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Registration Open Now for Fall Collaborative-Wide Meeting

Registration Open Now for Fall Collaborative-Wide Meeting

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

P4P Updates, Unblinded Data, & Networking

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

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

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

P4P Engagement Points

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

REGISTER NOW

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MVC Shares P4P Engagement Point Updates with Members, Highlights Remaining Activities

MVC Shares P4P Engagement Point Updates with Members, Highlights Remaining Activities

Peer collaboration, networking, and learning have always been foundational priorities for the Michigan Value Collaborative (MVC), with the Coordinating Center’s member engagement activities serving as a key platform in support of those priorities. These MVC engagement activities were further emphasized by their inclusion in the scoring for Program Years (PYs) 2024 and 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program (Figure 1) - a change meant to increase and enhance collaborative learning across the MVC network. At the end of July, MVC published engagement point snapshots via Dropbox to apprise members of their engagement point standing for PY 2024, with each participating P4P hospital receiving a summary of all engagement activities completed by their site between Jan. 1 and June 30.

Figure 1. PYs 24-25 Scoring Structure

To date, the MVC Coordinating Center has offered a wide range of engagement activities by which members may earn up to two engagement points and learn from the larger collaborative. These engagement activities have included: MVC’s spring collaborative-wide meeting and poster session, virtual workgroups and workgroup presentations, health equity and quality improvement surveys, and custom analytic reports, among others. Points earned through participation in these activities are tracked by the Coordinating Center with quarterly updates on point standing.

Following the dissemination of the Q2 reports, MVC identified sites at risk of finishing the year with low engagement points and will soon reach out to site coordinators to detail their available options for PY 2024 scoring. Sites that wish to take advantage of the remaining MVC engagement activities for 2024 can reference MVC’s complete list available on MVC’s P4P page. Several of these options include deadlines to request or complete a given activity by Sept. 30 to ensure its completion before the end of the year. Namely, members may submit a request no later than Sept. 30 for:

Members have until Sept. 30 to submit in Qualtrics their completed quality improvement survey (0.25).

In addition to these opportunities, MVC is hosting a virtual networking event next Tues., Aug. 13, from 12-1 p.m. This networking event titled Collaborate, Innovate, Integrate: Evaluating MVC’s PY 24-25 P4P Offerings will be an opportunity to reflect with peers on the most recent changes to point allocations for the MVC Component of the BCBSM P4P Program – including the introduction of value metrics and engagement activities. Sites who participate in this session and complete a post-networking event survey are eligible to receive 0.25 engagement points. Additional in-person networking events are currently being planned and more details with dates will be available in the coming weeks.

MVC’s in-person fall collaborative-wide meeting is scheduled for Fri., Oct. 25, at 10 a.m. at the Vistatech Center in Livonia. Members may now register through Oct.15. Hospitals can earn 0.25 engagement points for attendance by a site representative for the entire meeting. For sites that also attended MVC’s spring 2024 collaborative-wide meeting in May, a hospital can earn a total of 0.75 engagement points for attendance at both meetings, which is tracked by check-in and completion of MVC’s post-meeting survey. As part of the fall collaborative-wide meeting, MVC will again offer a poster session for members to showcase the quality improvement work happening at their hospitals and physician organizations. If you are interested in submitting a poster, please complete the poster proposal form (link) by Fri., Sept. 13. Hospitals who participate in this poster session are eligible to receive 0.5 engagement points.

MVC is currently in the process of developing its engagement point menu for PY 2025 and look forward to disseminating this to members in the coming months.

If you have any questions or would like to schedule an individual consultation to ensure your site is on track to earn the full two engagement points in PY 2024, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

Thank you for your ongoing partnership. We look forward to seeing you at future events!

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Using Human-Centered Design Thinking to Improve Healthcare

Using Human-Centered Design Thinking to Improve Healthcare

At its foundation, healthcare quality improvement is a process of systematically improving care to better meet the needs of patients. Similarly, the concept of human-centered design thinking asks us to put people at the center of processes meant to address problems and improve outcomes. Although people have leveraged the concept of design to develop innovative solutions for centuries, “human-centered design thinking” is a relatively new approach in healthcare settings that is gaining in popularity.

One leader in this space is IDEO, a global design and innovation company; they launched a series of resources and toolkits to implement design thinking into tangible projects and emphasized the mindset behind the theory—the notion that how one thinks about design directly affects the impact of the solution. Through their design kit, IDEO suggests a three-step guide to cultivate a practical and repeatable approach to arriving at innovative solutions: inspiration, ideation, and implementation. IDEO urges professionals to connect with the population they wish to serve to ensure a project’s goals align with the needs of the intended community, and then to generate tangible ideas and solutions to address identified issues. This connection to a specific community puts the individuals they are designing for in the spotlight.

As the use of human-centered design thinking continues to grow, innovators continue to generate different visualizations of the process. Similar to IDEO’s three steps, another popular approach has been the Design Council’s double diamond model. Created to convey the process of design to designers and non-designers alike, this model (Figure 1) highlights a balance between big-picture thinking and detail-oriented refinements while translating ideas into action. This double diamond model was the guiding framework for the development of the Michigan Cardiac Rehabilitation network (MiCR) NewBeat materials – a partnership effort between MVC, BMC2, and HBOM (Figure 2). Strategically understanding the perspectives and needs of patients after undergoing a major cardiovascular event was pivotal to the success of the project.

Figure 1.

Figure 2.

Leading the NewBeat project was Larrea Young, who works as a multimedia and human-centered design project manager at MCT2D and HBOM. In reflecting back on the success of the cardiac rehab NewBeat project, she said, “One of the first questions we ask people when we talk about design is, what does it mean to design? People’s answers often focus on aesthetics; design makes things pretty or more accessible. While aesthetics is an important aspect of design, it is only one small part. We define design as envisioning and building a preferred future. This is the essence of the human-centered design process, an approach that examines challenges through lenses of aesthetics, culture, society, technology, and economics to define what something should be. In this process, we gain a deep understanding of people’s lived experiences, challenge conventional norms, and pilot innovative solutions. In the realm of healthcare, this process helps us build solutions that contribute holistically to the health and well-being of our providers and patients.”

Further evidence of the value of design thinking can be found in the quality improvement projects that placed critical importance on understanding the population they wished to serve. Many of these also have a heightened focus on patient-centered in the context of social drivers of health. Taking this into account, a number of healthcare initiatives are now incorporating a design thinking framework to ensure the circumstances, needs, and desires of patient populations are understood; and the results are promising.

In another recent study published in JAMA Network, Dr. Alex Peahl and colleagues wanted to determine how prenatal care could be redesigned to improve access and quality for Black pregnant people with low income. Utilizing human-centered design thinking, they interviewed 19 patients and 19 healthcare workers at prenatal care clinics in Detroit, Michigan, focusing on the first two phases of IDEO’s process: inspiration and ideation. In conducting this series of personalized interviews, Dr. Peahl and colleagues not only collected data to prove that current care failed to meet patient needs, but they also gathered ideas from the patient population of ways to redesign prenatal care for pregnant people in the community. By placing the individuals affected by the redesign at the center of a project, the team ensured the solutions they developed would lead to improved outcomes and experiences (Figure 3).

Figure 3.

Recently, Dr. Alex Peahl, MD, MSc, Assistant Professor in Obstetrics and Gynecology at the University of Michigan, led the MVC Coordinating Center through a workshop on design thinking. Dr. Peahl outlined its principles, provided personal and professional examples from her work, and facilitated a space for MVC teammates to collaborate and practice design thinking with one another.

As the MVC Coordinating Center looks ahead, design thinking will be incorporated more frequently to improve the quality and impact of MVC offerings. If your team has successfully adopted human-centered design thinking or other patient-centered frameworks that can be shared with peers across the state, please contact MVC.

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MVC Introduces New Multi-Payer Cardiac Rehab Registry Reports

MVC Introduces New Multi-Payer Cardiac Rehab Registry Reports

The MVC Coordinating Center added four new multi-payer reports to its online registry in April. These new reports evaluate cardiac rehabilitation utilization and encompass all metrics previously provided annually in MVC’s hospital-level cardiac rehab push report for acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), heart valve repair or replacement (SAVR or TAVR), coronary artery bypass graft (CABG), and congestive heart failure (CHF). Each report reflects the most up-to-date available claims data from Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service, and Medicaid insurance plans. Users may select any combination of cardiac conditions and insurance plans to assess in each report.

In addition to allowing dynamic selection of cardiac conditions and payers, the reports allow for customization of report date range (the span of episode start dates), episode length (the time period following each index event), and index place of service (e.g., inpatient, outpatient, emergency department). Users may also filter by patient characteristics including gender, age, and comorbidities (diagnoses prior to the index event). Other patient-level characteristics related to the reflected episode can also be filtered, including whether the patient was transferred during their index event, was diagnosed with COVID-19 during the index event or within 30 days post-discharge, and by certain diagnoses during the index event or within 90 days. Up to four comparison groups are offered for each figure: the collaborative-wide measure, MVC All; the measure among other hospitals in the region, Hospital Region; the measure among only hospitals of the same type, Acute Care/Critical Access Cohort; and the measure among other rural hospitals (if applicable), MHA Rural Hospital Cohort.

Cardiac Rehab Utilization Rates

The first of the four new report provides data on cardiac rehab utilization rates (Figure 1). This report includes a description of cardiac rehab benefits followed by two figures reflecting utilization rates among episodes of the desired condition and payer combinations after all selected filters have been applied. The first figure shows the overall rate of cardiac rehab compared to utilization goals set by the Michigan Cardiac Rehab network (MiCR) and Million Hearts®. The second figure shows utilization trends over time at the user’s hospital(s) and a selected comparison group. This full report and all other reports can be downloaded as a ready-to-print PDF or image file.

Figure 1. Cardiac Rehab Utilization Rates Report

Cardiac Rehab Utilization Rankings

The next report provides data on cardiac rehab utilization rankings, showcasing the ranked order of hospital-level utilization rates for a selected comparison group. For example, in Figure 2 there are data points for cardiac rehab utilization rates during AMI, CABG, PCI, SAVR, and TAVR episodes originating at MVC Hospitals A, B, and C between December 1, 2018, and November 30, 2023 compared to all other MVC general acute care hospitals. The average rate across all comparison hospitals is about 31%, and each point outlined in orange represents the rate at an individual comparison hospital. Again, this report and all others may be downloaded in a ready-to-share format.

Figure 2. Cardiac Rehab Utilization Rankings Report

The remaining new cardiac rehab registry reports provide visual hospital rankings in the same format as the utilization rankings report, but for two other measures: 1) mean days to first cardiac rehab visit, which ranks the average number of days from index discharge to patients’ first cardiac rehab visit (up to 365 days); and 2), mean number of cardiac rehab visits, which ranks the average number of cardiac rehab visits completed within a selected episode length. These reports offer the same dynamic filters and output capabilities.

All MVC registry users will have access to these reports to view the data for their site(s). If you do not have registry access and are interested in using the registry to view these data, you should complete MVC’s user access request form. If you have any questions or feedback about the new registry reports, please contact the Coordinating Center.

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MVC 2024 Spring Collaborative-Wide Meeting Summary: Promoting Care Coordination Across the Continuum

MVC 2024 Spring Collaborative-Wide Meeting Summary: Promoting Care Coordination Across the Continuum

The Michigan Value Collaborative (MVC) held its spring 2024 collaborative-wide meeting on Friday, May 10, in Midland. A total of 114 attendees representing 69 hospitals, 10 physician organizations, 4 Collaborative Quality Initiatives (CQIs), and 10 healthcare systems from across the state of Michigan came together to discuss new strategies for coordinating care across the continuum. The theme of this meeting was chosen in response to questions echoed by many attendees at the fall 2023 meeting about how to improve care coordination for our patients and families. Looking to the success stories of members and other stakeholders across the state, the MVC Coordinating Center recognized care coordination as a key strategy to high-value healthcare delivery.

MVC Director Hari Nathan, MD, PhD, kicked off Friday’s meeting with an update from the MVC Coordinating Center (see slides). He welcomed MVC’s newest team members - Site Engagement Coordinator Emily Bair and Senior Advisor Nora Becker – and expressed recognition and gratitude for Mike Thompson’s contributions as MVC’s Co-Director as he transitions to the role of senior advisor. Additionally, Dr. Nathan highlighted the successes delivered by the Coordinating Center since October’s collaborative-wide meeting, including co-hosting the Michigan Cardiac Rehab network (MiCR) meeting and launching a preoperative testing trial. MVC’s new multi-payer cardiac rehab registry reports were also introduced. Dr. Nathan then provided an overview of MVC’s refreshed strategic framework, which will serve to guide the Coordinating Center’s strategic direction over the coming years. Key components of MVC’s refreshed framework (Figure 1) include augmenting existing data to enhance and enrich MVC data sources, methods, and outputs; extending membership reach to broaden MVC’s membership base and refresh engagement approaches; and emphasizing equity to increase focus on health equity and social risk to improve the health of all groups.

Figure 1.

Following the MVC’s updates, Dr. Nathan introduced Kim Fox, MPH, Senior Data Analyst with MVC, who led a presentation on exploring organizational and system-level insights through MVC custom analytics (see slides). In collaboration with McLaren Macomb, the session highlighted MVC’s custom analytic process, the value and impact of customized reports (Figure 2), and findings from a recent report prepared for McLaren Macomb.

Figure 2.

Ms. Fox detailed how this recent custom report investigated total episode payments, post-discharge care utilization, and specialist participation for patients admitted for a congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD) event. After a detailed walk-through of the report components, focusing on patients with CHF, Ms. Fox introduced Beth Wendt, DO, Vice President of Clinical Operations and Medical Director of Quality and Accreditation at McLaren Macomb, who shared how McLaren Macomb has leveraged it’s custom MVC report to inform quality improvement efforts for their patients (Figure 3).

Figure 3.

After Dr. Wendt’s presentation, Ms. Fox shared unblinded data from MVC hospitals for timing of first home health visit by patients following a CHF-related admission. If you are interested in a custom analytic report, please reach out to the MVC Coordinating Center to schedule a kick-off meeting.

Following the MVC data presentation, an MVC member presentation was delivered by Steven Frazier, BA, RN, ACM, RN, Director of Quality and Patient Safety, Post-Acute Care with MyMichigan Health, and Allison Klimaszewski, RN, BSN, Nursing Supervisor at the Continuing Care Clinic Midland with MyMichigan Medical Group. They detailed how MyMichigan Health has implemented a continuing care clinic model (Figure 4) to support patients struggling to access primary care services in receiving post-discharge follow-up care after a hospitalization (see slides). Mr. Frazier and Ms. Klimaszewski shared that, while data is limited, the Continuing Care Clinic is making a difference for their patients. Patients receiving transition support care through the Continuing Care Clinic are showing lower all-cause readmission rates, pneumonia mortality rates are decreasing, and feedback is positive.

Figure 4.

Following MyMichigan Health’s presentation, attendees were invited to participate in a poster session, featuring quality improvement initiatives from MVC hospital and physician organization members. The MVC Coordinating Center would like to thank all poster presenters for sharing their work. Electronic copies of the posters are available here: Posters 1-6, Posters 7-13.

After a networking lunch, attendees reconvened for roundtable discussions. During the session, attendees visited five tables of their choosing, where they learned about the work of the roundtable speaker, asked questions, and discussed the table topic with their peers. The MVC Coordinating Center would like to thank its roundtable presenters (Figure 5) for sharing their work and expertise.

Figure 5.

Following the roundtable discussions, Jana Stewart, MS, MPH, Project Manager with MVC, presented results from MVC’s recent health equity member survey (see slides). After discussing the survey’s goals, use cases, and overarching questions, Ms. Stewart provided a high-level snapshot of the results, including the most common initiatives to reduce patient access challenges, common demographics of focus, the top barriers preventing hospitals from developing and implementing health equity initiatives, and the most common data sources hospitals are using to identify or measure patient health disparities. Ms. Stewart also shared MVC’s equity strategy (Figure 6), detailing how MVC will support members in the health equity space.

Figure 6.

To close out the meeting, MVC Co-Director Mike Thompson, PhD, MPH, provided a review of Program Year (PY) 2023 of the MVC Component of the BCBSM P4P Program (see slides). After reviewing the program components, Dr. Thompson provided a summary of PY23 performance across the collaborative. It was also noted that PY 2024 mid-year scorecards will be distributed in the summer and current scores can be access by members on the MVC registry. If you or members of your team would like access to MVC’s registry, please contact the MVC Coordinating Center.

If you have questions about any of the topics discussed at MVC’s spring collaborative-wide meeting or are interested in following up for more details, contact the MVC Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Friday, October 25, 2024, in Livonia.

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MVC Welcomes Emily Bair, MS, MPH, RDN as Site Engagement Coordinator

MVC Welcomes Emily Bair, MS, MPH, RDN as Site Engagement Coordinator

I’m excited to be joining the Michigan Value Collaborative (MVC) as a Site Engagement Coordinator. As a new member of MVC, I am looking forward to learning and working alongside this talented team of forward-thinking coordinators, administrators and analysts in their efforts to improve the health of Michigan through accessible, high-value healthcare.

Throughout my training I have always been fascinated by the intersection of physical and social sciences. Specifically, how healthcare and medical practices are influenced by social constructs such as race, education and economic stability. I was first introduced to this during my undergraduate education when I pursued a Bachelor of Arts in Anthropology & Biology at Kalamazoo College. I then continued in this vein of study earning a Master of Science in Biomedical Anthropology at SUNY Binghamton University and then a Master of Public Health (MPH) in Nutrition Sciences at the University of Michigan School of Public Health.

Following this portion of my educational journey, I decided to additionally train to become a registered dietitian and was honored in being selected for a Michigan Leadership Education in Neurodevelopmental and Related Disabilities (MI-LEND) fellowship. Through these experiences I developed a greater understanding of the barriers to accessing healthcare for specific populations, namely women, children and the disabled, as well as a passion for educating both patients and providers in these issues.

For the last 5 years I have practiced as a clinical registered dietitian specializing in pediatric gastrointestinal disorders, surgical recovery, and developmental disabilities. I’ve also engaged with projects spanning simulated medical education, hospital volunteer program development, and clinical research writing. This collection of experiences has provided me with a unique lens through which to observe and drive future healthcare efforts.

As Site Engagement Coordinator, I look forward to working with MVC and its members to continue to identify equitable health practices and opportunities for improved health outcomes. If you have any questions or wish to get in touch, please feel free to email me at baire@med.umich.edu.

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Health Equity in Action: Using Data to Drive Systematic Change

Health Equity in Action: Using Data to Drive Systematic Change

In the United States, disproportionate rates of chronic disease and illness are commonly documented among communities of color. National Minority Health Month (NMHM) takes place throughout April as a way to raise awareness about health disparities among minority groups and how racism and barriers to healthcare access have historically marginalized such groups. According to the CDC, health equity is “the state in which every individual has a fair and just opportunity to attain their highest level of health.” To achieve such a state, extensive efforts are necessary to address systematic injustices and support equitable access to healthcare.

At MVC, emphasizing this vast issue and supporting change begins with one critical step: identifying and quantifying current disparities within patient communities in Michigan. MVC is utilizing claims-based data analytics to identify differences in care for specific patient demographic groups. For instance, in a recent analysis of MVC claims, MVC found differences by race in the rates of patients attending cardiac rehabilitation after a coronary artery bypass graft (CABG), with lower average utilization rates among some minority groups compared to patients who are white and higher average utilization rates among other minority groups (Figure 1). There are also significant disparities in cardiac rehabilitation utilization rates after CABG by gender and payer categories. Highlighting the landscape of current healthcare utilization may help quality improvement teams understand where disparities exist within their patient populations and prompt discussions about the social and environmental circumstances that may contribute to such findings.

Figure 1.

MVC also recently collected surveys from its members on their health equity priorities, challenges, and initiatives to date. The survey results will be summarized at MVC’s upcoming spring collaborative-wide meeting, and some of the survey responses will be further expanded upon and shared with members as blogs and case studies to provide real-world examples of the work happening in hospitals across the state. Since health equity is a strategic priority for many healthcare teams, MVC’s recent survey was developed to help members understand what others are doing and facilitate shared learning on this topic.

However, there is also much to learn from national examples and strategies. In December 2022, for example, Blue Cross Blue Shield of Massachusetts announced the creation of payment contracts that provide financial rewards to practices addressing racial and ethnic inequities in healthcare delivery. Dr. Mark Friedberg, Senior Vice President, Performance Measurement and Improvement at Blue Cross explained, “This encourages health care systems to increase their investments in developing, expanding and sustaining programs that produce measurable improvements in equity.” This financial investment is a huge breakthrough for Blue Cross which will allow healthcare providers and organizations to learn what barriers to care exist and methods of resolution.

Financial incentives focused on equity are also a large component of State Medicaid strategies. In California, Medicaid plans could earn incentive funds by demonstrating improvement in the two race/ethnicity groups with the lowest baseline vaccination rates. In Michigan, there are financial incentives for using withheld funds for improvement on a subset of quality measures within the African American and Hispanic population groups. As more states and systems begin to invest in financial incentives with equity goals, MVC is working to re-evaluate the methodologies and metrics of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program for opportunities to similarly incentivize and reward achievement and/or improvement in equitable care delivery.

As health equity activity continues to grow and evolve, MVC is committed to expanding its data sources and reporting to support members' understanding of the needs of their patients. Studies emphasize that disparate health outcomes are closely related to social determinants/influencers of health (SDOH/SIOH), with social factors often predicting the incidence of illness and disease. It is for this reason that MVC has continued to incorporate Distressed Communities Index (DCI) data into patient demographic tables in MVC push reports, in addition to stratifying select outcome measures by relevant demographic categories. MVC continues to explore opportunities to integrate additional supplemental SDOH data sets into its analyses – a recent example was shared at MVC’s October collaborative-wide meeting presentation (see slides), which focused on the relationship between county-level social need indicators and post-discharge care utilization.

Organizational strategies and investments are rapidly growing and evolving within healthcare, and will likely be necessary for years to achieve meaningful improvements. MVC is eager to support member activity in this space to achieve high-value care for all and will continue to highlight the excellent work and success stories happening across its membership. If you have a success story to share or would like to request a custom analysis focused on a specific patient population, please contact the MVC Coordinating Center.

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MVC Coordinating Center Releases 2023 Annual Report

MVC Coordinating Center Releases 2023 Annual Report

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

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MVC Component of the BCBSM P4P Program: PY23 in Review

MVC Component of the BCBSM P4P Program: PY23 in Review

This month the Michigan Value Collaborative (MVC) Coordinating Center distributed the final scorecards for Program Year (PY) 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The 2023 program year was the second year of a two-year cycle for which hospitals were evaluated using MVC data. Hospitals were scored on two conditions that they selected from seven options: chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure one shows the frequency of hospital condition selections for the two-year program cycle. Joint replacement was the most commonly selected condition, and colectomy was selected the least.

Figure 1. Distribution of Hospital Condition Selections for PY 2023

The MVC Component of the BCBSM P4P Program evaluates each participating hospital’s risk-adjusted, price-standardized, average 30-day episode payments for their two selected conditions through two methods. Hospitals can earn points by reducing their payments from the baseline period (which included index admissions in 2020) to the performance period (which included index admissions in 2022). These are termed “improvement points.” Alternatively, hospitals can earn points by being less expensive than the other hospitals in their cohort. These are referred to as “achievement points.” The MVC cohorts are groups of hospitals determined to be peers using bed size and case mix index.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each condition. Hospitals were also eligible to receive a bonus point for each condition by completing a questionnaire designed to inform MVC of member hospital quality improvement practices. While 12 points were available, a maximum of 10 points were awarded to participating members. Figure 2 shows the distribution of total points earned by hospitals for the 2023 program year.

Figure 2. Distribution of Total P4P Scores for PY 2023

On average hospitals earned 7.4 points total, a decrease of 0.3 points from PY 2022’s average of 7.7 points. The majority (90.7%) of hospitals earned at least one of the two possible bonus points. As shown in Figure 3, the condition with the highest average point total was joint replacement (4.5 points) followed by spine surgery (4.3 points).

Figure 3. Average Points by Condition

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2022 and 2023 and the MVC P4P FAQ PY 2022-2023. If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.  The Coordinating Center will evaluate and release mid-year scorecards for PY 2024 in the summer of 2024.

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Post-Discharge Workgroup Highlights Systems Approach to Caring for Multiple-Visit Patients

Post-Discharge Workgroup Highlights Systems Approach to Caring for Multiple-Visit Patients

This month MVC hosted its first post-discharge follow-up workgroup presentation of the year, which featured a presentation by guest speaker Lisa Powell, MBA, PTA, Clinical Director of Operations of Sparrow Hospital. She shared insights from a recent Sparrow Hospital project launched to reduce readmissions and acute care utilization.

The project came about when E.W. Sparrow Hospital identified that readmissions were a key driver of capacity limitations in the acute care setting and that Sparrow was underperforming compared to peers. After observing high readmission rates for their facility, Sparrow investigated utilization by asking questions about the social determinants of health impacting the patient population and looking into specific identity metrics.

Figure 1.

As part of Sparrow’s investigation, they drilled down on specific patient cases for context, discovering 35 discrete patients in 2021 who accounted for a total of 434 admissions and 2,088 acute care days. This unique subset of patients was defined by the Sparrow team as multiple-visit patients (MVPs)—those with 10 or more combined inpatient and observation admissions over the past 12 months. The data available on MVPs exemplified a disconnect in the delivery, management, and transition of care, and a need for a care plan that could be implemented the next time an MVP patient presented to the emergency department. The resulting plan was designed to transition away from episodic care, close the primary care gap to improve care in the right setting, and remove barriers to accessing specialty care, all within Sparrow's resource and time constraints.

Focusing on one patient at a time, the physicians and care team members were tasked to work offline on their own time to articulate a brief care plan and synopsis of the patient from their respective disciplines. The providers later came together at one-hour multidisciplinary virtual meetings to discuss each patient and achieve consensus on their proposed plan. Once a plan was established and agreed upon, the team distributed the information to hospital staff utilizing layered EMR tools such as FYI flags, specialized note types for MVP care plans, and best practice advisories (BPA).

After receiving initial feedback and analyzing usage data, providers found certain EMR tools more effective than others. FYI flags were the least utilized tool and not effective on their own in changing clinical behavior, as they were often ignored. Implementing a specialized note type for MVP care plans, however, was extremely effective and user-friendly (Figure 2). Through this development, providers no longer needed to search through lengthy patient medical histories to locate their MVP care plan, increasing the likelihood that the care provided would be in line with the agreed upon multidisciplinary plan.

Figure 2.

Four months after Sparrow Hospital launched this EMR systems approach, they reduced acute care days as well as the number of patients who met the multi-visit patient definition of 10 or more admissions over 12 months (see Figures 3 and 4) with sustained improvement for over two years. Providers consistently provide positive feedback and Sparrow has continued to expand the scope and use of the approach.

Figure 3.

Figure 4.

Although over the past two years, readmission rates and the number of MVPs that frequent their hospital have decreased (Figure 5), the impact of this project expands far beyond improving hospital readmission rates and acute care utilization. Sparrow Hospital’s systems approach to MVPs keeps patients out of the hospital and improves their lives. Although no patient-reported outcomes data has been collected on this to date, Sparrow Hospital is confident that this approach is improving the quality of life for many patients.

Figure 5.

As the project continues to evolve, Sparrow Hospital hopes to expand the utilization of multidisciplinary care plans delivered through EMR tools, which are inherently designed for flexibility in use. The target population can be broadened, providers can escalate patients who may benefit from an MVP plan of care, and tools can be utilized for difficult transitions of care.

Sparrow’s systems-level approach to supporting MVPs in a hospital setting has shown great promise in care management and improvement, and the participants in last week’s workgroup were eager to share the success of this project with their sites and colleagues. Sparrow Hospital identified an area of poor performance and collaborated to design an initiative that addressed patient needs within established systems and resources. As we look toward the future of healthcare quality improvement, feasibility in implementation must be a high priority to achieve success.

MVC workgroups consist of a diverse group of representatives from Michigan hospitals and physician organizations that meet virtually to collaborate and share ideas. If you were unable to attend this workgroup, you can access the recording here. To register for upcoming workgroups, visit MVC’s 2024 events calendar. If your team has a successful initiative or project to share with the Collaborative, please reach out to MVC.