2023 sees the launch of three new Bree Collaborative workgroups. Each workgroup will meet monthly to discuss common barriers and develop best practices to improve access, affordability, outcomes, and equity in Washington state. Meeting dates and a brief description of each workgroup are listed below. Please reach out to Bree staff nlocke@qualityhealth.org if you are interested in participating on a workgroup. Additional meeting material can be found on our Bree website.

• Diabetes Care
  First Meeting: January 12 from 8:00 – 9:30am | Second Thursdays
  Approximately 582,000 people in Washington (9.7% of adults), have been diagnosed with diabetes, with an estimated cost of $6.7 billion each year. According to IHME data, diabetes is the 7th leading cause of death and impaired plasma glucose is the 3rd leading cause of death and disability in Washington. At the same time, Washington state performs below the NCQA 25th percentile for blood sugar testing for people with diabetes. Additionally, there are significant disparities in diabetes diagnosis and access to medication, with Black, Latinx/Hispanic, and American Indian/Alaska Native having a higher prevalence of diabetes, and low socioeconomic status has been associated with a lower uptake of high-cost insulin. This workgroup aims to improve equitable access to quality diabetes management and improve diabetes prevention and treatment in Washington.
• Difficult to Discharge
  First Meeting: January 19 from 3:00 – 4:30pm | Third Thursdays
  In a survey from August of 2021, hospitals in Washington state reported that more than 900 patients who were ready to be discharged were stuck in the hospital.  In one widely reported example, Harborview Medical Center announced in summer 2022 that they will only accept patients in urgent need of specialized care, as they have more than 100 medically stable patients in need of long-term post-acute care. It can be difficult to find appropriate post-acute care for a number of reasons, including patients’ complex behavioral health or social needs and a lack of appropriate post-discharge care sites. While COVID-19 is a contributing factor to hospital capacity concerns, the primary issue appears to be access to appropriate post-acute care facilities. This workgroup aims to improve discharge practices to post-acute facilities, and will address capacity, access, and quality concerns.
• Maternal Mental Health
  First Meeting: January 30 from 8:00 – 9:30am | Third Mondays
  Perinatal depression is one of the most common pregnancy complications, affecting one in seven women, and may contribute to adverse neonatal, infant, and child outcomes. Both the US Preventative Services Task Force and the American College of Obstetrics and Gynecology recommend screening for depression and anxiety during pregnancy and the post-partum period, as well as initiating treatment or referring to mental health care providers for maximum benefit. Despite these recommendations, stigma around mental illness, lack of insurance coverage for behavioral health, and structural barriers all prevent access to quality mental health care. This workgroup will build off previous Bree recommendations related to perinatal care and focus on access to high-quality behavioral health services during pregnancy and the perinatal period.

By Ginny Weir, MPH, CEO