0
View Post
September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

Since its founding, a core component of MVC’s strategy has been organizing opportunities to collaborate with and learn from peers, leading to the ongoing facilitation of MVC workgroups. MVC has hosted workgroup presentations twice per month in recent years, and this year’s workgroups are focused on six topic areas: post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. Going forward, MVC will publish a monthly blog to highlight key takeaways and shared resources from the prior month’s presentations. In doing so, all MVC members and partners may utilize and benefit from the content regardless of their live participation.

September Post-Discharge Follow-Up Workgroup

MVC hosted a post-discharge follow-up workgroup on Sept. 10 featuring a presentation by Brian Leideker, RRT, COPD Navigator for Trinity Health Oakland Hospital. Leideker’s presentation summarized Trinity Heath Oakland Hospital’s progress since initiating an A3 COPD readmission committee in June 2021, including the key interventions their team has implemented to date.

One initial intervention was the hiring of a COPD navigator. Leideker described how his unique role as a respiratory therapist involved in case management has allowed him to be “a middleman between respiratory physicians and other entities trying to deliver and support services” for COPD patients.

Following several root cause analyses, the COPD committee identified that nearly 90% of patients readmitted for COPD at Trinity Health Oakland Hospital had an interruption in intended continuation of pharmacotherapy and/or non-pharmacotherapy treatments. This finding encouraged Leideker’s team to work to improve the education of patients, providers, and the greater healthcare community on ambulatory treatment for COPD as well as reviewing the testing and documentation needed to ensure coverage of durable medical equipment (DME) post-discharge.

With the help of an MVC custom analytic report, Leideker was able to trend DME utilization rates for patients hospitalized with COPD since the initiation of these interventions, as seen in Figure 1.

Figure 1. Annual Select* DME Utilization Rates During the Index and 30-Day Post-Discharge Period Among Patients Hospitalized for COPD at Trinity Health Oakland (2020-2023)**

Generally, the utilization rate of post-discharge non-bi-level home ventilators (E0466) was found to increase over time, while bi-level home ventilator (E0470) utilization has decreased. Leideker noted that this was somewhat expected since patients routinely report difficulty with the utilization of bi-level home ventilators (BiPAP) and often move on to non-bi-level home ventilators (CPAP). Additionally, based on Trinity Health Oakland’s internal analyses as of May 2024, their COPD three-day readmission rates have been reduced to <18% for all payers.

Sept. 10 Post-Discharge Follow-Up Workgroup

September Rural Health Workgroup

MVC hosted a rural health workgroup on Sept. 26 featuring a presentation by Brent Mikkola, MBA, PMP, Manager of Community Health at MyMichigan Health. Mikkola’s presentation summarized MyMichigan Health’s approach to developing a strategic plan for health equity and an overview of some specific community programs currently in place. MyMichigan Health’s phased approach to integrating health equity is currently focused on evaluating social determinant of health (SDoH) opportunities in an “assess, analyze, and address” model.

Some unique community partnerships that resulted from this process include:

  • Gratiot County Public Transit voucher program
  • Rx 4 Health – partnership with Michigan State Extension and specific grocery suppliers including SpartanNash, SaveALot, and Meijer
  • Food Pharmacies & Weekend Kits - partnership with the Greater Lansing Food Bank and the Food Bank of Eastern Michigan
  • Bridge to Belonging - virtual series on loneliness and social connection
  • Continuing Care Clinic Pilot with Community Health Workers (CHWs)
  • Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) Suspension Diversion Program

In addition to developing a strategic framework for reporting and developing objectives around health equity, Mikkola described how MyMichigan Health delved into the data collection, analysis, and quality improvement work surrounding health equity. For example, after initially integrating CHWs into community practices and inpatient services, MyMichigan Health further integrated CHWs following the WHO’s CHW Lifecycle Approach, as seen in Figure 2.

Figure 2.

CHWs have become instrumental to MyMichigan’s assessment of SDoH as required by CMS and JCAHO mandates by filling gaps in system workflows and in the expansion of the Continuing Care Clinic Pilot. To date, nearly 500 well visit appointments have been completed by CHWs at MyMichigan. Of those patients, 34% were identified as having SDoH needs and 50% of those needs have now reportedly been met through connections to community support services.

To learn more about the efforts showcased by Trinity Health Oakland and MyMichigan Health, or to view past workgroup presentations, visit MVC’s YouTube channel here.

October’s workgroups will include a health in action presentation on Oct. 8 about the University of Michigan’s Hospital Care at Home program, as well as a sepsis presentation on Oct. 17 by Garden City Hospital. You can view the complete 2024 calendar of events and register for workgroups here. To learn more about MVC workgroups or other presentation opportunities, contact the MVC Coordinating Center by emailing us here.

0
View Post
MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

Chronic disease management was a key driver of healthcare utilization over the last decade and has been cited as the most expensive chronic disease in the U.S. In response, MVC recently partnered with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to develop a statewide report on Type 2 Diabetes (T2D), a chronic illness that impacts over 1 million adults in Michigan. This new report was recently shared by both MVC and MCT2D at the Michigan Obesity Summit and will be distributed to MVC member hospitals later this week.

The report summarized demographics, healthcare utilization, and prescription patterns among those patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. To create this report, MVC first used its claims data to identify beneficiaries aged 18 and older with a qualifying T2D diagnosis in the past year. After identifying annual cohorts of beneficiaries with T2D for each year, 2017-2023, MVC assessed annual utilization of T2D prescription medications, emergency department (ED) visits, inpatient hospitalizations, and provider visits.

MVC assessed filled prescriptions among T2D beneficiaries with corresponding prescription coverage using its pharmacy claims. This was the first time MVC included prescription claims data in a member push report and the first time that prescription claims from all MVC payer sources were utilized in a single MVC analysis. Medicare beneficiaries were excluded from 2022 and 2023 prescription utilization rates because Medicare pharmacy claims were only available through 12/31/2021. Diabetes-related drug classes were identified in pharmacy claims based on National Drug Code (NDC) as well as standardized prescription names and classes.

Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are frequently prescribed to improve glucose control, reduce mortality, slow kidney disease progression, and aid in weight loss. The American Diabetes Association now recommends the use of these medications for patients with cardiovascular disease, kidney disease, and obesity. In keeping with these guidelines, MVC’s analyses indicated a large increase in utilization of GLP-1 receptor agonists (3.1% to 18.6%) and SGLT2 inhibitors (2.3% to 14.2%) between 2017 and 2023 (Figure 1). In the same period, prescriptions decreased from 2017 to 2023 for insulins (20.9% to 16.5%) and sulfonylureas (17% to 10.9%).

Figure 1.

Demographic characteristics including age, sex, race (Figure 2), and insurance provider (payer) were described within the report for all beneficiaries with T2D across all payers 2017-2023 and compared to the characteristics of all beneficiaries reflected in MVC data during those years. Compared to all beneficiaries, those with T2D were older, with an average age of 66 years versus the average of 43 years among all beneficiaries. T2D beneficiaries were also more likely to be male (50% vs 43%), Black (20% vs 15%), and more often covered by non-commercial insurance plans (45% vs 28%).

Figure 2.

From 2017 to 2023, rates of diabetes-related ED visits and hospital admissions remained relatively infrequent among T2D beneficiaries. Around two percent of T2D beneficiaries visited an ED for a reason related to diabetes each year, and one percent were hospitalized in relation to diabetes. ED utilization unrelated to diabetes decreased from 37.4% in 2017 to 33.1% in 2023 among T2D beneficiaries (Figure 3). Hospital admissions unrelated to diabetes decreased from 21.3% to 16.4% (Figure 4).

Figure 3.

Figure 4.

In contrast, T2D beneficiaries saw primary care physicians, nephrologists, and endocrinologists more frequently between 2017 and 2023, with observed increases for all three provider types (Figure 5). Most notably, visit utilization with primary care providers increased from 18.3% to 32.9%. Nephrologist visit utilization increased from 1.2% to 2.2%, and endocrinologist visit utilization increased from 1.9% to 3.6%.

Figure 5.

This new report created in partnership with MCT2D provided a high-level overview of healthcare utilization among T2D beneficiaries within Michigan. Since the analyses utilized data derived from medical insurance claims, one key limitation was the exclusion of uninsured individuals as well as key indicators of T2D outcomes that are not accurately captured in claims data, such as HbA1C levels, blood pressure, continuous glucose monitor utilization, and retinopathy screening. Despite these gaps, the data revealed promising trends in diabetes care, including increased primary care visits, greater use of guideline-directed medications proven to show significant benefit, and reduced emergency department visits. MVC’s analyses also underscored areas for improvement, such as the need to address health equity gaps and continued promotion of guideline-directed medical therapy.

MVC will share copies of the completed report directly with members later this week, and a copy is also available on the MVC website [PDF]. If you are interested in pursuing a custom analysis for any of these measures or a different tailored custom analysis, please reach out to MVC.

0
View Post
MVC Welcomes Rachel Folk, MHA, New Site Engagement Coordinator

MVC Welcomes Rachel Folk, MHA, New Site Engagement Coordinator

I am excited to be joining the MVC team as a site engagement coordinator. I look forward to working with my fellow engagement team members, data analysts, and leadership to build healthcare improvement partnerships throughout Michigan.

I have worked in various healthcare related roles over the past seven years including skilled nursing facilities, senior communities, the Michigan Medicine Cardiovascular Center outpatient clinic and most recently in Michigan Medicine’s care management department as an administrative specialist. As I moved through these various professional experiences I also continued to build on my education; in 2023 I graduated from Central Michigan University with a Master of Health Administration.

In my last role, I had the opportunity to help develop an internal physician advisor program at the hospital. I found that I enjoyed process/workflow development, ascertaining valuable information from collected data, and participating in creative teamwork with a variety of healthcare professionals. I look forward to pursuing these interests with MVC and continuing to develop my skills and knowledge.

While professional development is important to me, I also have other interests that I enjoy in my free time. I find great joy in working in my garden, learning new plants, and integrating native plants into my landscaping to help support local flora and fauna. I also have an art background and enjoy drawing/sketching and painting, and love adventuring to new places with my family.

I look forward to working with MVC members and partners in the coming months. Please reach out if you have any questions.

0
View Post
MVC Publishes its 2024 QECP Annual Report as a Qualified Entity

MVC Publishes its 2024 QECP Annual Report as a Qualified Entity

Recently, the MVC Coordinating Center published its annual Qualified Entity Certification Program (QECP) public report for 2024. This report [PDF] was published in a new QECP section on the MVC website’s Data/Registry page and is an annual requirement for MVC as a qualified entity with the Centers for Medicare & Medicaid Services (CMS). This was MVC’s third public QECP report and continued to provide unidentified aggregated data about Michigan hospital performance on two measures: rates of 30-day rehospitalizations following start of home health care, and rates of outpatient follow-up received after hospitalization for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

All measures in the report were created using data from MVC claims-based episodes of care initialized by inpatient hospitalizations or surgeries between Jan. 1, 2018 and Dec. 31, 2022. Claims were incorporated from all MVC payer sources, including Medicare Fee-for-Service, Blue Cross Blue Shield of Michigan, Blue Care Network, and Michigan Medicaid.

The reported overall rate of 30-day unplanned rehospitalizations after the start of post-acute home health care among episodes beginning at MVC hospitals in Michigan was 11.6% for 2018-2022. Risk-adjusted rates by index hospital ranged from 2.5% to 17.2%. By home health provider, risk-adjusted rates ranged from 0.0% to 23.5% (Figure 1). Patients whose episode of care began with an index event for endocarditis, COPD, CHF, or percutaneous coronary intervention (PCI) were more likely than patients with other index conditions to experience an unplanned rehospitalization in the 30 days after they started home health care. Patients with a joint replacement episode of care were least likely to have an unplanned rehospitalization following the start of home health care.

Figure 1. Risk-Adjusted Rates of 30-Day Unplanned Rehospitalization from Home Health, by Home Health Provider

Results for the outpatient follow-up metrics remained similar to findings from previous annual reports. Across episodes of care for index events in 2018-2022 at the 106 MVC hospitals in Michigan, the unadjusted rate of patients receiving outpatient follow-up within 7 days after hospitalization for CHF was 44% (Figure 2). Following index hospitalizations for COPD, 36% of patients received outpatient follow-up within 7 days (Figure 3). For both conditions, there was wide variation across hospitals in Michigan in their 7-day follow-up rates after hospitalization, with rates ranging between less than 10% to over 60%. Rates of follow-up were fairly steady over time.

Figure 2. 7-Day Follow-Up After CHF Hospitalization by MVC Hospital

Figure 3. 7-Day Follow-Up After COPD Hospitalization by MVC Hospital

For more information and the entire set of findings we invite you to read the full 2024 report, available here.

QE certification status allows MVC to provide hospital members with additional data from Medicare Fee-for-Service (FFS) claims at a level of granularity which would not otherwise be available under standard CMS data use agreements. Reports located under the “QE Medicare” icon on the MVC registry allow hospital registry users to see unsuppressed Medicare data including case counts <11 as well as utilization rates and average payments based on case counts <11. In addition, on any QE Medicare registry report, members can click on specific data points to load a list of all episodes underlying that data point. From that episode list it is possible to view drilldown information on individual episodes to learn more about the claims and price-standardized payments comprising that episode.

Members may contact the MVC Coordinating Center by emailing Michigan-Value-Collaborative@med.umich.edu to learn more about data available through MVC’s QECP reports and to receive the forms necessary to gain access on the registry.

0
View Post
MVC, BMC2, HBOM Announce New Cardiac Rehab Materials & Opportunities at MiCR Meeting

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

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

NewBeat Success and Re-Orders

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

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

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

Figure 2. Implementing NewBeat Feedback Video

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

Figure 3. NewBeat Sticker Journey Design

Figure 4. NewBeat Sticker Golden Ticket Design

MiCR Mini Grant RFP Opens for Second Round

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

MiCR Updates & Meeting Materials

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

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

0
View Post
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

0
View Post
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!

0
View Post
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.

0
View Post
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.

0
View Post
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.