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Developing Health Care Best Practices for Washington State through the Bree Collective

Monday, November 18, 2019   (0 Comments)
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Written by: Ginny Weir, MPH, Director, Bree Collaborative


Bringing together the siloed pieces of our health care system to focus on improvement is all too rare. The Bree Collaborative was created to do just this – to improve health care quality, outcomes, and affordability in Washington State. Achieving these goals requires collaboration between the many different stakeholders in health care. Our Collaborative was created in 2011 by our State Legislature to provide an unbiased, transparent setting so that collaboration can be successful. Our members are appointed by the Governor and represent public health care purchasers for Washington State, private health care purchasers (employers and union trusts), health plans, physicians and other health care providers, hospitals, and quality improvement organizations. You can see our list of members here. We are named in honor of the late Dr. Robert Bree, a leader in appropriate medical imaging.


Each year, our members identify four to five health care services with variation in the way that care is delivered, that are frequently used but do not lead to better care or patient health, that have patient safety issues, or that are inequitable. For our topic areas, we convene workgroups made up of clinical experts, health care administrators, patients, and others. Our volunteer workgroup members bring their personal experience, their insight, and their frustrations to our meetings to review published evidence, guidelines from national and local groups, and policies from across the country. We examine how care is delivered in health care systems and sites in our state and others and how to effectively make change happen.


The input of care delivery systems like community health centers is pivotal in making sure that our recommendations are appropriate for the real world. We welcome participation in our workgroups when recommendations are being developed or through our public comment process that happens before our work is finalized. All of our meetings are open to the public and we encourage anyone who is interested to attend or call into a meeting. You can find all of our meeting times and call-in information here.




We have created recommendations for a wide variety of topics; twenty-three sets of recommendations with five additional to be completed at the end of 2019. Our work spans areas from appropriate cesarean-sections to prostate cancer screening to suicide care. We have spent the greatest amount of time focused on improving care in behavioral health, mainly through integration into primary care, surgical procedures, and recommendations for both acute and chronic pain. Currently, we are developing a bundled payment model for maternity care including pre- and post-natal care and recommendations for palliative care, shared decision making, providers caring for patients who may have a risk of violence to others, and for supporting patients who have been prescribed long-term opioid therapy.


Again and again, we’ve learned that there is a gap between coming to consensus on what should happen in health care and changing how health care is actually delivered. Our main implementation pathway is through the Washington State Health Care Authority who uses our work to guide the type of health care provided to Medicaid enrollees, state employees, and other groups. You can see how the Health Care Authority has been a leader in transforming health care delivery on their website here. We also aim to set a community standard of care with our recommendations so that everyone can have access to interventions that we know are beneficial like having an advance care planning conversation no matter where people receive care.


To more effectively change care delivery we are embarking on a new implementation initiative. Part of this will be focused on integrating behavioral health into primary care through practice transformation and coaching. We aim to assist, supplement, and build up existing behavioral health programs within primary care clinics or help start a behavioral health integration effort if none currently exists. We will be working with primary care sites to be a part of a pilot group with 1:1 practice coaching, facilitated assessment, and monthly webinars or trainings on our recommendations.


Outside of this higher-intensity practice coaching, we will be supporting practice transformation across the state through regional engagement and virtual trainings. Our monthly webinars will be available to everyone in our health care community and we will offer practice transformation as needed. Our staff can’t be everywhere and so we are working to be strategic with limited resources. To support these pilot primary care sites and our broader community, we will be holding an implementation summit on March 17th, 2020 in SeaTac. We will also be holding a second summit before the end of the project in 2021.


We would love to involve community health centers in both how we develop recommendations and in our implementation efforts. Let me know if you are interested in being a part of one of our 2020 workgroups – primary care, colorectal cancer, chemotherapy and hospital use, and reproductive health care – or would like to be involved in our implementation work. Contact information is here.






NWRPCA welcomes and regularly publishes white papers and articles submitted by members, partners and associates with subject matter expertise. The appearance of any guest publication in our Health Center News database represents the views of the author and does not constitute endorsement by NWRPCA of the stated opinions or perspectives, nor does it suggest endorsement of the contributor's products or services.

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