Please see information on the Hysterectomy Report under the “Reproductive Health” section.
Surgery Bundles and Payment Models
Bariatric Surgery Bundle and Warranty
Guideline title: Bariatric Surgery Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2016
Date of last evidence search: 2016
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of the warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. Our bundled payment model includes bariatric surgery as a treatment option for select individuals and requires a holistic approach in which surgery is but one possible component of care. We organize our bundled payment model into four cycles including: appropriateness outlining requirements for a trial of non-surgical care, requirements for fitness for surgery, elements of best practice surgery and components of care aimed at our ultimate outcome, rapid return to function.
Supporting Materials:
Letter from Health Care Authority Accepting Bariatric Surgical Bundle and Warranty
Evidence Table for Bariatric Surgical Bundle
Accountable Payment Models: Bariatric Surgery Charter
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
| 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) |
Cardiovascular Health
Guideline title: Cardiovascular Health – Appropriateness of Percutaneous Coronary Interventions Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2013
Date of last evidence search: 2013
Scope: clinical scenarios and indications
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty includes no reimbursement for complications resulting from poor care. Percutaneous coronary intervention (PCI), also known as angioplasty, is a non-surgical procedure used to treat excess plaque in the arteries. While the majority of these procedures are done appropriately and successfully as needed for emergency cardiovascular conditions, a significant number are done electively and may not benefit patients in the same way. One way to improve care given to patients is to look at the data on whether past PCI procedures were appropriate. The availability and transparency of this data is a major issue across Washington State hospitals.
Supporting Materials:
Appropriate Use of PCI, 2012, by hospital
Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations
Article on Appropriateness of PCIs, Journal of the American Medical Association, June 2011: Appropriateness of Percutaneous Coronary Interventions in Washington State; S. Bradley, C. Maynard, C. Bryson; Circulation – Cardiovascular Quality and Outcomes – Journal of the American Heart Association; May 8, 2012
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Coronary Artery Bypass Graft Surgery Bundle and Warranty
Guideline title: Coronary Artery Bypass Graft (CABG) Surgery Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2015
Date of last evidence search: 2015
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the intent of this warranty is to distribute financial risk across professional and facility components in proportion to the revenue generated by the procedure. We believe the CABG bundle represents an incremental advance in helping to create a market for quality in health care. We will continue to refine and improve the bundle as new information becomes available. We encourage purchasers to contribute to the success of this bundle by reimbursing for essential services (e.g., health coach, care coordination)
Supporting Materials:
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
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
| 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 Surgical Bundle and Warranty
Guideline title: Lumbar Fusion Surgical Bundle and Warranty Report and Guidelines
Publication Status: Needs minor revisions – to be scheduled
Date of publication: 2018
Date of last evidence search: 2018
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty* is against avoidable hospital readmissions. We selected lumbar fusion due to a disproportionate rise in lumbar fusion compared to other spine surgeries, high variation in quality and billed charges, and evidence that for many patients considered candidates for elective lumbar fusion, there was no clear benefit of surgery compared to non-surgical care.
- Quality standards: appropriateness, evidence-based surgery, ensuring rapid and durable return to function, the patient care experience, and avoidance of readmissions as an indicator of safety and control of cost.
- *Warranty: purchaser will not provide reimbursement for readmission for avoidable complications within the risk windows specified at 7, 30, and 90 days.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
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 |
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 |
Previous Meeting Materials
Total Knee and Total Hip Replacement Surgical Bundle and Warranty
Guideline title: Total Knee and Total Hip Surgical Bundle and Warranty Report and Guidelines
Publication Status: Active
Date of publication: 2021
Date of last evidence search: 2021
Scope: Diagnosis, assessment for surgery fitness, procedure, post operative care
Methods: Current guidelines and literature review and expert consensus
Description: The majority of health care payments are for number of services provided rather than quality of care or per person or per episode of care. Bundled payments tie reimbursement to an entire episode of care while the warranty includes no reimbursement for complications resulting from poor care. We selected total knee and total hip replacement bundle and warranty which is primarily designed for osteoarthritis, but these standards may be applied to joint replacement related to other conditions.
In 2023 the Bree Collaborative introduced a new process of metrics and measures identification that has been embedded into the guideline development process. A framework for evaluation has been created and recommended metrics have been identified by audience (below).
Delivery Sites and Health Systems
Health Plans
Health Care Purchasers
Washington State Health Care Authority
Workgroup Members
| Name | Title | Organization |
| Bob Mecklenburg, MD (Chair) | Retired | Virginia Mason Medical Center |
| Matt Albright Kevin Fleming, MBA Michael Griffin |
Regional Director of Orthopedics & Sports Medicine Chief Operating Officer Associate Vice President |
Providence St. Joseph Health |
| Lydia Bartholomew, MD, MHA, FAAPL, FAAFP, CHIE | CMO Clinical Health Services West and Southcentral |
Aetna |
| LuAnn Chen, MD, MHA | Senior Medical Director | Community Health Plan of Washington |
| Michael Chen | Senior Program Consultant | Premera Blue Cross |
| Andrew Friedman, MD Kevin Macdonald, MD |
Physical Medicine & Rehabilitation Specialist Orthopedic surgeon |
Virginia Mason Medical Center |
| Paul Manner, MD | Orthopedic surgeon | University of Washington |
| Cat Mazzawy, RN | Senior Director, Safety and Quality | Washington State Hospital Association |
| Linda Radach | Patient Advocate | |
| Tom Stoll, MD | Chief, Orthopedic Surgery | Kaiser Permanente Washington |
| Emily Transue, MD, MHA | Associate Medical Director | Health Care Authority |
| Steve Overman, MD, MPH, FACR | Medical Director for Population Health & Clinical Integration | KenSci |
Previous Meeting Materials
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