20 Apr 2023
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MVC Evaluates Impact of MOQC Antiemetic Initiative on Healthcare Utilization During Chemotherapy

MVC Evaluates Impact of MOQC Antiemetic Initiative on Healthcare Utilization During Chemotherapy

April 20, 2023 | 0 Comments | , , ,

Chemotherapy-Induced Nausea and Vomiting (CINV) is among the most feared side effects of chemotherapy among cancer patients. It impairs the patient's quality of life and also adds to the morbidity and cost of therapy. That is why the Michigan Oncology Quality Consortium (MOQC)—a physician-led, voluntary collaborative of medical and gynecologic oncologists who work to improve the quality and value of cancer care in Michigan—initiated its Antiemetic Initiative. Through this initiative, MOQC supports participating oncology practices in aligning with current guidelines for use of prophylactic antiemetics, including olanzapine, in patients receiving chemotherapy. The Michigan Value Collaborative (MVC) recently partnered with MOQC to evaluate the impact of this initiative and estimated a cost savings of $334,095 across the course of chemotherapy from the increased use of olanzapine and decreased inpatient admissions in this cohort of patients.

Olanzapine is underused in patients receiving high-emetic-risk chemotherapy, despite evidence of efficacy and good patient tolerance (Navari et al., 2016). Olanzapine is a long-used medication (originally in higher doses for the treatment of psychosis) that is highly effective at decreasing nausea and vomiting. Uptake of olanzapine has been low, however, in part due to oncologists' lack of familiarity with the medication, lack of awareness or agreement with the guidelines, and lack of olanzapine inclusion on prepopulated order sets. The current labeling of olanzapine as an antipsychotic poses an additional barrier since this labeling generates additional concerns about stigma and side effects among patients. A benefit to this medication, in addition to its effect on nausea and vomiting, is its low cost compared with other medicines used to prevent the side effects of chemotherapy; the cost for each pill is about 25 cents.

Practices participating in MOQC’s Antiemetic Initiative receive performance data and baseline assessments in the area of CINV guideline adherence, support in identifying gaps in care and quality improvement measures, and resources for provider and patient education. To help evaluate the impact of this work on guideline-concordant olanzapine use, MOQC first reached out to MVC in 2022 to leverage its robust claims-based data. MOQC hypothesized that patients treated in medical oncology practices with low rates of olanzapine prescribing would have higher rates of healthcare utilization, including hospitalizations, emergency department (ED) visits, and unplanned outpatient visits between treatment cycles. The goal of this analysis was to estimate the initiative's overall impact on healthcare utilization for breast cancer patients undergoing chemotherapy as well as any related cost savings that improved the value of care delivery.

Methodology

The cohort for this analysis was comprised of female patients with a 90-day claims-based MVC episode of care for lumpectomy or mastectomy in 2016-2021 who received combination chemotherapy with doxorubicin and cyclophosphamide as either neoadjuvant or adjuvant chemotherapy. The cohort included patients covered by Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN HMO MA, and Medicare Fee-For-Service. The resulting MVC analysis included episodes for 1,891 patients who had a breast cancer resection, received both chemotherapy drugs on the same day, and were attributed to a MOQC provider/practice. Patients were attributed to 45 of MOQC's participating practices.

Practice-level olanzapine data collected by MOQC was then used to assess whether each patient's first chemotherapy receipt was during a time when their attributed practice had high or low prescribing rates of olanzapine. The threshold for high versus low prescribing at a particular practice was set at a 25% prescribing rate. Once a practice reached 25% prescribing rates of olanzapine in MOQC's data, that practice was considered to have "high" olanzapine prescribing rates in all subsequent months for this analysis. Using that distinction of whether the practice was a high or low prescriber during the course of the patient's chemotherapy regimen, MVC compared post-chemotherapy healthcare utilization among patients treated by high- versus low-prescriber practices. Sub-analyses further restricted the cohort to patients attributed to a practice that ever became categorized as having high olanzapine prescribing rates. When limiting the analysis to practices that became high prescribers at any point, the cohort was narrowed down to patients attributed to 15 MOQC practices.

Limitations

The nature of claims data limited MVC's ability to identify patients attributed to participating oncologists at MOQC practices; the requirement of each patient in the cohort having a MOQC provider NPI on one of their claims reduced the analytic cohort to a smaller size than what would be seen in clinical data. Another limitation is that the findings may include period effects not controlled for in this analysis. Practice behavior and availability of inpatient beds may have differed between when a practice was a low olanzapine prescriber compared to when they began prescribing olanzapine at a higher rate. Finally, payment calculations included in this analysis are limited to dollars saved among the attributed claims-based population and, therefore, do not reflect savings that may be attributed to olanzapine use among the broader population of interest.

Impact & Next Steps

A key finding in the analysis included a significant difference in healthcare utilization across the course of chemotherapy among patients treated by high olanzapine prescribing MOQC practices compared to when they had low olanzapine utilization. Among the patients with cancer who received their first cycle of chemotherapy when their provider's practice had a high prescribing rate (≥25%), 10% were hospitalized (Figure 1). This inpatient admission rate was significantly lower than for those patients undergoing chemotherapy regimens at practices with low olanzapine prescribing rates, 15% of whom were hospitalized (p=0.02). This finding was based on a subset of patients attributed to practices who eventually became high olanzapine prescribers during the study period (922 patients at 15 practices).

Figure 1. Rates of Inpatient Admission Across Patients' Course of Chemotherapy, by Practice's Utilization Rate of Antiemetics at the Start of Chemotherapy (N=922)

This analysis further discovered a significant difference in the percentage of patients who had either an ED visit or inpatient admission. Of the patients receiving chemotherapy at MOQC practices, fewer patients at high-prescribing practices had either an ED visit or inpatient admission (19%) across the course of their treatment compared to patients receiving care at low-prescribing practices (26%).

MVC estimated a cost savings of $334,095 across the course of chemotherapy from the increased use of olanzapine and decreased inpatient admissions in this cohort of patients. Dollars saved were calculated by taking the number of patients whose chemotherapy began when their practice was a high prescriber (525), multiplied by the difference in the percentage of patients with an inpatient admission across the course of chemotherapy attributed to practice antiemetic prescribing rate (5.3%), multiplied by the average price-standardized payment for an inpatient admission during a 90-day episode of care among breast cancer resection episodes for the included payers ($12,007).

This analysis demonstrated further evidence that the use of prophylactic olanzapine is an effective strategy for managing CINV-related ED visits or hospitalizations. It furthermore identified tangible CQI impact in the form of patients who underwent breast cancer treatment being less likely to visit the ED or be hospitalized over the course of their chemotherapy regimen, as well as in the form of dollars saved on facility inpatient costs across the course of chemotherapy. Ongoing work will continue to support practices to make changes in the use of olanzapine, not only in patients receiving combination therapy with doxorubicin and cyclophosphamide but also in other high-emetic-risk regimens.

MVC’s expertise and data frequently result in partner projects like this; MVC completed a number of CQI impact assessments last year, as well as several more so far in 2023. 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.

13 Apr 2023
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MVC Announces Speakers, Breakout Sessions for Spring Collaborative-Wide Meeting

MVC Announces Speakers, Breakout Sessions for Spring Collaborative-Wide Meeting

April 13, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce the agenda for its Spring Collaborative-Wide Meeting on Friday, May 19, 2023, from 10 a.m. – 3 p.m., at the Vistatech Center in Livonia, MI. This meeting’s theme of “connecting the dots” reflects a focus on interdisciplinary collaboration, care transitions, and alternative sites of care. This meeting also serves as the official launch of MVC’s 10-year anniversary celebration, which will highlight MVC’s achievements in promoting high-value healthcare throughout the last decade.

Presentations will highlight unblinded MVC data, inter-organizational partnerships, care team collaboration to improve patient outcomes, and supporting care transitions. Attendees will learn to utilize MVC’s claims data more effectively and efficiently to inform patient-centered quality improvement opportunities at their respective healthcare organizations. After this meeting, attendees will have insights and tools to help improve the following patient outcomes: care transitions and post-discharge support, readmissions, patient experience, treatment adherence, and patient education.

MVC’s Director Hari Nathan, MD, PhD, and Co-Director Mike Thompson, PhD, MPH, will kick off the day with Coordinating Center updates, announcements about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and success stories that celebrate MVC’s 10-year anniversary. This will be followed by the unveiling of new MVC episodes based on care initiated in the emergency department (ED), which were developed in partnership with the Michigan Emergency Department Improvement Collaborative (MEDIC). This presentation will include an unblinded data presentation using new ED-based episodes for congestive heart failure (CHF) patients.

The guest presentations will feature two MVC partners, a physician organization and a fellow Collaborative Quality Initiative (CQI). Speaking in the morning will be the Trinity Health IHA Medical Group. Caitlin Valley, MHA, Senior Population Health Project Manager at IHA, will present on transitional care collaboration and management for healthcare improvement. In the afternoon, attendees will hear from the INHALE (Inspiring Health Advances in Lung Care) team, a new population health CQI focused on the quality of care for adults with chronic obstructive pulmonary disease (COPD) and adults and children with asthma. Speaking about COPD care transitions and post-discharge support on behalf of INHALE will be Co-Director Michael Sjoding, MD, MSc, who is also an Associate Professor of Internal Medicine at Michigan Medicine.

In addition to traditional presentations, attendees will have multiple opportunities to network with and learn from their peers. The meeting includes a mid-day poster session that will highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions. Posters should feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to MVC conditions or 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.

There will also be breakout sessions in the afternoon that focus on the new value metrics for Program Years 2024-2025 of the MVC Component of the BCBSM P4P Program. Attendees were asked to select one of four breakout sessions upon registering, including cardiac rehabilitation, post-discharge follow-up (focus on CHF, COPD, pneumonia), preoperative testing, and sepsis readmissions. MVC members interested in referencing the value metrics selected by specific hospitals participating in P4P can refer to MVC's value metric selection document located here.

Those interested in attending MVC's spring 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. The fall collaborative-wide meeting will take place in October with a focus on health equity.

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 4.25 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

30 Mar 2023
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MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

March 30, 2023 | 0 Comments | , , , ,

MVC staff stepped out of their daily routines recently when they volunteered as a team at a local nonprofit organization. Eager to make this service opportunity as meaningful to their work as possible, MVC staff selected an organization with ties to health and well-being. Last month they were hosted by Food Gatherers, the food bank and food rescue program serving Michigan residents in Washtenaw County. MVC teammates worked together to sort rescued produce in the Food Gatherers warehouse, saving and packing 1,312 pounds of produce for the community.

Though MVC teammates were excited and impressed by that number, it pales in comparison to the amount of food processed by food banks like Food Gatherers, which last year distributed 7.3 million pounds of food — the equivalent of 6 million meals — through its network of partner programs. In order to collect and distribute all those meals, Food Gatherers maintains a working warehouse where an average of nine tons of food are processed each day, and a busy community kitchen prepares and serves hot meals seven days a week. Volunteers play a significant role in these operations.

Produce boxes and other foods that are processed by volunteers eventually find their way into the hands of over 170 community partners, such as food pantries or emergency groceries. In addition to distributing food, Food Gatherers also works to connect beneficiaries to SNAP and other federal food programs and provide innovative food distribution initiatives at area schools and clinics. A new area of focus is the cultivation of partnerships with healthcare providers to further identify and address food insecurity in the community.

Food Gatherers established its Health Care and Food Bank Partnership Initiative to create a connection between local healthcare institutions and Food Gatherers’ network of partner pantries. It was designed to increase access to food for community members in partnership with healthcare providers. Key activities of the initiative include establishing food insecurity screening and referral programs within primary care locations, training medical professionals such as residents and allied health professionals on the role of food security as a key social determinant of health, and drawing attention to the issue of hunger and healthy food access with healthcare providers.

This is a growing area of interest for food banks across the country since food insecurity is closely linked to poor health outcomes and increased risk of chronic disease. According to one study, in fact, the rate of Type 2 diabetes is 25% higher in adults who are food insecure. In addition, as many as one-third of patients with a chronic illness are unable to afford food, medications, or both. A recent publication using MVC data also found strong associations between chronic disease burden and financial outcomes.

Several components of the Food Gatherers Health Care and Food Bank Partnership Initiative were initially supported through a Michigan Medicine grant. Food Gatherers has worked with Michigan Medicine, Trinity Health St. Joseph Mercy Ann Arbor, and IHA as well as with community-based clinics such as the Hope Clinic, Packard Health, and the Corner Health Center. Though the grant ended in 2021, the larger concept of partnership between healthcare providers and community food banks is still an area of interest and opportunity.

"Food Gatherers has been working with our local health care partners to support and encourage the use of food insecurity screening in primary care settings,” said Markell Miller, MPH, Director of Community Food Programs at Food Gatherers. “When providers can identify food insecurity in a patient, they can help connect the individual to resources - specifically SNAP, or if it's an urgent need, a local food pantry. Hunger is a health issue, and when providers talk about food security, they reinforce the connection between nutrition and health, and also destigmatize the experience for individuals facing food insecurity. Our Hunger and Health Training program provides baseline information for physicians on food security as a social determinant of health, and how to support individuals facing food insecurity. We've focused on training medical residents going into careers in primary care, but there is an opportunity to train other providers to increase knowledge and comfort with food insecurity screening and referrals. We look forward to future opportunities to expand our partnership with health care providers, and also continue to seek sustainable funding solutions to support the network of healthy pantries that are available in our community."

Similar programs are also underway at other food banks across Michigan, such as Gleaners Community Food Bank of Southeastern Michigan. In 2015, Gleaners was one of three participating food banks in a two-year randomized controlled research study on the impact of food bank interventions on outcomes for patients with Type 2 diabetes. They have partnerships with the CHASS Center, Covenant Community Care, Henry Ford Health System, the Michigan Health Endowment Fund, the National Kidney Foundation of Michigan, and Trinity Health St. Joseph Mercy Livingston, and have thus far connected more than 500 patients with healthy food.

MVC recently invited Jessica Ramsay, MPH, Director of Wellness and Nutrition Education at Gleaners, to present at MVC’s upcoming chronic disease management workgroup on Thurs., April 20, from 2 - 3 p.m. The presentation will focus on partnerships between healthcare providers and community organizations, highlighting pilot programs and initiatives at Gleaners that improved both patient outcomes and healthcare utilization through reduced food insecurity. Registration for this workgroup presentation is open now.

To learn more about the food banks mentioned, please visit the websites of Food Gatherers and Gleaners Community Food Bank of Southeastern Michigan. Reach out to MVC if your hospital or PO has a similar partnership in place with a community-based organization – MVC would love to highlight this work.

To learn more about the ways in which food insecurity impacts health, check out the video below from Feeding America.

Illuminating Intersections: Hunger and Health (Feeding America)

16 Mar 2023
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Analysis Finds Strong Association Between Chronic Disease Burden and Financial Outcomes

Analysis Finds Strong Association Between Chronic Disease Burden and Financial Outcomes

March 16, 2023 | 0 Comments | ,

The Commonwealth Fund recently reported that the U.S. continues to spend more on healthcare than other nations, and has the highest rate of people with multiple chronic conditions. Within this healthcare environment, many individuals are at risk of financial crises in part due to medical debt. MVC recently helped prepare a unique data set that linked its robust claims-based data with Experian’s commercial credit report data, resulting in an insightful analysis of the association between a patient’s chronic disease burden and their financial outcomes. The work was led by Nora Becker, M.D., Ph.D., and other colleagues from the U-M Institute for Healthcare Policy and Innovation, who published their analysis in JAMA Internal Medicine.

The financial burdens of illness can be due to the direct cost of medical care or the indirect effects of lost income due to illness. Many healthcare providers have first-hand anecdotes about patients who struggle to cover expenses necessary to manage their chronic condition, then avoid future healthcare services that lead to a worsening of their health or the development of additional chronic conditions. This negative feedback loop and the burden of medical debt are critical to understand so that healthcare leaders can adopt policies that improve financial outcomes for patients with chronic conditions.

Dr. Becker and her colleagues sought to understand the association between chronic disease diagnoses and adverse financial outcomes among commercially insured adults. Prior work in this area was limited, as researchers lacked data containing both clinical diagnoses and financial outcomes for the same individuals across a variety of chronic conditions. This time, however, MVC helped link patient data from its Blue Cross Blue Shield of Michigan (BCBSM) Preferred Provider Organization (PPO) claims to Experian credit data for the same patients’ financial histories. This data set was prepared for Dr. Becker and her colleagues, who performed the subsequent analysis and composed the resulting publication.

The 13 chronic conditions included in the analysis were selected for their prevalence, clinical importance, and association with financial challenges. These included cancer, congestive heart failure, chronic kidney disease, Alzheimer’s disease and other dementias, depression and anxiety, diabetes, hypertension, ischemic heart disease, liver disease, chronic obstructive pulmonary disease and asthma, serious mental illness, stroke, and substance use disorders.

The results of the analysis demonstrated a strong association between a patient’s chronic disease burden and adverse financial outcomes. For instance, among individuals with no chronic conditions versus those with 7 to 13 chronic conditions, the estimated probabilities of having medical debt in collections (7.7% vs 32%), nonmedical debt in collections (7.2% vs 24%), a low credit score (17% vs 47%) or recent bankruptcy (0.4% vs 1.7%) were all considerably higher for patients managing more chronic conditions (see Figure 1), with notable increases in rates of adverse financial outcomes between patients with no chronic conditions and those with 2 to 3 conditions or 4 to 6 conditions. Furthermore, among individuals with non-zero amounts of debt, the amount of debt increased as the number of diagnosed chronic conditions increased (see Figure 2). For instance, the adjusted dollar amount of medical debt increased by 60% from $784 for individuals with no chronic conditions to $1252 for individuals with 7 to 13 chronic conditions.

Figure 1. Predicted Probability of Credit Outcomes by Number of Chronic Conditions

Figure 2. Average Debt Among Individuals with Nonzero Debt by the Number of Chronic Conditions

In addition to finding an almost dose-dependent association between adverse financial outcomes and the presence of multiple chronic diseases, the analysis examined which conditions had the highest dollar amount of debt for the 10% of patients with medical debt in collections (see Figure 3). Congestive heart failure, stroke, substance use disorders, and serious mental illness racked up the most debt. Additionally, the probability of having medical debt in collections was substantially higher for patients managing serious mental illness or substance use disorders (see Figure 4).

Figure 3. Estimated Increase in Dollar Amount of Medical Debt in Collections by Type of Chronic Condition Among Individuals with Nonzero Medical Debt in Collections

Figure 4. Estimated Increase in the Probability of Having Medical Debt in Collections by Type of Chronic Condition

“We were expecting an association between adverse financial outcomes and chronic disease burden, but we were really struck by the magnitude and strength of the association that we found,” said Dr. Becker. “To see such a large increase in rates of adverse financial outcomes by chronic conditions really emphasizes that there is a crisis of financial instability among individuals with high chronic disease burden.”

Such significant variation across chronic conditions could be the result of several factors, such as some conditions requiring more costly treatments and high out-of-pocket expenses, and others making it more likely that patients miss work or cannot stay employed. The implications of such findings are impressive given the already high rate of patients with multiple chronic conditions—4 in 10 adults in the U.S. have more than one chronic condition—and the fact that poorer financial health is linked to more forgone medical care, worse physical and mental health, and greater mortality. Chronic conditions are already the leading causes of death and disability as well as the leading drivers of America’s $4.1 trillion in annual healthcare costs.

Dr. Becker and her colleagues were clear that their analysis did not determine causality—it is still unknown whether poor financial health leads to the development of chronic conditions or vice versa. Therefore, they advocated for the value of further analyses to determine underlying causes, which would inform how to approach improvements. The authors offered that if poor financial health causes additional chronic disease, then new social safety-net policies intended to reduce poverty rates may be beneficial. If chronic diseases are leading to poorer financial outcomes, then changes to the design of commercial insurance benefits could provide additional protections from medical expenses for costly chronic conditions.

“Additional work to determine the causal mechanisms of this association is crucial,” said Dr. Becker. “If we don’t figure out why this association exists, and who is most vulnerable, we can’t hope to design social policies to help protect patients from adverse financial outcomes.”

One of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. In the future, MVC hopes to do more with commercial credit report data given its unique uses and implications. It is the Coordinating Center’s hope that this work will help identify at-risk populations, understand how economic instability affects health outcomes, and generate insights that help working-age adults recover and return to work after major health events. The MVC team will continue exploring uses for this data in 2023 and engage its partner CQIs and collaborators to identify additional reporting opportunities for members.

As was recently highlighted in MVC’s 2022 Annual Report, MVC contributed to several other projects in the last 12 months similar to the analysis completed by Dr. Becker and her colleagues. MVC data and expertise also contributed to projects that resulted in new condition and report development, return on investment estimations for various healthcare initiatives, and additional insights on care delivery and patient outcomes. MVC will continue to identify partnerships and projects that leverage its rich data to achieve more sustainable, high-value healthcare in Michigan.

Publication Authors

Nora V. Becker, MD, PhD; John W. Scott, MD, MPH; Michelle H. Moniz, MD, MSc; Erin F. Carlton, MD, MSc; John Z. Ayanian, MD, MPP

Full Citation

Becker NV, Scott JW, Moniz MH, Carlton EF, Ayanian JZ. Association of Chronic Disease With Patient Financial Outcomes Among Commercially Insured Adults. JAMA Intern Med. 2022; 182(10): 1044–1051. doi:10.1001/jamainternmed.2022.3687.

09 Mar 2023
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Follow-Up After CHF, Cardiac Rehab Top New Value Metric Selections for P4P PYs 24-25

Follow-Up After CHF, Cardiac Rehab Top New Value Metric Selections for P4P PYs 24-25

March 9, 2023 | 0 Comments | , ,

In the final months of 2022, the MVC team distributed metric selection reports for Program Years 2024 and 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These reports were provided in conjunction with details pertaining to the selection process as well as changes to the program structure, scoring methodology, and cohort assignments for the upcoming two-year cycle.

Eligible hospital members were tasked with reviewing these reports and returning their selections in recent months. MVC has now received metric selections for PYs 2024 and 2025. This program cycle will award a maximum score of 10 points, made up of a maximum of four points from an episode spending metric, a maximum of four points from a value metric (a new component), and a maximum of two points from engagement activities completed in the program year (the calendar year following the performance year). Each participating hospital selected one of the six available conditions for the 30-day episode payment component: chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, and pneumonia. The episode spending metric that the most hospitals selected was joint replacement (32), followed by CHF (20). No sites selected colectomy. See Figure 1 for a depiction of the total selections for each condition.

Figure 1.

The distribution in episode spending selections was consistent when stratified by MVC region of Michigan; joint replacement was the top choice within all four MVC regions, and CHF was generally the next most common. However, Region 1 (which constitutes Northern Michigan) had a smaller percentage of sites select CHF, with a slight preference for pneumonia. In addition, hospitals located in Region 4 (southeast Michigan) were more likely to select COPD (Figure 2).

Figure 2.

Brand new in PYs 2024-2025 will be value metrics, which are evidence-based, actionable measures with variability across the state. Hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Seven value metrics were available for hospitals to choose from: cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), seven-day follow-up after CHF, 14-day follow-up after COPD, seven-day follow-up after pneumonia, preoperative testing, and risk-adjusted readmission after sepsis. The preoperative testing value metric is composed of a group of three low-risk procedures: cholecystectomy, hernia repair, and lumpectomy. Each preoperative testing procedure will be scored separately, and points for that value metric will be awarded based on the highest points achieved for a hospital’s eligible procedures.

In its first year offering a value metric, MVC found that seven-day follow-up after CHF was selected by the most participants (25). Metrics related to cardiac rehabilitation participation accounted for 23 selections; 17 sites selected cardiac rehabilitation after PCI and five selected cardiac rehabilitation after CABG (Figure 3).

Figure 3.

There was more variation by MVC region for value metric selections than for episode spending selections (Figure 4). In Region 1 (Northern Michigan), seven-day follow-up after pneumonia was the most common selection. Nearly all the sites located in Region 2 (west Michigan) selected seven-day follow-up after CHF—this metric accounted for 71% of selections in this part of the state. Region 3 (mid-Michigan and the thumb region) had more sites select risk-adjusted readmission after sepsis, but Region 3 had a more even distribution of selections across the available metrics than Regions 1 or 2. Finally, Region 4 (southeast Michigan) had selections for all the available value metrics. Region 4 also had the most interest in 14-day follow-up after COPD.

Figure 4.

Two of MVC’s new value metrics align with existing value campaigns for which MVC is offering additional support. MVC established campaigns for both cardiac rehabilitation and preoperative testing in October 2020. Since then, MVC has developed reports on these two areas of healthcare utilization, which have historically been shared biannually. In addition, beginning in 2023, MVC is offering workgroups tailored to these value metrics. MVC’s first cardiac rehabilitation workgroup of 2023 took place on Feb. 16 during cardiac rehabilitation week featuring guest presentations by Haley Stolp of Million Hearts and Mike Thompson, PhD, MPH, Co-Director of MVC and Co-Director of the Michigan Cardiac Rehabilitation Network. A full recording of this session is available here. MVC’s first preoperative testing workgroup of 2023 will take place next week on Wed., March 15, from 1-2 p.m., featuring MVC Director Hari Nathan, MD, PhD. Those interested in learning about ready-to-use tools and strategies for the de-implementation of low-value testing may register here. Attending hospital sites will be encouraged to share their experience thus far with quality improvement related to preoperative testing, such as resources in use or in development and common barriers to change.

P4P cohorts were reassigned for PYs 2024 and 2025. Those cohort assignments and the new technical document have been published on the MVC website’s P4P page. The cohorts were not intended to group hospitals that are exactly alike; rather, they create a reasonably comparable grouping from which MVC can complete statistical analyses.

MVC’s P4P measure began in 2018 when BCBSM allocated 10% of its P4P program to an episode of care spending metric based on MVC data. If you would like to receive notices about the MVC workgroups or have questions about any aspect of the MVC Component of the BCBSM P4P Program, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

02 Mar 2023
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MVC, MBSC Estimate Significant Diabetes Medication Savings Following Bariatric Surgery

MVC, MBSC Estimate Significant Diabetes Medication Savings Following Bariatric Surgery

March 2, 2023 | 0 Comments | , , ,

Diabetes is commonly cited as the most expensive chronic disease in the U.S., accounting for over $37 billion in 2017. As many as 1 in 10 Americans have been diagnosed, 90-95% of whom have Type 2 diabetes. Management of Type 2 diabetes involves healthy eating, physical activity, and often taking medication prescribed by a doctor, such as insulin, other injectable medications, or oral diabetes medicines to help manage blood sugar. It is both clinically and economically significant, then, that the Michigan Value Collaborative (MVC) was recently part of an analysis that estimated over $76.5 million in insurance savings on prescription diabetes medications after patients underwent metabolic surgery.

MVC identified these savings in partnership with the Michigan Bariatric Surgery Collaborative (MBSC) last year and published their findings in a co-authored research letter in JAMA Surgery. This work was featured recently by the medical news site Medpage Today.

The partner project was initiated by MBSC in 2022 to help assess the impact of bariatric surgery on prescription fills for diabetes medications across the state of Michigan, driven largely by existing evidence in the literature that bariatric surgery resolved or improved Type 2 diabetes symptoms in a large proportion of patients (Varban et al., 2022). MBSC is a regional group of hospitals and surgeons that aim to innovate the science and practice of metabolic and bariatric surgery through comprehensive, lifelong, patient-centered obesity care.

Using its rich administrative claims data sources, the MVC team first analyzed pre-surgery and post-surgery receipt of diabetes medications, which was then used to estimate a high-level snapshot of the overall impact across Michigan. MVC's analysis included estimated cost savings to health insurance providers that could be attributed to a decrease in post-surgery diabetes medication prescription fills.

The analysis used bariatric surgery episodes for Roux-en-Y Gastric Bypass (RYGB) and sleeve gastrectomy hospitalizations. It was limited to bariatric surgery patients with a diagnosis of Type 2 diabetes who filled an outpatient diabetes medication prescription prior to their discharge. The analysis focused on episodes with index admissions between 2015 and 2021 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage plans for individuals who were continuously enrolled in a prescription sub-plan. This amounted to 760 patients with Type 2 diabetes undergoing gastric bypass (22%) or sleeve gastrectomy (78%) between 2015 to 2021.

In the 120 days prior to surgery, MVC found that 88% of patients filled an outpatient oral diabetes medication prescription, 30% filled an insulin prescription, and 21% filled a GLP-1 receptor agonist prescription. From the 120 days pre-surgery to the 120 days post-surgery, there was a significant decrease in fills for any diabetes medication (p<.001). The most frequent change in medications between pre- and post-surgery was from oral diabetes medication to no diabetes medication. In the 1 to 120 days following surgery, half (50%) of patients filled no diabetes medication prescriptions, and in the 121 to 240 days following surgery, most patients (63%) filled no diabetes medication prescriptions (see Figure 1).

Figure 1.

This amounted to an average decrease in diabetes prescription payments made by the insurance provider of approximately $4,133 per patient in the first year following surgery. Given that 34% of bariatric surgery patients have diabetes and 54,454 bariatric surgeries were performed in Michigan between 2015 and 2021, MVC estimated that insurance providers in Michigan saved $76.5 million on diabetes medications in the 360 days following bariatric surgeries in 2015-2021. In addition, data suggest that savings would continue to increase in future years due to long-term diabetes remission and cost benefits from optimized diabetes management. These results provide evidence of significant statewide clinical outcome improvement and cost savings for Type 2 diabetes following bariatric surgery.

These findings and their implications were also highlighted recently during an MVC workgroup featuring Dr. Oliver Varban of MBSC as the guest speaker. See below for a complete recording of his insightful presentation about bariatric surgery, its impact on chronic disease management, and more.

MVC’s expertise and data frequently result in partner projects like this; MVC completed three other CQI impact assessments last year (Figure 2). These projects are an example of MVC’s interest in CQI collaboration, which is also demonstrated through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data.

Figure 2.

To request a copy of any of MVC’s completed impact assessments from 2022 or prior, please contact the MVC Coordinating Center.

23 Feb 2023
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MVC Resources Shared During Latest Cardiac Rehab Week

MVC Resources Shared During Latest Cardiac Rehab Week

February 23, 2023 | 0 Comments

Last week, the Michigan Value Collaborative (MVC) joined others across the country in celebrating Cardiac Rehabilitation Week, a time to promote the value of this life-saving program. Now with the week-long promotional campaign complete and the end of February’s American Heart Month approaching, MVC is proud to share some of its recent activity.

Cardiac rehabilitation has been a priority for MVC since 2020 when the Coordinating Center identified it as a focus area for which it would provide dedicated data and resources. Therefore, in celebrating Cardiac Rehabilitation Week, MVC sought to educate stakeholders about the program’s benefits, current utilization rates at hospitals across the state, and initiatives currently underway to improve patient participation.

One of MVC’s key strategies was the facilitation of a special cardiac rehabilitation workgroup, which featured presentations by MVC Co-Director Mike Thompson, PhD, MPH, Assistant Professor of Cardiac Surgery at Michigan Medicine, and Haley Stolp, MPH, Health Scientist at Million Hearts®, about state-level and nationwide strategies to improve enrollment. The session summarized much of the evidence behind the value and impact of cardiac rehabilitation and helped orient attendees to the current state of patient participation in Michigan. Both speakers highlighted their organization’s goals for participation rates in the future, as well as the resources available to providers interested in implementing initiatives in their setting. A full recording of the workgroup was made available on MVC’s social media channels and was shared with all registrants (Figure 1).

This workgroup provided detailed evidence of the benefits of participating in cardiac rehabilitation while recovering from a number of cardiac events or procedures. However, one of the reasons why this program is so heavily underutilized—currently only about 30% of eligible Michigan patients enroll—is a lack of awareness about what it is and its value. Both patients and providers often don’t have a complete understanding. Therefore, MVC created an introductory video outlining the program’s components and encouraged members to spread the word by sharing the video with their colleagues and patients.

MVC also recently announced a new program structure for future cycles of the MVC Component of the Blue Cross Blue Shield of Michigan Pay-for-Performance (P4P) Program, which included the adoption of a new value metric scoring component for Program Years 2024 and 2025. Value metrics are evidence-based, actionable measures that show variability across the state; hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Over one-quarter of hospitals that returned metric selections to the MVC Coordinating Center will be scored in part on their facility’s achievements and improvements for cardiac rehabilitation utilization. The MVC team hopes its adoption of a P4P metric focused on cardiac rehab will incentivize continued emphasis and growth.  Learn more.

Furthermore, all MVC hospital members will continue to receive MVC’s cardiac rehabilitation push reports as part of its work on behalf of the Michigan Cardiac Rehabilitation Network (MiCR). These reports showcase wide variability in cardiac rehabilitation participation across the collaborative, with some members meeting the recommended levels and some well below. Many members, therefore, have valuable insights that could help a peer to enroll more patients. These report findings were highlighted last week. In the coming months, MVC plans to approach high-performing members to request advice and tools for the benefit of the broader collaborative.

Hospitals interested in improving their participation rates are encouraged to also review the MiCR Best Practices Toolkit for guidance. It was developed in partnership with providers and experts across Michigan as well as the BMC2 Coordinating Center. It highlights specific interventions that support patient enrollment, continued attendance, and flexible program structures. Several pages are centered on physician referrals, which some researchers have found increases the likelihood of participation. MVC promoted this message last week (see Figure 2) to emphasize the importance of a strong physician endorsement during patient interactions. For many patients, this is the only reason they sign up.

Figure 2.

MVC is grateful to the many providers, partners, and other stakeholders who contributed to Cardiac Rehabilitation Week this year. It continues to be a high priority for the MVC team, and the Coordinating Center is excited about the growing emphasis and interest in this area of high-value care. Together, we can save lives by equitably increasing participation in cardiac rehabilitation for all eligible individuals in Michigan. Please contact the MVC team with any questions about attending future cardiac rehabilitation events or receiving related materials.

16 Feb 2023
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HMS CQI Receives Endorsements from National Quality Forum

HMS CQI Receives Endorsements from National Quality Forum

February 16, 2023 | 0 Comments | , ,

Michigan healthcare systems and professionals have the unique opportunity to leverage a portfolio of Collaborative Quality Initiatives (CQIs), all working diligently to support collaboration and data sharing. Together with their partners, these CQIs improve the quality and value of healthcare in Michigan and beyond. One such CQI achieved a momentous distinction in January 2023 when the National Quality Forum (NQF) recognized the Michigan Hospital Medicine Safety Consortium (HMS) with two prestigious endorsements for measures that can reduce unnecessary antibiotic use.

“We are incredibly proud of the work our collaborative has accomplished to date,” said Dr. Scott Flanders, MD, HMS Program Director. “Having two of our quality measures validated by the National Quality Forum reinforces the value of our work in Michigan and across the nation.”

The focus of these measures relates to two common and costly hospital incidents: inappropriate diagnosis of community-acquired pneumonia (CAP) in hospitalized medical patients, and inappropriate diagnosis of urinary tract infection (UTI) in hospitalized medical patients. HMS’s work in this space began in 2017 when the Joint Commission launched required standards for hospital antimicrobial stewardship. The HMS team, led by infectious disease physician Dr. Tejal Gandhi, partnered with experts from the Centers for Disease Control and Prevention (CDC) to develop and validate related quality measures across a diverse set of hospitals. The primary aim of this work was to prevent the use of unnecessary antibiotics, which can lead to adverse events, antibiotic resistance, and delays in diagnosing underlying conditions. Since antimicrobial use is broad within the hospital setting, HMS first narrowed its scope to CAP and UTIs, which accounted for up to 50% of antibiotic use in general hospitalized patients. The HMS team collected hospital data on the appropriate duration of treatment for patients with uncomplicated CAP as well as testing and treatment of asymptomatic patients with a UTI. The CDC already uses HMS collaborative-wide improvement rates to set national targets.

In the early years of the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnership program, several CQIs were actively partnering with hospitals on various aspects and types of surgery. However, this failed to account for the care of hospitalized medical patients, who are at risk for adverse events and account for over 50% of healthcare costs. In response, HMS was established with the aim to help Michigan hospitals improve patient safety and care quality for hospitalized medical patients (i.e., general medicine, emergency medicine, infectious diseases, pharmacy, vascular access, etc.). HMS supports hospitals via rigorous data collection and analysis, as well as collaboration on best practice implementation.

Since its formation, the HMS team has achieved many substantial successes throughout its tenure. Long before its antibiotic stewardship initiative, HMS had significant success working on venous thromboembolism (VTE). The collaborative helped hospitals make significant gains by increasing rates of VTE risk assessment, increasing pharmacologic prophylaxis in at-risk patients, and increasing the use of mechanical prophylaxis in patients with contraindications for pharmaceutical prophylaxis. The HMS VTE initiative has since been retired, though resources are still available here.

In 2014, HMS pivoted into other areas of patient safety when members voted to focus on the appropriate use of peripherally inserted central catheters (PICC) and measuring complication rates associated with these devices, led by hospitalist Dr. Vineet Chopra. At the time, the use of these devices was growing and there were few evidence-based best practices to support indications for use and management of complications. Together with national experts and collaborative members, HMS developed guidelines for the use of devices in different scenarios, a resource known as the Michigan Appropriate Guide to Intravenous Catheters (MAGIC) that was published in the Annals of Internal Medicine. This toolkit is used across the world to determine appropriate catheter device use and is offered in conjunction with other PICC quality improvement resources on the HMS website here.

In conjunction with its PICC initiative, HMS later adopted a focus on the appropriate use and complication rates for midlines. While doing quality work related to PICCs, a number of HMS member hospitals noticed significant use of midlines at their hospitals. HMS leveraged its unique ability to collect data on midline use across its membership to understand complication rates, which resulted in the development of the HMS Midline Toolkit available here.

More recently in 2021, HMS launched a new sepsis initiative at 12 volunteer pilot sites, collecting data to assess the care of patients diagnosed with sepsis, led by intensivist Dr. Hallie Prescott. The initiative was introduced to the remaining HMS-member hospitals in January 2023. The sepsis initiative focuses on the care of sepsis patients during the entire continuum of care, including on admission/early diagnosis, inpatient hospitalization, discharge, and 90 days post-hospitalization.

The Michigan Value Collaborative (MVC) and HMS teams have partnered several times over the years, especially on recent sepsis-related initiatives. Developed in partnership with HMS, MVC developed and shared a sepsis report with MVC and HMS member hospitals in 2021 and 2022, providing insights on measures such as 90-day price-standardized total episode payments, inpatient length of stay, ICU/CCU utilization, 90-day post-acute care utilization, and 90-day readmission rates. Both CQIs hoped to facilitate cross-collaboration between clinical and quality personnel on the identification of patterns, opportunities, and strategies related to care for sepsis patients. MVC and HMS have also partnered on various matching exercises designed to bring MVC’s robust administrative claims data together with HMS’s clinically rich abstracted data to further inform quality improvement efforts.

Projects focused on such a large, diverse patient population inherently come with complex challenges. One challenge is the need for HMS to engage all areas of the hospital, generating buy-in among those individuals treating hospitalized medical patients. At the outset, HMS primarily engaged with member hospitals and hospitalists. However, over the last several years the collaborative has increasingly engaged muti-disciplinary stakeholders, such as infectious disease physicians, critical care physicians, emergency medicine, infection preventionists, pharmacists, vascular access experts, interventional radiologists, nursing, and hospital leadership.

As evidenced by its recent endorsement and focus areas to date, the work of the HMS team impacts the majority of patients treated at Michigan hospitals and beyond. With a focus on improving care for hospitalized patients, there are also many other possible focus areas for quality improvement on the horizon. For more information on HMS, visit their website.

As MVC continues to build its offerings for members, the MVC Coordinating Center is cognizant that hospitals and providers partner with multiple CQIs. Throughout 2023, MVC will post quarterly 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.

09 Feb 2023
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MVC to Honor Medical Pioneers for February’s Black History Month

MVC to Honor Medical Pioneers for February’s Black History Month

February 9, 2023 | 0 Comments | ,

Black History Month is an opportunity to celebrate the triumphs and reflect on the struggles of African American or Black persons throughout the history of the United States. In honor of this celebration, the MVC team is highlighting some of the Black pioneers who opened doors to medical fields and advanced the field of health through research.

It seems logical to begin by highlighting the work of James McCune Smith (Figure 1), notably America’s first Black physician. He received a medical degree from the University of Glasgow in 1837, when African Americans were denied admission to medical schools in the U.S. He also later became the first Black man to operate a pharmacy as well as the first Black author to be published in a medical journal. He applied his scientific mind and expertise to debunking poor science, outdated assumptions, and racist theories related to African Americans. As an abolitionist and close friend of Frederick Douglass, he wrote the introduction to Douglass' book, My Bondage and My Freedom.

Figure 1.

He was followed by many inspiring African American and Black healthcare providers who made history in their respective fields. There were leaders such as Daniel Hale Williams (1856-1931), who founded the Provident Hospital and Training School for Nurses in Chicago, America’s first Black-owned and interracial hospital. He is also known for having performed the world’s first successful heart operation, which saved the life of a man who had been stabbed in the chest.

Then there was Robert F. Boyd (1858-1912) who in 1895 co-founded the National Medical Association, the nation’s oldest and largest organization representing Black physicians and health care professionals. He served as its first president.

Alexa Canady (Figure 2), born in 1950, is also a Black physician of great strength and impact. She fought her way into one of the most competitive and exclusive fields of medicine when she became the first Black female neurosurgeon in the U.S. in 1981. She is an alumnus of the University of Michigan Medical School who specialized in pediatric surgery. She became chief of neurosurgery at the Children’s Hospital of Michigan from 1987 until her retirement in June 2001.

Figure 2.

As representation and institutional support grew, so too did the voice of African Americans in published medical research. Prominent physician and researcher Charles Richard Drew (1904-1950) studied blood transfusions and helped develop large-scale blood banks deployed during World War II. Patricia Bath (1942-2019), an ophthalmologist dedicated to blindness prevention in marginalized communities, was the first Black female physician to be awarded a medical patent for her invention of a laser cataract treatment.

A wealth of researchers working today dedicate their expertise to studying disparities, race, and ethnicity in healthcare. The Agency for Healthcare Research and Quality (AHRQ) honored Black History Month recently by highlighting the work of its grantees. Dr. Fabian Johnston, for instance, studies early utilization of palliative care for African Americans using culturally informed patient navigation, and Dr. Mya Lee Roberson evaluates geographic variation in breast cancer surgical outcomes among Black women in the South. AHRQ’s spotlight for Black History Month also includes an expansive list of recent research findings and publications related to race and health equity.

These professionals and countless others had a profound impact on medicine, research, and society. However, Black History Month is also a time to acknowledge the struggles and ongoing challenges experienced by the African American and Black communities. While much of the 20th and 21st centuries allowed for a series of “firsts,” they also bore witness to abhorrent racism that resulted in gruesome experiments, forced sterilizations, harmful research studies, and undertreatment for pain. As a result, there is rampant mistrust of the healthcare system within the Black community, even among some medical professionals. This was evident throughout the COVID-19 pandemic; hospitalized patients who did not trust healthcare providers were less likely to believe they were at increased risk of severe illness and were less likely to become vaccinated.

The MVC Coordinating Center is committed to emphasizing equitable care in Michigan by providing members with equity metrics and collaboration opportunities. The MVC team set several concrete goals to share research findings and resources throughout 2023 in service of members’ equity-related initiatives. Some of these resources may be used to build communication and trust with patients and solicit their input on healthcare practices.

In addition, those who follow MVC on Twitter or LinkedIn will see additional stories about African American medical pioneers throughout the remainder of February. If you have a colleague or individual you would like to nominate to be featured this month, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

02 Feb 2023
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MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

February 2, 2023 | 0 Comments | , , , ,

The birth of a child is a life-changing experience and a significant clinical event, with those experiencing pregnancy and childbirth hoping for a positive experience and healthy outcome. Yet the maternal mortality rate in the United States was 23.8 per 100,000 live births in 2020, and four in five pregnancy-related deaths were preventable according to the CDC. One in four of these deaths occur on the day of delivery or within one week, with considerable evidence that negative outcomes are more likely for patients of color. These findings are evidence of the need for quality improvement initiatives that ensure all people who are pregnant or postpartum receive the care they need. In light of this, the Michigan Value Collaborative (MVC) recently collaborated with the Michigan Health and Hospital Association (MHA) Keystone Center on the development of a statewide report on birth outcomes.

MVC claims data comprise approximately 84% of Michigan's insured population; these data are processed into 30- and 90-day price-standardized and risk-adjusted episodes of care that allow MVC to identify practice variation and measure the value of care. MVC creates episodes for over 40 medical and surgical conditions, including vaginal and cesarean childbirth delivery. MVC used a subset of claims from its data on Michigan childbirth episodes to create this new statewide report. The goal was to highlight statewide disparities in care and support the MHA Keystone Center and the Michigan Alliance for Innovation on Maternal Health (MI AIM) in their efforts to increase equitable care and decrease preventable severe maternal morbidity and mortality in Michigan.

MVC’s new statewide childbirth episodes report provides information on total episode payments, mode of delivery, patient characteristics, and rates of certain birth-related complications using 90-day episodes of care for vaginal and cesarean delivery. Measures in this report are based exclusively on Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial episodes for childbirth index admissions that occurred at MVC-participating hospitals between 1/1/19 and 12/31/21. Hospitals in this report were unidentified and each was required to have a minimum of 20 childbirth episodes across the reporting period to be included. Similarly to other MVC reports, several metrics were displayed by the index hospital’s geographic region of Michigan as categorized by MVC (see MVC regions here), with others stratified by race or mode of delivery.

The analysis found an average price-standardized, risk-adjusted 90-day total episode payment of $7,765 for vaginal delivery and $10,264 for cesarean delivery (Figure 1), with average index lengths of stay of 3.1 and 4.0 days, respectively. Additionally, the overall rate of cesarean delivery was 32.3% in July-Dec. of 2021, a slight increase compared to cesarean rates in 2019 and 2020 (Figure 2).

Figure 1. Average Price-Standardized and Risk-Adjusted 90-Day Total Episode Payments by Mode of Delivery, Overall and by Hospital

Figure 2. Rates of Cesarean Delivery, 2019 Through 2021, Overall and by Region of Michigan

Overall, 7.5% of patients had a diagnosis of hemorrhage, 4.2% had a diagnosis of hypertension, and 1.8% had a diagnosis of severe maternal morbidity (SMM) during their index birth hospitalization. A notable finding was the difference in rates of these complications by race (Figure 3). Patients who were identified as Asian or Pacific Islander had higher rates of hemorrhage than other race categories, and patients who were identified as Black had higher rates of hypertension and SMM than the overall population. This is consistent with other research findings related to disparate health outcomes for non-white patients.

Figure 3. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity (SMM), Overall and by Race

Health disparities such as these are an area of focus within the MVC Coordinating Center’s broader strategic framework. MVC’s health equity sub-committee meets regularly to strategize how to emphasize equity among its membership and support related quality improvement initiatives. The Coordinating Center’s aim is to use MVC data to help members identify areas of opportunity and support quality improvement through collaboration with peers. To this end, MVC is currently developing a hospital-level adaptation of the new statewide birth outcomes report to share site-specific data with its members later this year.

“Claims data such as those included in MVC’s episodes of care present a great opportunity to use state-wide data to highlight important findings and disparities related to birth outcomes in Michigan,” said Kristen Hassett, the lead MVC analyst for the analysis. “This report represents an important step in MVC’s work to identify areas of health inequality and then support initiatives to reduce those disparities.”

For the MHA Keystone Center, the statewide report provides valuable data to further inform its work.

“We are proud to partner with organizations like the Michigan Value Collaborative to collect and examine critical data related to childbirth within Michigan health systems,” said Sarah Scranton, vice president of safety and quality at MHA and executive director of MHA Keystone Center. “By evaluating hemorrhage, hypertension and severe maternal morbidity rates across several regions of the state, we are able to address the challenges facing Michigan mothers and birthing centers.”

The MVC statewide childbirth episodes report will aid MHA’s field engagement team while they engage with hospitals not yet partnering with MI AIM. Since its adoption in Michigan in 2016, MI AIM has contributed to significant improvement in hemorrhage-related SMM, hypertension-related SMM, and overall SMM through the implementation of hemorrhage, hypertension, and sepsis patient safety bundles with Michigan birthing hospitals.

To view the complete report, visit the MVC website. The Coordinating Center welcomes any additional questions about the report findings or any custom report analyses inspired by its creation. Contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.