1. Bree CollaborativeReadmissions Joe Gifford, MD Executive Medical Director Regence January 2012

2. Readmissions Mission Statement • Drive accountability by reducing unnecessary readmissions Strategy • Gather, track, & review data • Financial incentives: agree on common definitions for all-payer approach to warranty pricing, evolve toward bundled warranty pricing

3. Readmission Data • All-in readmission rate according to an agreed-upon method (CMS? NCQA?) • By hospital • By medical group? • With and without risk adjustment? • Specific diagnoses with “pure” method • CMS PPR method • CHF, AMI, pneumonia • Add our own • COPD, hip fx, spines, knee & hip replacement

4. Incentives • Warranty pricing • Bundled payments with warranty

5. Warranty Pricing • Agree on specs for all-payer implementation • 30- or 60-day • List of 5 – 10 DRGs • Technical spec: what readmits are in (same dx) and what are out (hit by bus) • Rate structure: is readmit a “never event” or should the warranty come with a cost? • Professional fees part of the warranty!!

6. Bundled Warranty Pricing • Agree on specs for optional all-payer implementation • 3 day before to 30 or 60 day post • Services are all in (esp professional) • List of exceptions • Treatment of co-morbidities, etc • Price of bundle is private negotiation, but structure of it (rules) are arrived at by community