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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

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.

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CQI Leader Selected as 2024 Presidential Leadership Scholar

CQI Leader Selected as 2024 Presidential Leadership Scholar

The Collaborative Quality Initiatives (CQIs) will be represented in this year’s Presidential Leadership Scholars (PLS) program, which invites 60 scholars to participate in a six-month, one-of-a-kind, bipartisan initiative focused on learning from the presidencies of George W. Bush, William J. Clinton, George H.W. Bush, Lyndon B. Johnson, and their administrations.

Scholars are chosen from a highly competitive field and must undergo a rigorous application and review process. They are selected based on leadership growth potential and the strength of their personal leadership projects addressing local, national, or international challenges.

For Amanda Stricklen, RN, MSN, it’s an opportunity to continue her lifelong professional journey of improving healthcare, and she brings robust experience in healthcare quality improvement and patient safety to the PLS program. She earned bachelor’s and master’s degrees from the University of Michigan School of Nursing before gaining years of experience in bedside nursing. Currently, Stricklen serves as the program manager for the Michigan Bariatric Surgical Collaborative (MBSC) and the Michigan Surgical Quality Collaborative (MSQC) focusing on improving clinical outcomes, enhancing patient experiences, and building a statewide community of providers who work together to elevate the care of surgical patients. Like the Michigan Value Collaborative, the coordinating centers for MSQC and MBSC are housed at Michigan Medicine.

“I am honored to be one of 60 scholars for this year’s Presidential Leadership Scholars Program,” said Stricklen. “I look forward to learning new leadership skills and representing the Collaborative Quality Initiatives, Michigan Medicine, Blue Cross Blue Shield of Michigan, and the University of Michigan as a whole. My goal is to learn new leadership goals to empower and provide support to participating hospitals and healthcare providers to enhance care in Michigan and across the nation.”

“Amanda Stricklen is one of the longest serving program managers in Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiative program, the first of its kind, internationally recognized, award-winning model that focuses on a critical challenge – improving health care quality and value,” said Tom Leyden, director of the BCBSM Value Partnerships program, which provides funding for the CQIs. “Amanda is an accomplished leader who demonstrates a strong commitment to the CQIs’ shared principles of transparency, collaboration, trust, and measuring performance.”

Stricklen will join leaders from across the country representing the military, non-profit organizations, public and private sectors. Scholars will travel to each participating presidential center to learn from key former administration officials, business and civic leaders, and leading academics. They will study, put into practice varying approaches to leadership, and exchange ideas to help strengthen their impact in the communities they serve.

“Amanda, a beacon of excellence in Michigan's quality improvement landscape, has earned her place as a Presidential Leadership Scholar, illuminating the path of leadership with dedication and innovation,” said CQI Portfolio Director Michael Englesbe, MD. “We look forward to benefiting from the enhanced skills she will gain through this program.”

The 2024 program kicks off Jan. 24 in Washington, D.C.

About the Presidential Leadership Scholars

The Presidential Leadership Scholars program is a partnership among the presidential centers of George W. Bush, William J. Clinton, George H.W. Bush, and Lyndon B. Johnson. To learn more, visit presidentialleadershipscholars.org.

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MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

On Monday, organizations large and small will honor the work and legacy of Dr. Martin Luther King Jr. His work has continued to inspire the country on issues such as equality, discrimination, and systemic racism. As the MVC Coordinating Center approaches this national holiday, we reflect on the continued relevance of one of Dr. King’s famous quotations about healthcare injustices: "Of all the forms of inequality, injustice in health is the most shocking and inhuman.” Dr. King made this comment and others about healthcare discrimination in 1955, and yet almost 70 years later our healthcare system continues to grapple with issues of inequity, discrimination, and racism.

As a result, health equity is currently a priority across most major healthcare and government agencies. The MVC Coordinating Center has similarly identified health equity as a strategic priority in recent years and in its newest strategy refresh. This means that a variety of health equity conversations, reporting, and learning opportunities will be offered to MVC members throughout the year. In discussions with members to date, it has been evident that many are still in an information-gathering phase and desire advice around best practices. Therefore, MVC will seek to identify differing approaches to health equity across the collaborative through a health equity survey, which will be shared with members at the end of January. Members will have until mid-April to complete this survey, after which MVC will report aggregate results and facilitate connections between members.

MVC also plans to continue integrating health equity into its workgroup offerings, with each workgroup series (e.g., cardiac rehab, preoperative testing, post-discharge follow-up, rural health, sepsis, health in action) offering at least one session focused on equity. In addition, MVC is planning to offer a reimagined health equity report informed by the results of the survey that integrates supplemental data sets tied to social determinants of health.

MVC’s equity activities this year come on the heels of MVC’s fall collaborative-wide meeting, which focused on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare. The agenda incorporated the voices of key leaders and community-based organizations working to improve equity in care delivery, including keynote speaker Renée Branch Canady, PhD, MPA, who serves as CEO of the Michigan Public Health Institute (MPHI) and is a recognized national thought leader in the areas of health inequities and disparities, cultural competence, and social justice. Key takeaways and links to slides from Dr. Canady and other guests are available in MVC’s meeting summary. The session also included roundtable speakers from community-based organizations, which helped to facilitate collaboration and networking to support direct patient support services. MVC will strive to offer similar networking and collaboration opportunities at future collaborative-wide meetings.

The MVC Coordinating Center wishes its members and partners well as they celebrate MLK Day in their way. We are grateful for your continued engagement and partnership on important issues as we collectively strive to provide high-quality care for all.

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MVC Celebrates Q4 Updates and Successes to Close Out 2023

MVC Celebrates Q4 Updates and Successes to Close Out 2023

The Michigan Value Collaborative distributes a quarterly newsletter to highlight recent MVC events, reporting, partnerships, and member activity. The final newsletter of 2023 was emailed to subscribers this week and summarizes activities and accomplishments from Q4. First and foremost, the Coordinating Center is grateful to its members for their partnership throughout 2023 - MVC's 10th year in operation as a value-based Collaborative Quality Initiative. This was a special year for the MVC team as we celebrated key successes from the last decade (Figure 1). MVC also celebrated a new addition to the Coordinating Center team in Q4, with MVC Engagement Manager Jessica Souva joining in October (Figure 2).

Figure 1.

Figure 2.

The Q4 newsletter included summary highlights from MVC's fall collaborative-wide meeting, which was held Oct. 20 in Lansing with the theme of "high-value care for all." This newsletter edition also highlighted important updates to MVC's strategy, which were informed by member insights and strategic planning activities over the past year. The resulting revised strategic framework will shape MVC's priorities and activities in 2024 and beyond.

Another key focus of the Q4 newsletter was the release of MVC's Program Year 2024 Engagement Point Menu, available here. Hospitals may earn up to two MVC P4P engagement points toward their PY24 scorecard by mixing and matching the included offerings. MVC hosted an Engagement Point Menu Webinar to introduce this menu and answer questions in November 2023. The webinar recording can be accessed here. In addition, MVC developed a Frequently Asked Questions guide available here.

The Q4 newsletter highlighted a large portfolio of reports and activities completed by MVC staff from October through December. MVC prepared several refreshed hospital-level push reports that were then shared with hospital and physician organization members via their unique Dropbox folders, including refreshed versions of MVC's preoperating testing, sepsis, common condition, and chronic disease management reports. Additionally, MVC and MUSIC worked together on a pair of value-based improvement exercises to assess the impact of MUSIC initiatives on opioid prescription use. One of these exercises focused on the impact of MUSIC's ROCKs initiative on opioid spending following kidney stone surgery, and a second focused on the impact of MUSIC's Michigan Pain-control Optimization Pathway (MPOP) initiative on opioid spending following prostate surgery. MVC also partnered with BMC2, HBOM, and Trinity Health Ann Arbor to co-host the Michigan Cardiac Rehab Network Fall 2023 Stakeholder Meeting in November, during which the new MiCR website and other cardiac rehab resources were announced. 

In January, BCBSM will be conducting its 2024 CQI Coordinating Center Survey, which provides an opportunity for members to evaluate the MVC Coordinating Center staff. We value your feedback and thank you in advance for your participation. The MVC Coordinating Center looks forward to continuing its work in 2024 and wishes everyone a happy holiday season and new year!

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MVC Announces Key Event Dates in 2024 Engagement Calendar

MVC Announces Key Event Dates in 2024 Engagement Calendar

The Michigan Value Collaborative (MVC) offers several opportunities for hospitals and physician organizations (PO) to collaborate and share best practices, from collaborative-wide meetings and workgroups to regional networking events and virtual webinars. MVC is thrilled to share its 2024 event calendar with a full list of currently scheduled events and registration links. Some events have yet to be scheduled for 2024, such as networking events or ad hoc webinars. Once scheduled, the 2024 calendar will be updated to include those dates and posted to the MVC events page.

Collaborative-Wide Meetings

MVC holds collaborative-wide meetings twice each year to bring together quality leaders from across the state for networking and peer learning. MVC usually shares updates and unblinded data and invites guest speakers to share success stories on topics of interest to members.

MVC will host its spring collaborative-wide meeting on Friday, May 10, 2024, in Midland, MI. The fall collaborative-wide meeting is set for Friday, October 25, 2024, in Livonia, MI. Registration is not yet available for these two meetings and will be shared with members in the months leading up to each date.

MVC Workgroups

Workgroups consist of a diverse group of representatives from Michigan hospitals and POs that meet virtually to collaborate and share ideas. The 2024 workgroup topics include cardiac rehabilitation, health in action, post-discharge follow-up, preoperative testing, rural health, and sepsis. All MVC workgroups offered in 2024 will occur from 12-1 p.m.

Program Year 2024-2024 P4P Engagement Points

Many hospitals participating in the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program know that the program structure for Program Years (PYs) 2024-2025 includes up to two points for completed engagement activities. Many of the engagement offerings available to all members in 2024 will allow P4P hospitals to earn engagement points. One way that hospitals can earn engagement points is by presenting at a 2024 MVC workgroup, worth 0.5 points. Hospitals interested in presenting at a 2024 workgroup for P4P points must submit a presentation proposal form (link). For Q1 workgroup presentations in February or March, the deadline to submit presentation proposals will be extended to Dec. 15, 2023. MVC will review submissions on a rolling basis and communicate decisions and next steps as proposals are received.

The full MVC PY24 Engagement Point Menu is available here. Hospitals interested in earning P4P engagement points can mix and match from the included offerings to earn up to two points toward their PY24 scorecard. MVC hosted an Engagement Point Menu Webinar to introduce this menu and answer questions in November 2023. The webinar recording can be accessed here. In addition, MVC developed a Frequently Asked Questions guide available here.

Please email the MVC Coordinating Center at mailto:Michigan-Value-Collaborative@med.umich.edu if you have any questions.

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Michigan Cardiac Rehab Network Hosts In-Person Stakeholder Meeting at Trinity Health

Michigan Cardiac Rehab Network Hosts In-Person Stakeholder Meeting at Trinity Health

The Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield Cardiovascular Consortium (BMC2) recently held a successful 2023 Fall Michigan Cardiac Rehab Network (MiCR) Stakeholder Meeting on Fri., Nov. 17. This was the second in-person MiCR Stakeholder Meeting since MVC and BMC2 founded the MiCR partnership in 2022. The meeting brought together 63 individuals representing 28 organizations and was co-hosted by Trinity Health Ann Arbor’s cardiac rehab team.

The day’s agenda accounted for a variety of topics, including updates and material releases by the MiCR team, presentations and panel discussions about the new MVC and BMC2 pay-for-performance measures for cardiac rehab (see slides), advice and updates about cardiac rehab billing (see slides), recent findings about liaison-mediated referrals and their impact on cardiac rehab participation after percutaneous coronary intervention (see slides), and breakout groups to help brainstorm opportunities within various focus areas.

One unique and memorable aspect of the day was the ability to learn from the meeting’s hosts, Trinity Health Ann Arbor. Professional representatives from the site included Frank Smith, MD, Medical Director of the Intensive Cardiac Rehabilitation Program for the Ann Arbor and Livingston locations, and Mansoor Qureshi, MD, Medical Director of the Cardiac Catheterization Lab and Structural Heart Program for Ann Arbor, who provided opening remarks about the importance of facilitating provider buy-in and referrals. They emphasized cardiac rehab as a key high-value service to improve patient lives. Their slides can be viewed here.

They were also joined by Amy Preston, BS, CEP, Cardiac Rehab Manager and Exercise Physiologist, who organized optional tours of the Trinity Ann Arbor rehab space. Nearly all the meeting’s attendees opted to participate in the tours to learn about the unique spaces and strategies utilized at Trinity.

The MiCR team was also thrilled to announce the launch of New Beat, a multi-component intervention developed in partnership with the Healthy Behavior Optimization for Michigan (HBOM) team (see slides). The New Beat program’s interventions address specific barriers to patient participation, such as gaps in patient or physician knowledge about benefits, the need for stronger physician endorsement, and access issues resulting from transportation barriers. The offerings developed by MiCR and HBOM to support these New Beat strategies include MiCR’s new website (MichiganCR.org), patient- and provider-facing educational materials, cardiac care cards that can be signed by providers and delivered to patient rooms prior to discharge (Figure 1), and an Uber Health pilot. In particular, please note that the interest form on the MiCR website is now open for those interested in accessing these resources or requesting others.

Figure 1.

As of the Nov. 17 meeting, the 2024 CMS reimbursement rules for cardiac rehab had not been announced. Once they are, MiCR will help share those updates and related resources with its contacts. Please reach out to info@michigancr.org with any questions.

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MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

Today is National Rural Health Day. Since 2010, the National Organization of State Offices of Rural Health set aside the third Thursday of every November to highlight the unique healthcare challenges facing residents within rural communities and celebrate providers who deliver innovative, affordable, and coordinated rural healthcare. MVC’s current membership includes 44 hospitals based in rural communities, 22 of which are designated as Critical Access Hospitals (CAHs). In tribute to National Rural Health Day and the needs of its growing rural membership, MVC hosted a special rural health workgroup yesterday.

The workgroup featured a guest presentation by Stephanie Pins, MSA, CPHQ. Pins is the Director of Quality, Risk, and Compliance for MyMichigan Medical Center Sault, formerly War Memorial Hospital, and is co-leading the Health Equity Council for MyMichigan Health. She led the creation of a transportation program for War Memorial Hospital by working with local transportation companies and applying for grants to cover the cost of the program.

This guest presentation focused on how MyMichigan is supporting rural communities through their Non-Emergency Medical Transportation (NEMT) Project, and the steps their team took to develop this program. Beginning in 2024, CMS will require that hospitals screen admitted patients for five social determinants of health (SDOH) domains. One of those five required domains is transportation needs since access to transportation and distance to care have a significant impact on healthcare outcomes.

MyMichigan Medical Center Sault primarily services the very rural communities of Chippewa, Luce, and Mackinac counties, located in the eastern Upper Peninsula of Michigan. A resident of Drummond Island—part of Chippewa County—may have to drive as many as 70 miles each way to get to an appointment at MyMichigan Medical Center Sault. Limited vehicle access in this part of the state was highlighted recently at MVC’s fall collaborative-wide meeting; the eastern Upper Peninsula had some of the highest rates in the state for housing units with no vehicle (Figure 1).

Figure 1.

While presenting, Pins emphasized that once MyMichigan identifies a need through screening, the next step is to find a way to connect those patients with the assistance they need to access medical care. One transportation solution utilized by MyMichigan Medical Center Sault is the Road-to-Recovery program, offered in partnership with McLaren Northern Michigan in Petoskey. The MyMichigan Medical Center Sault location offers some oncology cancer treatment services, but not radiation, so patients may need to travel to Petoskey—a distance of over 90 miles—to receive radiation therapy as part of their cancer treatment. The fully funded Road-to-Recovery program is available five days a week free of charge to anyone in the eastern Upper Peninsula. A hospital-owned van is driven by a volunteer driver from the MyMichigan Medical Center Sault location to scheduled pick-up locations along the I-75 corridor to Petoskey. Service times are coordinated with McLaren Northern Michigan’s oncology group so all the patients using this service have aligned appointment times. Pins shared that one noteworthy ancillary benefit of this program has been the peer support and relationship building that resulted from patients traveling together for extended periods while going through a similar treatment experience.

A second transportation solution utilized by MyMichigan Medical Center Sault is the Rides-to-Wellness Program, a partnership effort with local transportation companies and Connect UP. Patients can use this service to travel to other appointments or patient care services and serves as a critical stopgap in ensuring patients have somewhere to turn for time-sensitive transportation needs. Pins shared that the patient testimonials from those utilizing the service are helpful evidence of its value to the eastern Upper Peninsula (Figure 2).

Figure 2.

MyMichigan Medical Center Sault identified several lessons learned from delivering its Rides-to-Recovery Program over the last 10 years and applied many of those lessons to the development of its more recent Rides-to-Wellness Program. Pins also shared several tips for starting similar hospital-based transportation support programs at other locations throughout the state (Figure 3).

Figure 3.

Those who missed the workgroup and would like to learn more about these two programs, how they are managed, and how they were developed can review the full recording here. MVC is excited to offer a new rural health workgroup series quarterly in 2024. Contact MVC if you are interested in receiving invitations to those workgroups.

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MVC, MUSIC Estimate Significant Reduction in Opioid Spending After Kidney Stone Surgery

MVC, MUSIC Estimate Significant Reduction in Opioid Spending After Kidney Stone Surgery

In 2019, more than 71,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Nearly 70% of those overdoses involved a prescription or illicit opioid. The economic cost of the U.S. opioid epidemic was estimated to be $1,021 billion as of 2017 and rising. It is for this reason that clinicians and health systems have adopted evidence-based practices for reducing the number and amount of opioid prescriptions ordered for their patients. It is both clinically and economically significant, then, that the Michigan Value Collaborative (MVC) was recently part of an analysis that estimated over $4.8 million in avoided opioid prescription spending after kidney stone surgery.

MVC identified these savings in partnership with the Michigan Urological Surgery Improvement Collaborative (MUSIC), a physician-led quality improvement collaborative comprised of urology practices across the state of Michigan. MUSIC works to evaluate and improve the quality and cost-efficiency of urologic care. Since 2011, the MUSIC team has led prostate-related quality improvement activities such as improving patterns of care in the radiographic staging of men with newly diagnosed prostate cancer, reducing prostate biopsy-related hospitalizations, and enhancing the appropriateness of treatment decisions. In 2016, MUSIC expanded its scope of work to kidney stone surgery and in 2017 to small renal masses.

With kidney stone incidence on the rise affecting both men and women, MUSIC created a program focused on Reducing Operative Complications from Kidney Stones (ROCKS). It focuses on improving the quality of care for kidney stone patients, particularly by decreasing modifiable emergency department (ED) visits for expected symptoms and side effects of ureteroscopy (URS) or shockwave lithotripsy (SWL) surgeries that are typically avoidable. MUSIC ROCKS aims to minimize these by developing resources that help patients manage their pain and urinary tract symptoms following kidney stone surgery.

Since its formation, the MUSIC ROCKS initiative led to the development of stent omission appropriateness criteria, a URS vs. SWL patient-provider shared decision aid, standardized patient education, and recommendations for postoperative pain control regimens. The ROCKS pain control optimization (POP) guidelines were developed in 2019 and recommended prescribing no opioids following kidney stone surgery. The goal of these guidelines is to minimize opioid use in patients undergoing kidney stone surgery while maintaining patient safety and satisfaction.

The MUSIC Coordinating Center reached out to MVC in 2022 to help assess the impact of its ROCKS initiative on opioid prescription use following surgery. The goal was to estimate MUSIC ROCK's impact on opioid utilization and prescribing rates following URS or SWL kidney surgeries in Michigan, as well as the related impact on the value of care.

METHODOLOGY

Data Sources & Study Population

MVC kidney stone surgery episodes were used for this analysis, which compared outcomes between URS and SWL procedures for MUSIC and non-MUSIC providers. It was restricted to kidney stone surgery claims for Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) Commercial and Medicare Advantage plans between Jan. 1, 2015 and July 31, 2022. The cohort was further restricted to BCBSM/BCN-insured patients with no opioid prescription fills in the 90 days prior to their surgery who were continuously enrolled in a prescription sub-plan 90 days prior to surgery through 30 days post-surgery. The final cohort used in the opioid analysis included 14,967 Michigan patients.

Methodological Approach

The study population was identified using professional claims for MVC kidney stone surgery episodes that occurred within the index dates of the surgery. All professional claims missing a provider NPI on the claim were excluded. The remaining NPIs were characterized by information derived from the National Plan and Provider Enumeration System (NPPES) data set. Claims of providers or facilities outside of the state of Michigan were also excluded. The remaining NPIs were then categorized into MUSIC and non-MUSIC categories. Opioid utilization was assessed through the presence of paid outpatient opioid prescription claims in the 30 days following surgery.

Limitations

Approximately 90% of Michigan urologists participate in MUSIC. However, only 58% of all MVC kidney stone surgery episodes were identified as being performed by a MUSIC provider via National Provider Identifier (NPI). Some MUSIC providers may be performing these procedures on patients with an insurance plan not reflected in MVC data. It could also be related to MVC's episode structure. Episodes are mutually exclusive; therefore, if a patient were to have a hospitalization prior to their surgery that resulted in an MVC episode creation, their care would not be classified as a kidney stone surgery episode. It is also possible that billing NPI was not always a reliable field.

Second, MVC only has outpatient prescription claims for BCBSM and BCN patients with a prescription sub-plan. For this analysis, only BCBSM-insured patients were assessed. As a result, only about 35% of MVC's URS and SWL episodes were included in assessing opioid utilization. Furthermore, the analysis is of opioid utilization, not provider prescribing patterns. Given that a claim is only generated once a prescription is filled, this analysis cannot provide a full picture of changes in provider prescribing patterns.

FINDINGS & NEXT STEPS

Among the BCBSM/BCN-insured patients who underwent kidney stone surgery between 2015 and 2021, 50.3% of patients on average filled an opioid prescription within 30 days of surgery, with a higher average opioid utilization rate among SWL patients (54.9%) than among URS patients (47.4%). There was a strong decline in opioid utilization after 2017 across Michigan for both types of procedures (Figure 1), with lower utilization following URS.

 

Figure 1.

Notably, the rate of opioid utilization after kidney stone surgeries performed by MUSIC providers is consistently lower than those performed by non-MUSIC providers (Figure 2). For example, among URS procedures performed by MUSIC providers after 2016, 43.8% resulted in an opioid fill on average, whereas an average of 53.8% of procedures performed by non-MUSIC providers resulted in an opioid fill. In addition, the absolute decrease in opioid prescription fill rates was greater for MUSIC providers. These trends were similar for SWL surgeries, with consistently lower average opioid utilization rates among patients treated by MUSIC providers (52.1%) vs. non-MUSIC providers (60.9%).

Figure 2.

MVC further estimated cost savings from the reduction in opioid prescription fills by examining differences in 365-day prescription payments among the MUSIC cohort. The changes in opioid prescribing resulted in an estimated yearly average savings of $2,712 per patient from reduced opioid prescription fills post-surgery. Using this estimated savings, MVC multiplied the number of URS procedures performed each year by MUSIC providers combined with the yearly percent reduction from baseline in opioid prescribing to further estimate a savings of over $4.8 million from avoided opioid prescription payments since 2016.

The notable decreases in both prescribing rates and prescription payments demonstrate the substantial impact of the MUSIC ROCKS initiative on opioid utilization after kidney stone surgery, including a likely reduction in the total number of filled opioids circulating in the Michigan community as a result of fewer patients receiving prescriptions. MVC completed a similar analysis in partnership with MUSIC looking at prescribing patterns after prostate surgery, and estimated that MUSIC providers helped avert an estimated $1.6 million in avoided opioid prescription spending.

MVC’s expertise and data frequently result in partner projects like this; MVC completed several CQI impact assessments last year, as well as several more so far in 2024. MVC also participates in collaborative activities with peer CQIs through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data. To request a copy of any of MVC’s completed CQI impact assessments, please contact the MVC Coordinating Center.

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MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

The MVC Coordinating Center is excited to announce open registration for its upcoming Fall Collaborative-Wide Meeting on Friday, Oct. 20, 2023, from 10 a.m. – 3 p.m., in Lansing, MI. This meeting’s theme is “High-Value Care for All: Collaborative Approaches to Equitable Healthcare,” and will focus on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

This meeting will include presentations on health equity frameworks for quality improvement, insights from claims-based data, and inter-organizational partnerships to improve patient outcomes. MVC is thrilled to be joined by Renée Branch Canady, PhD, MPA, CEO of the Michigan Public Health Institute (MPHI), as its keynote speaker. Dr. Canady has extensive experience in diversity, equity, and inclusion (DEI) efforts, and was recognized as Crain’s 2021 Notable Executives in DEI. She received this honor for her work implementing incremental changes in health equity and social justice at MPHI. Under her leadership, MPHI established the Staff of Color Affinity Group, the Center for Health Equity Practice (CHEP), and the Center for Culturally Responsive Engagement (CCRE). She also recently published a new book titled Room at the Table: A Leader’s Guide to Advancing Health Equity and Justice.

The MVC Coordinating Center will also present MVC data linked with supplemental social determinants of health data sets, updates about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and other Coordinating Center updates.

MVC’s fall collaborative-wide meeting will also feature a new roundtable format with insights from a wide variety of guest speakers, including Nora Becker, Michigan Medicine; Diane Hamilton, Corewell Health Trenton; Matthias Kirch, Michigan Social Health Interventions to Eliminate Disparities (MSHIELD); Laura Mispelon, Michigan Center for Rural Health; Amanda Sweetman, the Farm at Trinity Health; Larrea Young and Noa Kim, Healthy Behavior Optimization for Michigan (HBOM); and Thomas West, U-M Health West. Attendees will rotate through several mini-presentations and discussions about specific health equity topics, such as demographic data collection and patient screening practices, developing and funding community benefit programs, addressing transportation access barriers, support programs within rural communities, tobacco cessation interventions, financial toxicity risks for patients, and more.

Attendees will have multiple opportunities to network and learn from their peers. The meeting includes a mid-day poster session to highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions through 10/5/2023 that feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to health equity or MVC conditions/data, authored by clinicians and non-clinicians alike, or presentations already shared at a recent conference or event. Instructions for submitting a poster are available on MVC’s events page. The meeting also includes breakout sessions in the afternoon focused on regional trends and opportunities using MVC data and member insights, as well as an optional networking reception at the conclusion of the event, from 3-4 p.m.

Those able to attend MVC's fall collaborative-wide meeting may register here. MVC hosts two collaborative-wide meetings each year to bring together healthcare quality leaders and clinicians from across the state.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

Hari Nathan, MD, PhD; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH; Kristy Degener, MPH

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MEDIC Helps EDs in Michigan Improve Care for Adults, Children

MEDIC Helps EDs in Michigan Improve Care for Adults, Children

Serving a spectrum of functions, emergency departments (EDs) provide essential care and services, operating in the critical space between outpatient and inpatient care. EDs also serve as a safety net within the US healthcare landscape by performing necessary clinical services for populations who may not otherwise have access. Patients visiting the ED may undergo a wide range of rapid diagnostic and treatment options, ranging from unscheduled procedures, laboratory testing, utilization of basic and advanced imaging studies, and admission of patients to the hospital. Despite the ED’s critical role and services, there are few coordinated, scalable efforts to improve care quality in the ED. These realities within emergency medicine made it a prime opportunity for quality improvement (Kocher et al., 2019), which was the impetus for adding an emergency medicine-focused Collaborative Quality Initiative (CQI) to the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio.

The Michigan Emergency Department Improvement Collaborative (MEDIC) was founded in 2015 to address the critical gap in coordinated quality improvement in the ED, including intervention design through implementation and evaluation, at scale, across health systems. Michigan Value Collaborative (MVC) members recently heard about MEDIC and its work as part of the launch of MVC’s new ED-based episodes and reporting; MEDIC and MVC collaborated on the development of this new episode of care data structure.

MEDIC’s quality improvement efforts to date have included initiatives such as improved appropriateness of head CT imaging utilization for children and adults with minor head injuries, greater CT diagnostic yield for adults with suspected pulmonary embolism, decreased use of chest x-rays in children with respiratory illness (i.e., asthma, croup, bronchiolitis), higher rates of ED discharge for children with asthma and adults with low-risk chest pain, and increased distribution of take-home naloxone to patients with opioid use disorder (OUD) or who experience opioid overdose or withdrawal.

MEDIC Success Stories

Since 2017, MEDIC participating sites have significantly improved collaborative-wide performance on all MEDIC quality measures. By reducing unnecessary imaging utilization and decreasing unwarranted hospitalization rates from the ED, MEDIC positively impacted the emergency care experience for thousands of patients in Michigan who received more evidence-based care and fewer low-value services. These improvements also contributed to an estimated total reduction in the ED cost burden in the millions of dollars (Figure 1).

Figure 1.

Zach Sawaya, MD, an emergency physician at MyMichigan Medical Center, reflected positively on the benefits of partnering with MEDIC on specific quality improvement initiatives. "MEDIC has pushed our group to be more cognizant of our imaging use, in particular in the pediatric population,” he said. “We've seen significant improvements in our rates of pediatric head CTs and chest X-rays that have been driven by MEDIC-provided data and decision-making resources.  In particular, we've seen wait times on pediatric head injuries go down as parents have been very open to discussion of PECARN rules and foregoing head imaging.”

The fact that MEDIC’s efforts support patients of all ages within its participating sites is unique; MEDIC is one of only a few CQIs with initiatives focused on pediatric patients. The MEDIC 2023 pay-for-performance incentive program, for example, focused on performance improvement on its pediatric-specific metrics. A key goal of this work was to ensure that children receiving emergency care in community hospital EDs received the same high-quality evidence-based care delivered in a pediatric emergency center. Since there are only three Michigan pediatric centers—all members of MEDIC—most children receive emergency care in community hospital EDs, and MEDIC observed disparities in the quality of emergency care delivered to children treated in community EDs. Children seen in community EDs were less likely to receive evidence-based care, as measured by our quality initiatives, than those seen in pediatric centers. In an emergency, patients can’t often choose which ED to go to, rather they need to go to the closest option. Over time and with participation in MEDIC, the data indicate MEDIC community hospitals improved their collective performance on MEDIC pediatric measures to be nearly on par with that of pediatric specialty hospitals.

The COVID-19 pandemic and its resulting impact on EDs also put MEDIC in a unique position. Within days of the pandemic being declared in the US, the MEDIC team pivoted from its standard work to support the COVID-19 response by leveraging its collaborative-wide learning network to support frontline efforts. MEDIC rapidly assembled a platform for informal and formal discussion between member EDs, which manifested as a series of virtual town halls and Grand Rounds focused on information exchanges among colleagues to rapidly innovate and meet challenges as the situation evolved.

This series began with lessons learned from the experience of its southeast Michigan EDs where the pandemic first unfolded in Michigan. This allowed sites in other areas of Michigan to understand what they would likely experience in the coming weeks or months, giving them valuable preparation time. Over several weeks, these well-attended sessions focused on the following topics: conservation of PPE, management of COVID-19 respiratory failure, special considerations for the pediatric population, and supporting the wellness of the ED workforce.

MEDIC – ED Partnerships

EDs partner with MEDIC in two primary ways: data collection and collaborative engagement in quality improvement. To participate in MEDIC, a partner ED must establish a flow of electronic health data for all ED visits to the MEDIC data registry as well as provide additional abstracted data, facilitated by a data abstractor hired with support from BCBSM. This then allows MEDIC to provide detailed evaluation and performance reporting on all measured quality initiatives, which in turn helps facilitate and inform site quality improvement interventions. MEDIC provides member hospitals with a level of insight into their ED practice patterns that would not be possible without participating in the collaborative.

In addition to being able to understand their data, participating in MEDIC allows hospitals to learn from one another, which significantly shortens the learning curve for improvement. Each site’s emergency medicine physician champion and abstractor(s) lead local intervention design and implementation, participate in MEDIC tri-annual collaborative-wide meetings, and share experiences and lessons learned with collaborative peers. MEDIC provides quality improvement evidence, guidelines, standardized performance measurement, data visualization, evaluation, and support for local intervention efforts.

MEDIC currently partners with hospital EDs across the state. Any sites not currently partnered with MEDIC are encouraged to visit their recruitment page for more information on becoming a member and contacting the team.

As MVC continues to build its offerings for members, the coordinating center is cognizant that hospitals and providers partner with multiple CQIs. MVC posts regular blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with questions.