16 Jul 2025
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MVC Updates Registry with New Claims Across All Payers

MVC Updates Registry with New Claims Across All Payers

July 16, 2025 | 0 Comments | , , ,

This week MVC updated its registry with new claims from its included payers. This most recent update included the addition of three new months of Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) claims, one new quarter of Medicaid claims, and one new quarter of Medicare Fee-for-Service (FFS) claims. Following these updates, the MVC registry now has the following data ranges for its data:

  • BCBSM PPO (Commercial and Medicare Advantage): 01/01/2015 – 03/31/2025 (index events through 12/31/2024)
  • BCN (Commercial and Medicare Advantage): 01/01/2015 – 03/31/2025 (index events through 12/31/2024)
  • Medicaid: 01/01/2015 – 03/31/2025 (index events through 12/31/2024)
  • Medicare FFS: 01/01/2015 – 09/30/2024 (index events through 06/30/2024)

Anytime MVC publishes new data on its registry, the newest claims for each payer are incorporated throughout the various reports and dashboards where that payer’s data is present, including the interactive multi-payer reports for cardiac rehabilitation utilization and preoperative testing.

Refreshed Multi-Payer Cardiac Rehabilitation Reports

The multi-payer cardiac rehabilitation utilization reports were added to the registry in the first half of 2024 and have replaced the static PDF hospital-level push reports MVC previously distributed biannually to its members as well as BMC2 and MSTCVS contacts. The regular release of new data on the registry, therefore, gives members opportunities throughout the year to check progress on cardiac rehabilitation metrics more regularly and find opportunities for improvement. For example, available 2024 data on cardiac rehabilitation enrollment for all eligible patients (excluding heart failure patients) with episode start dates between Jan. 1, 2024, and Dec. 31, 2024, indicates wide variability among hospitals; the statewide average utilization rate is 34%, with the majority of sites observing rates below the Million Hearts recommended 70% rate as well as below the Michigan Cardiac Rehab Network goal rate of 40% (Figure 1).

Figure 1. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from AMI, CABG, PCI, SAVR, and TAVR, 1/1/2024-12/31/2024*

*Index events 1/1/24-12/31/24 for BCBSM Commercial and Medicare Advantage (MA), BCN Commercial and MA, and Medicaid; index events 1/1/24-6/30/24 for Medicare FFS

Similarly, there is significant variation between hospitals in their mean days to a patient’s first cardiac rehab appointment, with some hospital patients attending their first session 31 days after discharge and some waiting as long as 68 days. However, MVC has observed a steady yearly decrease over time in this metric, with a collaborative-wide average of 59 days in 2020 compared to 47 days in 2024.

These data along with metrics for mean number of visits and utilization rates for specific service lines and payers can be accessed via the multi-payer tab on the registry under the cardiac rehab heading.

Refreshed Multi-Payer Preoperative Testing Reports

The multi-payer preoperative testing utilization reports were added to the registry at the end of 2024 and have also replaced static hospital-level push reports that were previously distributed as biannual PDF reports to members as well as MSQC contacts. Looking at all available 2024 claims across payers, there is evidence of a small decrease in the MVC All rate of preoperative testing prior to low-risk surgery beginning in late 2022 through 2024 (Figure 2). The average testing rate in 2020 was 46.8% and the average rate in 2024 was 39.9%. Members whose rates are 40% overall or higher are eligible to participate in the RIght-sizing Testing before Elective Surgery (RITE-Size) program, which offers participating sites consultation and coaching, templates, best practice guidance, and other resources to help coordinate decreases in unnecessary testing across their institutions. MVC is also able to supplement registry data with custom analytics by an MVC analyst to meet the needs of members. One such site recently utilized MVC’s custom analytics to identify differences in preoperative testing rates by physician NPI to support conversations about intra-hospital variation by provider and service line.

Figure 2. Statewide Rate of Preoperative Testing and Relative Difference in Preoperative Testing by Quarter, 01/01/2020-12/31/2024*

*Index events 1/1/24-12/31/24 for BCBSM Commercial and Medicare Advantage, BCN Commercial and MA, and Medicaid; index events 1/1/24-6/30/24 for Medicare FFS

MVC’s registry contains an extensive collection of report views for multi-payer, P4P, and payer-specific metrics with select patient-level drilldown capabilities. If you are newer to the registry or would like a refresher on how best to leverage the information, reach out to the MVC Coordinating Center for information about a tailored registry training.

28 May 2025
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Refreshed Hospital-Level, ED-Based Episode Push Reports Released April 2025

Refreshed Hospital-Level, ED-Based Episode Push Reports Released April 2025

May 28, 2025 | 0 Comments | , ,

The MVC Coordinating Center distributed refreshed hospital-level versions of its push report utilizing emergency department-based episodes (“ED-based episodes”) in April, preparing versions for acute care hospitals and Critical Access Hospitals to include different comparison groups. The report leverages data focused specifically on patient episodes first initiated by a visit to the emergency department and follows those episodes to determine common metrics such as episode payments, post-ED care utilization, and outpatient service rates.

In addition to reflecting more recent data across all included payers, these refreshed hospital-level reports provide additional social risk data than was offered previously with the addition of several metrics based on patient Zip code to the patient population snapshot table. This allows hospitals to better understand the patients represented in various service line cohorts presented within the ED-based episodes report and the types of social risk factors that may be present, such as low median household income, SNAP usage, vehicle ownership, and homeownership.

Each page of the report is dedicated to a specific condition with mostly the same metrics throughout, such as risk-adjusted, price-standardized 30-day total episode spending, inpatient admission rates, and rates of post-ED utilization. Reports feature each hospital’s own attributed ED-based episode data for eight high-volume ED conditions: abdominal pain, cellulitis, chest pain (nonspecific), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes with long-term complications (including renal, eye, neurological, or circulatory), diabetes with short-term complications (including ketoacidosis, hyperosmolarity, or coma), and urinary tract infection (UTI).

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payment (Figure 1) for the reported conditions is highest for diabetes with long-term complications ($21,031), followed by CHF ($18,363), diabetes with short-term complications ($12,571), and COPD ($11,145). The collaborative-wide average total episode payment is lowest for chest pain ($3,327) and abdominal pain ($3,405). These rankings are consistent with the 2024 ED-based episode reports.

Figure 1.

A key goal of these reports is to provide insights into healthcare utilization following index ED events; therefore, the latest reports continue to include a dot plot (Figure 2) comparing patient post-ED utilization at a member hospital against their peer comparison group. Dot plots provide information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and the percent of patients who had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Rates of subsequent ED visits, outpatient services, home health, skilled nursing facility care, and inpatient or outpatient rehab are also provided.

Figure 2.

MVC uses its most recent medical insurance claims data from Medicare FFS, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, Blue Care Network HMO Commercial and Medicare Advantage plans, and Michigan Medicaid to build these ED-based episodes reports.

MVC recently presented data on the incidence of behavioral health co-diagnoses on ED-based episodes at its May collaborative-wide meeting. This presentation highlighted the presence of behavioral health ICD-10 codes on index ED visits for patients with a primary diagnosis code matching one of MVC’s ED conditions. MVC reported 13% of ED index events statewide contained a behavioral health code. The most common codes observed were for anxiety disorder (36.7%), major depressive disorder (10.6%), and dementia (8.7%). The recent ED-based episode reports include a row for “most frequent comorbidities” by condition, which will help members determine service lines where psychological disorders or substance abuse disorders are a common consideration for specific service lines at their hospital.

MVC’s ED-based episode structure was developed in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC), a BCBSM-funded Collaborative Quality Initiative with the goal of improving care and patient outcomes in Michigan emergency departments. MVC and MEDIC team members worked closely to develop 30-day episodes of care initialized by a patient’s visit to the ED and including all claims-documented care received in the 30 days following a patient’s index ED visit.

Please share your feedback with the MVC team if certain report measures are helpful or if you wish to see additional ED-based episode reporting for certain conditions and metrics. MVC is now also accepting custom report requests using its ED-based data. Contact MVC to learn more.

19 Mar 2025
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MVC Refreshes Registry Reports with New Data & Methods

MVC Refreshes Registry Reports with New Data & Methods

March 19, 2025 | 0 Comments | , , ,

At the end of February, MVC updated its registry with new payer data. MVC adds new data to the registry monthly upon receipt of new claims from included payers. This most recent update included the addition of two new months of Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) claims, one new quarter of Medicaid claims, and one new quarter of Medicare claims. Following these updates, the MVC registry now has the following data ranges for its data:

  • BCBSM PPO (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
  • BCN (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
  • Medicaid: 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
  • Medicare FFS: 01/01/2015 – 06/30/2024 (index events through 03/31/2024)

Anytime MVC publishes new data on its registry, the newest claims for each payer are incorporated throughout the various reports and dashboards where that payer’s data is present, including the interactive multi-payer reports for cardiac rehabilitation utilization and preoperative testing.

Refreshed Multi-Payer Cardiac Rehabilitation Reports

The multi-payer cardiac rehabilitation utilization reports were added to the registry in the first half of 2024 and have replaced the static PDF hospital-level push reports MVC previously distributed biannually. The regular release of new data on the registry, therefore, gives members opportunities throughout the year to check progress on cardiac rehabilitation metrics more regularly and find opportunities for improvement. For example, current data on cardiac rehabilitation enrollment for CABG patients with episode start dates between Jan. 1, 2024, and Sept. 30, 2024, indicates wide variability among hospitals, with many sites observing rates below the recommended 70%. Across the collaborative, enrollment in cardiac rehab after CABG procedures was as low as 28% at one MVC member hospital and as high as 83% at another with a statewide average of 61% (Figure 1). Similarly, cardiac rehab utilization is much lower on average among PCI patients over the same time period (32%), and there is wide inter-hospital variation with rates ranging between 6% and 86% (Figure 2).

Figure 1. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from CABG, 1/1/2024-9/30/2024

Figure 2. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from PCI, 1/1/2024-9/30/2024

This latest registry update also included a methodological change impacting cardiac rehabilitation reporting for attendance. These methodological improvements were meant to increase the accuracy of MVC’s reported mean number of visits attended within a selected time period. MVC noted that this change resulted in increases in the average number of completed cardiac rehabilitation visits overall, and especially among BCN and Medicaid beneficiaries. This increase in the average number of visits reflects the fact that MVC improved the capture of multiple cardiac rehabilitation visits over a longer time period billed on a single claim.

Refreshed Multi-Payer Preoperative Testing Reports

The multi-payer preoperative testing utilization reports were added to the registry at the end of 2024 and have also replaced static hospital-level push reports that were previously distributed as biannual PDF reports to members. Looking at all available 2024 claims across payers, there is evidence of a small decrease in the MVC All rate of preoperative testing prior to low-risk surgery beginning in late 2022 and continuing throughout 2023 and into 2024 (Figure 3). Those members who are working to reduce unnecessary preoperative testing are encouraged to check their updated data. MVC is also able to supplement registry data with custom analytics by an MVC analyst to meet the needs of members. One such site recently utilized MVC’s custom analytics to identify differences in preoperative testing rates by physician NPI to support conversations about intra-hospital variation by provider and service line.

Figure 3. Statewide Rate of Preoperative Testing and Relative Difference in Preoperative Testing by Quarter, 2020-2024

MVC’s registry contains an extensive collection of multi-payer, P4P, and payer-specific views and metrics. If you are newer to the registry or would like a refresher on how best to leverage the information, reach out to the MVC Coordinating Center for information about a custom registry review.

23 Oct 2024
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Hospitals Receive PY24 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY24 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

October 23, 2024 | 0 Comments |

Last week the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2024 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This report provided hospitals with their current standing for PY 2024.

Each hospital received a mid-year score out of a total of 10 points, including 0 to 4 points for their selected total episode payment metric, 0 to 4 points for their selected value metric, and 0 to 2 points for completed eligible engagement activities thus far in calendar year 2024. PY 2024 scores achievement and improvement points for each hospital’s selected episode spending conditions and value metrics using index admissions from 2023 as the performance year against admissions in 2021 as the baseline year. Hospitals are awarded the higher of their achievement and improvement point scores.

The performance data timeframes included in mid-year PY 2024 scoring were index events 1/1/2023-12/31/2023 for BCBSM PPO Commercial, BCBSM Medicare Advantage, BCN HMO Commercial, and BCN HMO MA, and index events 1/1/2023-9/30/2023 for Medicare FFS. The engagement points accrued represent all completed activities from 1/1/2024-9/30/2024. This is the first year of a two-year (PY24-25) P4P cycle. The full methodology for this program cycle can be found in the PY2024-2025 technical document.

Figure 1 illustrates the current distribution of total points out of 10 across the collaborative. The average points scored across the mid-year scorecards was 6.2/10. This average is 0.2 points lower than the average points scored at the conclusion of PY23.

Figure 1.

Figure 2 illustrates the breakdown of scoring on average by each program component (i.e., episode spending metric, value metric, engagement points). Hospitals could earn up to four points each for their episode spending and value metric selections, and up to two points for engagement activities. Across the collaborative, the average points scored was higher for value metrics (2.7) than for episode spending (2.5).

Figure 2.

Figure 3 illustrates the breakdown of average points by episode spending condition. Consistent with previous years, joint replacement was the highest scoring condition with an average of 3.1 points. Much of the recent success observed for the joint replacement condition could be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries; however, with most joint replacements now occurring in outpatient settings there is less savings to be achieved from such shifts going forward. Congestive heart failure and pneumonia were the lowest scoring conditions with hospitals earning less than two points on average for each.

Figure 3.

Figure 4 illustrates the breakdown of average points by value metric. The highest scoring value metric was preoperative testing with 3.4 points followed by 90-day cardiac rehab utilization after percutaneous coronary intervention (PCI) with 2.8 points. For both of these value metrics, hospitals have access to additional support and resources via MVC’s value-based improvement initiatives, including the RITE-Size (Right-Sizing Testing before Elective Surgery) initiative and the Michigan Cardiac Rehab Network (MiCR) offerings. The lowest scoring value metric was 7-day follow-up rates after pneumonia (2.1).

Figure 4.

These mid-year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2023 claims are incorporated. Hospitals can track their score through the P4P PY24-25 reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points in one place. These registry reports can be filtered by selected conditions/metrics to make the tracking of P4P points easier. Contact the MVC Coordinating Center [EMAIL] for a walkthrough of your hospital’s PY24 mid-year scorecard or P4P registry reports.

04 Sep 2024
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MVC, BMC2, HBOM Announce New Cardiac Rehab Materials & Opportunities at MiCR Meeting

MVC, BMC2, HBOM Announce New Cardiac Rehab Materials & Opportunities at MiCR Meeting

September 4, 2024 | 0 Comments | , , ,

In partnership with BMC2 and HBOM, the Michigan Value Collaborative recently co-hosted the Michigan Cardiac Rehab network (MiCR) virtual summer meeting, which brought together providers, quality improvement staff, rehab staff, and patients with a shared interest in improving participation in cardiac rehabilitation. Over 70 attendees from across the state joined the meeting on Aug. 9, where they heard updates from the MiCR leadership, previewed new MiCR resources, and heard from a panel of hospital representatives who discussed their experience using the MiCR NewBeat materials.

NewBeat Success and Re-Orders

One key announcement from the meeting included the launch of a second round for placing NewBeat material print orders [ORDER FORM LINK]. The MiCR team will accept submitted order forms through Tues., Sept. 24. Those who request the free printed materials can either pick them up at the fall in-person MiCR meeting in Midland or have them mailed to an address they designate. Early survey evidence suggests that implementation of the NewBeat program is associated with an increase in confidence across a number of metrics (Figure 1).

Figure 1. NewBeat Survey Results Pre- and Post-Implementation

Speaking to the value of these materials was a panel of representatives from Corewell Health South, Holland Hospital, and Michigan Medicine—three sites who ordered NewBeat materials in the first round at the start of 2024. Each shared their experience using the materials and advice on their integration. HBOM also recorded virtual interviews with the Corewell Health and Holland Hospital site contacts for use in a NewBeat success story video (Figure 2), which was played for the meeting’s attendees.

Figure 2. Implementing NewBeat Feedback Video

Those who wish to place an order for NewBeat materials in the current round will again have the opportunity to request the MiCR patient/provider educational handout (available in English, Spanish, and Arabic), the cardiac rehab liaison postcard, and the cardiac care cards. Some customizations are possible to the handout and postcard design to include local hospital or rehab center contact information. Additionally, there is a new offering included in this round of ordering that was launched at the meeting: a new discharge packet sticker. These new sticker designs (Figures 3 and 4) can be affixed to the outside of a patient’s discharge folder and are meant to stand out to patients and families who are often inundated with discharge paperwork. They alert the patient that their discharge paperwork includes a referral to cardiac rehab as the next step in their care.

Figure 3. NewBeat Sticker Journey Design

Figure 4. NewBeat Sticker Golden Ticket Design

MiCR Mini Grant RFP Opens for Second Round

The summer meeting also included an announcement that MiCR’s mini grant program to fund small, local cardiac rehab quality improvement projects will similarly be re-opened for a second round of submissions. The first round resulted in the funding of projects at MyMichigan Midland, DMC Huron Valley Sinai, and Ascension Rochester. MiCR is accepting new submissions through Fri., Sept. 13 for up to $5,000 per project. Full details on the RFP and application are available on the MiCR website.

MiCR Updates & Meeting Materials

Finally, the MiCR leadership team announced the development of a neutrally-branded, customizable patient education video that can be shared with hospitals or rehab programs to play on their own websites or waiting room monitors. The video was developed in response to feedback from partner sites that online materials need to be improved and that neutral video content about the value of cardiac rehab is limited. MiCR developed a video for use by network partners and also identified several existing videos published by MillionHearts, Mayo Clinic, and others.

The MVC and BMC2 teams are looking forward to the Michigan Cardiac Rehab Network's fall in-person meeting on Fri., Nov. 8, from 10 a.m. to 3 p.m., at the H Hotel in Midland. MyMichigan is serving as co-host for the event in collaboration with MiCR. Additional event details will be shared in the coming weeks. Those who were unable to attend the summer meeting can view the meeting recording [LINK] or meeting slides [LINK]. Please reach out to info@michigancr.org with any questions.

14 Aug 2024
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Registration Open Now for Fall Collaborative-Wide Meeting

Registration Open Now for Fall Collaborative-Wide Meeting

August 14, 2024 | 0 Comments

Registration is open to join the MVC Coordinating Center for its fall collaborative-wide meeting on Friday, October 25, from 10 a.m. to 3 p.m. at the VistaTech Center in Livonia, MI. This meeting's theme is Data-Driven Excellence: Strategies for Success in Quality Improvement, and will feature unblinded MVC data, member presentations on quality improvement successes, networking opportunities, and insights about improving value-based healthcare. Members and partners may register here until Oct. 15.

P4P Updates, Unblinded Data, & Networking

The MVC team will share updates on team activity, including the upcoming cycle of the MVC Component of the BCBSM P4P Program. MVC will also share unblinded data insights. Attendees will have several opportunities to network with peers from hospitals, physician organizations, and Collaborative Quality Initiatives (CQIs) from across the state of Michigan via a poster session and breakout room discussions.

If your site is interested in submitting a poster to present at the fall meeting, please complete this form no later than Sept. 13.

In the coming weeks, MVC will share a finalized agenda with speaker details and other updates on its collaborative-wide meeting webpage.

P4P Engagement Points

Hospitals that send a site representative to one of MVC’s 2024 collaborative-wide meetings will be eligible to earn 0.25 engagement points toward their PY24 P4P score, following the completion of a post-meeting survey. Hospitals that send a site representative to BOTH of MVC’s 2024 collaborative-wide meetings and complete both post-meeting surveys will be eligible to earn 0.75 engagement points toward their PY24 P4P score. View all eligible engagement activities for PY24 engagement points here.

REGISTER NOW

10 Apr 2024
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MVC Coordinating Center Releases 2023 Annual Report

MVC Coordinating Center Releases 2023 Annual Report

April 10, 2024 | 0 Comments |

The Coordinating Center published its 2023 annual report to the MVC website recently. It outlines key successes and activities accomplished last year and the new strategy guiding MVC's 2024 efforts. Read the report below or view the PDF Parts A [LINK] and B [LINK]) now.

20 Mar 2024
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MVC Opens Registration for May Collaborative-Wide Meeting

MVC Opens Registration for May Collaborative-Wide Meeting

March 20, 2024 | 0 Comments |

Registration is now open to join the MVC Coordinating Center for its spring collaborative-wide meeting on Friday, May 10, from 10 a.m. to 3 p.m. at the H Hotel in Midland, MI. This meeting's agenda is focused on promoting care coordination across the continuum, and will feature unblinded MVC data, member presentations on quality improvement strategies and programs, networking opportunities, and insights about improving value-based healthcare. Members and partners may register here.

Discounted Hotel Room Rate

The event will occur at The H Hotel in Midland, MI, 111 W. Main St., Midland, MI. If you plan to stay overnight at the H Hotel, please book your stay directly through MVC's H Hotel room block.

P4P Updates, Unblinded Data, & Networking

The MVC team will share updates on team activity, including the MVC Component of the BCBSM P4P Program. MVC will also share report and data insights, initiative resources, and an unblinded data presentation. Attendees will have several opportunities to network with peers from hospitals, physician organizations, and Collaborative Quality Initiatives (CQIs) from across the state of Michigan via a poster session and roundtable discussions.

In the coming weeks, MVC will share a finalized agenda with speaker details and other updates on its collaborative-wide meeting webpage.

P4P Engagement Points

Hospitals that send a site representative to one of MVC’s 2024 collaborative-wide meetings will be eligible to earn 0.25 engagement points toward their PY24 P4P score, following the completion of a post-meeting survey. Hospitals that send a site representative to BOTH of MVC’s 2024 collaborative-wide meetings and complete both post-meeting surveys will be eligible to earn 0.75 engagement points toward their PY24 P4P score. View all eligible engagement activities for PY24 engagement points here.

REGISTER NOW

13 Mar 2024
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Refreshed Hospital-Level, ED-Based Episode Push Reports Coming Soon to Members

Refreshed Hospital-Level, ED-Based Episode Push Reports Coming Soon to Members

March 13, 2024 | 0 Comments | , ,

The MVC Coordinating Center will soon distribute refreshed hospital-level versions of its push report utilizing emergency department-based episodes (“ED-based episodes”). MVC generated separate versions for acute care hospitals and Critical Access Hospitals (CAHs) with tailored comparison groups. In addition to reflecting more recent data across all included payers, these refreshed hospital-level reports differ from prior versions due to the addition of three high-volume ED conditions and the incorporation of Michigan Medicaid claims.

Each page of the report is dedicated to a specific condition with the same metrics throughout, such as risk-adjusted, price-standardized 30-day total episode spending, inpatient admission rates, and rates of post-ED utilization. Reports feature each hospital’s own attributed ED-based episode data for eight high-volume ED conditions: abdominal pain, cellulitis, chest pain (nonspecific), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes with long-term complications (including renal, eye, neurological, or circulatory), diabetes with short-term complications (including ketoacidosis, hyperosmolarity, or coma), and urinary tract infection (UTI). The three new conditions included in this year’s refresh include diabetes with long-term complications, diabetes with short-term complications, and UTI.

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payment (Figure 1) for the reported conditions is highest for diabetes with long-term complications ($20,568), CHF ED-based episodes ($17,245), diabetes with short-term complications ($12,087), and COPD ED-based episodes ($10,289). The collaborative-wide average is lowest for chest pain ($3,111) and abdominal pain ($3,123) ED-based episodes. Within each condition, MVC 30-day total episode payments are consistently higher for episodes in which the patient had a same-day inpatient admission compared to episodes in which the patient did not have an inpatient stay beginning on the date of their ED visit. With that information in mind, hospital members can also use their individualized reports to track their same-day inpatient admission rate at six-month intervals using trend graphs for each included ED-based condition (Figure 2).

Figure 1.

Figure 2.

A key goal for these ED-based episode reports is to provide insight into healthcare utilization following index ED visits. Therefore, reports continue to include a dot plot (Figure 3) comparing patient post-ED utilization at a member hospital against their peer comparison group. Dot plots provide information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and the percent of patients who had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Also provided are rates of subsequent ED visits, receipt of outpatient services, home health, skilled nursing facility care, and inpatient or outpatient rehab.

Figure 3.

These ED-based episodes are built using MVC’s most recent medical claims data from Medicare FFS, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, Blue Care Network HMO Commercial and Medicare Advantage plans, and Michigan Medicaid.

ED-based episodes utilize MVC’s newest episode of care data structure, which was developed last year in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC), a BCBSM-funded Collaborative Quality Initiative with the goal of improving care and patient outcomes in Michigan emergency departments. MVC and MEDIC team members worked closely to develop 30-day episodes of care initialized by a patient’s visit to the ED and including all claims-documented care received in the 30 days following a patient’s index ED visit.

Please share your feedback with the MVC team if certain report measures are helpful or if you wish to see additional ED-based episode reporting for certain conditions and metrics. MVC is now also accepting custom report requests using its new ED-based data. Contact MVC to learn more.

23 Feb 2024
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BMC2 Recognized as a 2023 Eisenberg Patient Safety & Quality Award Recipient by NQF, Joint Commission

BMC2 Recognized as a 2023 Eisenberg Patient Safety & Quality Award Recipient by NQF, Joint Commission

February 23, 2024 | 0 Comments | ,

BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) has been recognized with the prestigious John M. Eisenberg Patient Safety and Quality Award in the Local Level Innovation in Patient Safety and Quality category.

BMC2 has been honored for its remarkable improvements in the documentation of radiation use, a decrease in high-dose radiation exposure, and reduction in opioid pill prescribing rates. BMC2 is a statewide quality improvement collaborative that develops and administers a portfolio of quality improvement interventions for patients who undergo heart stenting, vascular surgical procedures, and transcatheter valve procedures in Michigan. The consortium is one of 22 Collaborative Quality Initiatives sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.

The Eisenberg Awards honor the late John M. Eisenberg, MD, MBA, and bring together the quality community to recognize groundbreaking initiatives in healthcare that are consistent with the aims of the National Quality Strategy: better care, healthy people and communities, and smarter spending. Dr. Eisenberg was the former administrator of the Agency for Healthcare Research and Quality (AHRQ) and an impassioned advocate for healthcare quality improvement. The award, presented annually by The Joint Commission and the National Quality Forum (NQF), recognizes major individual, local, and national achievements in healthcare that improve patient safety and healthcare quality.

“BMC2’s work impacts 30,000 patients treated by hundreds of physicians from more than 100 hospital teams each year,” shares Dr. Hitinder Gurm, Director of BMC2. “We are fortunate to have this unique partnership between providers, hospitals, and payers, that is focused solely on improving safety, quality, and appropriateness of care. The collaborative creates data-driven quality improvement goals and initiatives, shares best practices, and distributes reports benchmarked to statewide performance, all focused on improving cardiovascular care throughout Michigan.”

In Michigan, documentation of radiation use improved from 73.1% in 2019 to 85.5% in 2021, and BMC2 sites are outperforming national rates, which were 57.5% in 2019 and 74.3% in 2021. BMC2 sites achieved an overall 43% decrease in cases with high-dose radiation exposure (2.8% in 2018 to 1.2% in 2021), affecting hundreds of patients and care teams. BMC2 also reduced opioid pill prescribing; data showed improvement in the rate of patients with a prescription of less than 10 opioid pills by approximately 30% between 2018 (62%) and 2021 (91%). In addition, BMC2 has been exploring strategies to address healthcare disparities and partners with a patient advisory council to create resources for patients and providers.

The Eisenberg Award panel was impressed by BMC2’s dissemination of its work. BMC2 data has supported more than 100 publications in peer-reviewed medical journals and more than 100 presentations at national and international conferences. The panel noted that this kind of collaborative, best-practice approach improved outcomes, reduced costs, and could be replicated by other states. The panel was inspired by BMC2’s inclusive scope across so many clinicians, physicians, teams, and sites, acknowledging the collaborative is “working to improve care, at every institution, and for every patient. It's remarkable.”

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BMC2 is a collaborative consortium of health care providers in the State of Michigan comprised of three statewide quality improvement projects addressing percutaneous coronary interventions (BMC2 PCI), vascular and carotid interventions (BMC2 Vascular Surgery), and transcatheter aortic and mitral valve procedures (MISHC) in collaboration with the Michigan Society of Thoracic and Cardiovascular Surgeons. Learn more about BMC2’s activities and achievements in their 2023 Annual Report.

Like MVC, support for BMC2  is provided by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.