Welcome to MVC's 2025 Fall Collaborative-Wide Meeting, Data Driven Excellence: Adapting Together in 2025 and Beyond. MVC will share updates and announcements from the Coordinating Center followed by a presentation about the MVC Component of the BCBSM P4P Program PY 2026-2027 cycle.

The MSHIELD team will lay the foundation for the day by discussing non-medical drivers of health and related implications for quality improvement teams, including examples of metrics that help evaluate care across all patients and interventions that can help reduce gaps in patient outcomes.

Gloria Rey will present on Henry Ford’s post-acute care (PAC) transition program, and the ways in which their team partners with PAC groups to ensure effective, individualized handoffs and care delivery for all patients.

This data presentation will focus on MVC’s newest health outcome variation measure, including how it was developed, its use cases and benefits, a timeline for related data sharing, and unblinded data.

Community Paramedicine leverages partnerships between hospitals and EMS to expand access to care beyond emergency response, focusing on prevention, follow-up, and chronic disease management. This collaboration helps reduce hospital readmissions, improve patient outcomes, and strengthen continuity of care within the community.

McLaren Bay Region’s Family Health and Wellness Center is a primary care office serving a population in which more than 80% of patients are struggling with non-medical drivers of health. Learn how a pilot program with United Way Bay County identifies variation in healthcare needs in the community and ensures non-medical needs are met.

After a cardiac rehab referral is placed, delays can contribute to barriers in initiating care. Learn factors that contribute to those delays including location, external referrals, and organizational structure, and explore collaborative solutions to ensure all patients get high-quality care. An MVC led review of live cardiac rehab data registry reports will provide members with key insights to their site's cardiac rehab utilization.

The Traverse City Street Medicine program began in 2016 through a unique partnership with Munson Healthcare, Goodwill Northern Michigan, Traverse Health Clinic, and MSU College of Human Medicine’s Traverse City campus. Learn how a multidisciplinary team can serve its community, teach, and improve access to primary care for people living with housing insecurity.

Predictive analytics and risk assessment tools in EMRs enable physicians to proactively identify gaps in care and tailor interventions. Learn how this approach impacts readmission rates, post-discharge rates, and comprehensive care transition plans.

MVC will close out the session with reminders about upcoming meetings, key dates for the PY2026-2027 P4P metric selection process, and post-event survey information.