Foundation Program Sites

Surgery and Bundled Payment Models

Read the Bariatric Surgical Bundle
Read the Bariatric Surgical Warranty

(Adopted November 2016)
Read our Summary

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

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)

Read our Cardiology Report and Recommendations

(Adopted January 2013)

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.

To increase data visibility, improve appropriate PCI use, and decrease variation, we recommend building on the efforts of the Clinical Outcomes Assessment Program (COAP), a neutral, third-party quality improvement program of the Foundation for Health Care Quality. All hospitals in Washington State who perform open-heart surgery and PCIs participate in COAP. We recommend that COAP publicly disclose hospitals’ insufficient information reports and the appropriateness of PCI procedures. COAP staff are continuing to monitor rates of insufficient information and PCI appropriateness to assess the impact of public disclosure.

Supporting Materials:

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

Appropriate Use of PCI, 2012, by hospital

Letter from Health Care Authority Accepting Spine SCOAP and Cardiology Recommendations

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. The coronary artery bypass graft surgery workgroup met from February 2015 – September 2015.

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

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

Read our Guidelines

(Adopted January 2018)

Hysterectomy is one of the most commonly performed procedures in the United States, but rates are highly variable based on location. The workgroup met from March 2017 to January 2018 to develop to promote appropriate use of hysterectomy, including pre-surgical counseling and evaluation, while recognizing individual variation based on clinical opinion and patient preference with the following focus areas:

  • Assessment and medical management, by indication
  • Uterine sparing procedures, by indication
  • Surgical procedure including follow-up care, emphasizing the enhanced recovery after surgery protocol and use of a minimally invasive approach

Supporting Materials:

Letter from the Health Care Authority Accepting Hysterectomy Recommendations

Hysterectomy Charter and Roster

Workgroup Members

Name Title Organization
Pat Kulpa, MD, MBA Medical Director Regence BlueShield
Sharon Kwan, MD, MS Interventional Radiologist University of Washington Medical Center
John Lenihan, MD Medical Director of Robotics and Minimally Invasive Surgery MultiCare Health System
Jennie Mao, MD Clinical Assistant Professor, Department of Obstetrics and Gynecology University of Washington Medical Center
Rachelle McCarty, MPH Patient Advocate
Sarah Prager, MD Chair Washington State Section of ACOG
Kevin Pieper, MD Chief, Women’s and Children’s Providence Regional Medical Center Everett
Kristin Riley, MD, FACOG Assistant Professor, Department of Obstetrics and Gynecology University of Washington Medical Center
Jeanne Rupert, DO, PhD (Chair)  Family Physician One Medical
Anita Showalter, DO, FACOOG Associate Professor and Chair, Women’s Health Pacific Northwest University of Health Sciences
Susan Warwick, MD Obstetrics and Gynecology Kaiser Permanente

Read the Lumbar Fusion Bundle and Warranty

(Adopted January 2019)
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.

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

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

 

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

 

This topic is currently undergoing review.

Read the Total Knee and Total Hip Replacement Bundle and Warranty

(Adopted November 2017, Revised July 2018)
Read our Summary 

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.

 

2017 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

.

2013 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

Read our Bundled Payment Model

(Adopted May 2021)

The United States has a high maternal mortality rate with high racial disparities. Bundled payment models, one payment for multiple clinical services such as for obstetrics and pediatric care, are being used to address preventable complications and increase coordination of care. Our workgroup met through 2019 and reconvened in 2020 to develop clinical pathways for prenatal care, labor and delivery, postpartum care, and pediatric care supported by a bundled reimbursement model to improve the care delivery and therefore outcomes. Our fist iteration was finalized in 2020 and pediatric care added in 2021.

Meeting Materials

Date Materials
October 27 Agenda October 27
Minutes September 22
Draft Maternity Bundle w/ Peds
September 22 Agenda 09/22/20
Minutes 08/25/20
Draft Maternity Bundle w/ Peds
August 25 Agenda 08/25/20
Minutes 07/28/20
Draft Maternity Bundle w/ Peds
July 28 Agenda 07/28/20
Maternity Bundle Final
Newborn Care Bree Proposal
Perinatal Bundle Review
January 7 Agenda 01/07/20
Minutes 10/10/19
Draft Maternity Bundle
Minutes 01/07/20
October 10 Agenda October 10
Minutes September 12
Draft Maternity Bundle
ACOG Postpartum Care Plan
September 12  Agenda September 12
Minutes August 8
Draft Maternity Bundle
August 8 Agenda August 8
Minutes July 11
Draft Maternity Bundle
July 11 Agenda July 11
Minutes July 9
Draft Maternity Bundle
June 6 Agenda June 6
Minutes May 9
Draft Maternity Bundle
May 9 Agenda May 9
Minutes April 11
Draft Maternity Bundle
Literature Review
ACOG Optimizing Post Partum Care
April 11 Agenda April 11
Draft Minutes March 14
March 14 Agenda March 14
Draft Minutes February 14
HCP LAN Establishing Maternity Episode Payment Models
February 14 Agenda February 14
Minutes January 8
HCP LAN White Paper Maternity Bundle
January 8 Agenda January 8
Presentation Slides
Maternity Bundle Charter and Roster
Bree Process Infographic
HCP-LAN Maternity Clinical Episode Payment Model
AJMC Bundled Payments for Maternity Care
Conflict of Interest Form
OPMA Training Roster

Workgroup Members

Member Title Organization
Carl Olden, MD (Chair) Family Physician  Pacific Crest Family Medicine
Andrew Castrodale, MD Family Physician Coulee Medical Center
Angela Chien, MD Obstetrics and Gynecology EvergreenHealth
Neva Gerke, LM President Midwives Association of Washington
Molly Firth, MPH Patient Advocate
Lisa Humes-Schulz, MPA/
Lisa Pepperdine, MD
Director of Strategic Initiatives/ Director of Clinical Services Planned Parenthood of the Great Northwest and Hawaiian Islands
Rita Hsu, MD, FACOG Obstetrics and Gynecology Confluence Health
Dale Reisner, MD Obstetrics and Gynecology Swedish Medical Center
Janine Reisinger, MPH Director, Maternal-Infant Health Initiatives Washington State Hospital Association
Mark Schemmel, MD Obstetrics and Gynecology Spokane Obstetrics and Gynecology, Providence Health and Services
Vivienne Souter, MD Research Director Obstetrics Clinical Outcomes Assessment Program
Judy Zerzan, MD Chief Medical Officer Washington State Health Care Authority