans
Michael Garret Principle Mercer
Phyllis Cavens Pediatrician, Medical Director Child and Adolescent Clinic, Longview and Vancouver Washington Chapter of American Academy of Pediatrics
Thomas Green Orthopedic Surgeon
Wes Luckey Deputy Director Grater Colombia ACH
Yolanda Evans Adolescent Medicine, Pediatric and Adolescent Gynecology Seattle Children’s
Zandrea “Zandy” Harlan Quality Manager Kaiser Permanente

Shared Decision Making

Guideline Information

Guideline title: Shared Decision Making Report and Guidelines

Publication status: Active

Date of publication: 2019

Date of last evidence search: 2019

Scope: Common understanding and shared definition, priority areas, implementation framework

Methods: Current guidelines and literature review and expert consensus

Description: The Shared Decision Making work group’s goal is statewide movement toward greater use of shared decision making in clinical practice at a care delivery site and organizational level. The goal is for all care delivery sites to move toward greater adoption using a stages of change framework (i.e., pre-contemplation, contemplation, preparation, action, maintenance).

Resources and Tools

Resources and Tools

Washington State HCA Shared Decision Making Link 

Washington State HCA Certified Patient Decision Aids Link

AHRQ The SHARE Approach Link

SAMHSA Shared Decision Making Link

Continuing Education

Shared Decision-Making training. The American Academy of Family Physicians (AAFP) approved this training for continued medical education (CME) credits. The WA HCA’s SDM training is approved for 1.5 AAFP Prescribed credits. CMS credit is approved through April 3, 2024.

Related Bree Webinars Link

Metrics and Evaluation Tools

To support health system improvement the Bree Collaborative has created operational measures that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our operational measures, find the audience type, or types, that is closest to your organization and download the measures document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Operational measures are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report on operational measures, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards. Instructions for the self-report submission can be found in the section below.

Delivery Site and Health Systems

Health System Score Card  Health System Score Card – SDM

Health Care Professionals

Practitioners Score Card Practitioner Score Card – SDM

Health Plans

Health Plan Score Card Health Plan Score Card _ SDM

Washington State Agencies

Washington State Health Care Authority WA HCA Score Card – SDM

Private Purchasers/Employer

Purchaser/employer Evaluation Score Card Employer Score Card – SDM

Guideline Metrics

Shared decision making guidelines highlight the importance of using the shared decision making process for 10 specific activities or conditions including Abnormal Uterine Bleeding (procedural), Advance Care Planning, Attention, Deficit Hyperactivity Disorder Treatment (behavioral health), Cancer Screening (breast, prostate, colorectal, lung), Depression Treatment (behavioral health), Knee and Hip Osteoarthritis (procedural), Herniated disk (procedural), Opioid Use Disorder Treatment (behavioral health), Spine Surgery (Lumbar Fusion) (procedural), and Trial of Labor After Cesarean Section (procedural).

Shared Decision Making Process  Measure
Steward: Massachusetts General Hospital
NQF #2962

NCQA Supplemental items for Consumer Assessment of Healthcare Providers and Systems (CAHPS) ® 4.0 Adult Questionnaire (CAHPS 4.0H) NQF #0007

Bree Collaborative Bundled Payment Model Metrics
Merit-Based Incentive Payment System (MIPS) Trial of Conservative (Non-Surgical) Therapy # 350

Gains in Patient Activation Scores at 12 Months NQF #2483

Back Pain: Shared Decision Making NQF #0310

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

Workgroup Members

Member Title Organization
 Emily Transue, MD, MHA (Chair)  Associate Medical Director  Washington State Health Care Authority
Sharon Gilmore, RN Risk Consultant Coverys
Leah Hole-Marshall, JD General Counsel and Chief Strategist Washington Health Benefit Exchange
Steve Jacobson MD, MHA, CPC Associate Medical Director Care Coordination The Everett Clinic, a DaVita Medical Group
Dan Kent, MD Medical Director United Health Care
Andrew Kartunen Program Director, Growth & Strategy Virginia Mason Medical System
Dan Lessler, MD, MHA Physician Executive for Community Engagement and Leadership  Comagine Health
Jessica Martinson, MS Director of Clinical Education and Professional Development Washington State Medical Association
Karen Merrikin, JD Consultant Washington State Health Care Authority
Randy Moseley, MD Medical Director of Quality Confluence Health
Michael Myint, MD Medical Director, Population Health Swedish Hospital
Martine Pierre Louis, MPH Director of Interpreter Services Harborview
Karen Posner, PhD Research Professor, Laura Cheney Professor in Anesthesia Patient Safety Department of Anesthesiology & Pain Medicine, University of Washington
Angie Sparks, MD Family Physician and Medical Director Clinical Knowledge Development Kaiser Permanente
Anita Sulaiman Patient Advisor & Consultant IBEX

Telehealth

Guideline Information

Guideline title: Telehealth Report and Guidelines

Publication Status: Active

Date of publication: 2021

Date of last evidence search: 2021

Scope: Appropriateness; measurement; patient interactions; vendor requirements

Methods: Current guidelines and literature review and expert consensus

Description:  This guideline is directed to all those who provide, receive, and pay for health care and includes specific action steps following our framework for telehealth quality of appropriateness, person–centered interactions, and measurement and follow– up for: Health care providers, Delivery sites and systems, Health insurance plans, Those receiving care (consumers), and Employer health care purchasers.

Metrics and Evaluation Tools

To support health system improvement the Bree Collaborative has created operational measures that are designed to help measure progress on the implementation of our guidelines.These measures were developed in collaboration with subject matter experts and are aligned across audience types (such as state agencies, health plans, providers, community organizations, employers, etc.)

To use our operational measures, find the audience type, or types, that is closest to your organization and download the measures document. There may be more than one audience type that is relevant. For example, large health systems may want to track progress at both the organizational level and the individual practitioner level.

Operational measures are also aligned with the Bree Collaborative’s self-report data collection efforts. Organizations are not required to report on operational measures, however organizations can submit data to help track system wide progress, measure their progress against others, and to be eligible for implementation awards. Instructions for the self-report submission can be found in the section below.

Delivery Site and Health System

Health System Evaluation Score Card Health System Score Card _ Telehealth

Health Plans

Health Plan Evaluation Score Card Health Plan Score Card _ Telehealth

Guideline Metrics

The Bree Collaborative work group provided CPT codes and definitions to develop metrics for Telehealth recommendation implementation.

A) CPT modifier 95 for medicare

  • Codes unique to non-face to face encounters include:5455
  • 99421-99423: Up to seven days cumulative e-visits that cannot be used for scheduling appointments or conveying test results
  • 99441-99443: Audio-only visits

B) quality and safety domains should be measured, including modifier 51:

  • Downstream care utilization (e.g., to measure additional total cost of care)
    • Number of emergency department visits
    • Number of hospitalization
  • Patient experience and/or other patient-reported outcome measure
    • Patient activation measure (PAM)
  • Improvement in health outcomes
  • Effectiveness
  • Access
    • Time to third next available appointment or consultation
    • Percentage of patients with disabilities who are able to conduct a virtual visit through adaptive technologies

For more generic tools for planing, data collection and data management, please visit our Tool Depot

Jump to Evaluation Tool Depot

Workgroup Members

Name Title Organization
Shawn West, MD, FAAFP (Chair) Chief Medical Officer Embright
Christopher Cable, MD Executive Director of Operations, Telehealth and Access Management Kaiser
Sarah Levy, MD Medical Director, Solution Center and Telehealth Kaiser
Mandy A. Weeks-Green Senior Health Policy Analyst Washington State Office of the Insurance Commissioner
Tracey Hugel, MSN, RN Senior Clinical Program Consultant Regence
Lydia Bartholomew, MD, MHA, FAAPL, FAAFP, CHIE Chief Medical Officer, Clinical Health Services, West and Southcentral Aetna
Stephanie Shushan, MHA Senior Analyst, Integrated Programs & Strategic Initiatives Community Health Plan of Washington
Jennifer Polello, MHPA, MCHES, PCMH-CCE Senior Director of Quality and Population Health Community Health Plan of Washington
Laura Groshong, LICSW Director, Policy and Practice Clinical Social Work Association
Omar Daoud, PharmD Director of Pharmacy Community Health Plan of Washington
David Tauben, MD Chief of Pain Medicine University of Washington Medical Center
Lindsay Mas Senior Program Manager, Behavioral Health SEIU 775 Benefits Group

Award Winners

Award Winners for Best Practices in Telehealth:

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