6228-S.E AMH CODY SILV 385

ESSB 6228 - H AMD TO HCW COMM AMD (H-4399.1/14) 945

By Representative Cody

ADOPTED 03/07/2014

    On page 1, beginning on line 17 of the striking amendment, strike all of section 2 and insert the following:

    "NEW SECTION.  Sec. 2.  A new section is added to chapter 41.05 RCW to read as follows:

    (1) There is created a performance measures committee, the purpose of which is to identify and recommend standard statewide measures of health performance to inform public and private health care purchasers and to propose benchmarks to track costs and improvements in health outcomes.

    (2) Members of the committee must include representation from state agencies, small and large employers, the two largest health plans by enrollment, patient groups, federally recognized tribal members, consumers, academic experts on health care measurement, hospitals, physicians, and other providers.  The governor shall appoint the members of the committee, except that a statewide association representing hospitals may appoint a member representing hospitals, a statewide association representing physicians may appoint a member representing physicians, and a statewide association representing nurses may appoint a member representing nurses.  The governor shall ensure that members represent diverse geographic locations and both rural and urban communities.  The committee must be chaired by the director of the authority.

    (3) The committee shall develop a transparent process for selecting performance measures, and the process must include opportunities for public comment.

    (4) By January 1, 2015, the committee shall submit the performance measures to the authority.  The measures must include dimensions of:

    (a) Prevention and screening;

    (b) Effective management of chronic conditions;

    (c) Key health outcomes;

    (d) Care coordination and patient safety; and

    (e) Use of the lowest cost, highest quality care for preventive care and chronic and acute conditions.

    (5) The committee shall develop a measure set that:

    (a) Is of manageable size;

    (b) Gives preference to nationally reported measures and, where nationally reported measures may not be appropriate or available, measures used by state agencies that purchase health care or commercial health plans;

    (c) Focuses on the overall performance of the system, including outcomes and total cost;

    (d) Is aligned with the governor's performance management system measures and common measure requirements specific to medicaid delivery systems under RCW 70.320.020 and 43.20A.895;

    (e) Considers the needs of different stakeholders and the populations served; and

    (f) Is usable by multiple payers, providers, hospitals, purchasers, public health, and communities as part of health improvement, care improvement, provider payment systems, benefit design, and administrative simplification for providers and hospitals.

    (6) State agencies shall use the measure set developed under this section to inform and set benchmarks for their purchasing.

    (7) The committee shall establish a public process to periodically evaluate the measure set and make additions or changes to the measure set as needed."

EFFECT:   Modifies the section establishing a performance measures committee as follows:

· Directs the committee to propose (instead of set) benchmarks.

· Requires the committee membership to include federally recognized tribal members and the two largest health plans by enrollment (rather than health plans).  Permits a statewide association representing nurses to appoint a member representing nurses. 

· Requires the measures to include use of the lowest cost, highest quality care for preventive care and chronic conditions, in addition to acute conditions. 

· Requires the committee to give preference to measures used by state agencies or commercial health plans (instead of state agencies and the Health Benefit Exchange) where nationally reported measures may not be appropriate or available. 

· Requires state agencies to use the measure set to inform and set benchmarks for their purchasing decisions (rather than inform their purchasing decisions and set benchmarks).

--- END ---