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MVC Semi-Annual Meeting May 2021 – Virtual Meeting Recap

MVC Semi-Annual Meeting May 2021 – Virtual Meeting Recap

The Michigan Value Collaborative (MVC) held its first virtual semi-annual meeting of 2021 on Friday, May 7th. A total of 221 leaders from a variety of healthcare disciplines attended Friday’s virtual meeting, representing 74 different hospitals and 30 physician organizations (POs) from across the State of Michigan. These participants came together to hear about the planned adjustments to the MVC Component of the BCBSM P4P Program for Program Years (PY) 2022/23 and to discuss variations in transitions of care and ED utilization practices across Michigan.

MVC’s Director, Dr. Hari Nathan, started Friday’s meeting with an update from the MVC Coordinating Center, welcoming the eleven new hospital members who have joined the collaborative since the turn of the year and highlighting recent improvements to MVC data sources and push reporting. This included the “soft launch” of Medicaid data. MVC has now added Medicaid data to our data portfolio, meaning that MVC data sources now comprise over 80% of Michigan’s insured population. The Coordinating Center is in the final stages of validation and will have this new data source live for use by members in the coming months.

Dr. Mike Thompson, MVC’s Co-Director, then shared information on the MVC Component of the BCBSM P4P Program with attendees. An overview of PY20 was first provided, showing that participants earned an average of six points during this program year, an increase of around one point from the 2019 program year average. In an effort to continually improve the MVC Component, the Coordinating Center has introduced two methodological changes for the next two-year cycle (PY22 & PY23). Dr. Thompson walked through each of these changes, which include placing “Improvement” and “Achievement” on the same scoring scale, and introducing a new qualitative questionnaire for earning bonus points. The MVC Coordinating Center will be sharing further information on these changes and disseminating service line selection reports for the next program cycle with members in early June. Two dedicated P4P webinars will also be held around this time to assist members with selection.

Attention was then turned to looking at transition variations in Michigan hospitals, highlighting payment and ED utilization differences across MVC members, as well as the top reasons for readmission within the collaborative. To expand on this further, we were joined by guest speakers from the hospital, physician organization, and CQI setting to share their insights and learning. Dr. Robert Nolan and Michael Getty from Spectrum Health Lakeland were the first guest speakers of the day, discussing their organization’s efforts to reduce the cost of ED utilization and readmission rates. This highlighted the importance of real time data visuals, integrating documentation tools with best practices, and ensuring an effective longitudinal plan of care that is blended into natural work flows to enable physician buy-in. Dr. Nolan and Mike Getty were also able to spotlight the use of MVC data in these efforts, a custom option available to all MVC members.

Representing Professional Medical Corporation (PMC) and the Consortium of Independent Physician Associations (CIPA), Dr. Kyle Enger then shared how both entities have worked to promote appropriate emergency care in recent years. Again, this emphasized the importance of monthly data report cards to provide physicians with actionable data to guide activity, as well as the need to continue promoting urgent care as a viable alternative in certain situations. Our last guest speaker of the day was Dr. Keith Kocher, Director of the Michigan Emergency Department Improvement Collaborative (MEDIC). As well as providing a brief overview of the purpose of MEDIC and sharing some vital statistics relating to ED utilization across the US, Dr. Kocher discussed how best to approach the “ED readmission problem” and how local solutions can be used to minimize its impact.

To conclude Friday’s meeting, MVC’s Site Engagement Coordinator, Jeff Jameel, provided a synopsis of the day and highlighted key upcoming activities. The slides from Friday’s meeting are available here and a recording of the meeting can also be viewed here. If you have any questions on anything that was discussed at Friday’s semi-annual or are interested in finding out more about MVC’s offering, please reach out to the MVC Coordinating Center (michiganvaluecollaborative@gmail.com.) In the meantime, we look forward to seeing you all in-person again soon.

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MVC Launches New Physician Organization Reports

MVC Launches New Physician Organization Reports

The goal of the Michigan Value Collaborative (MVC) is to improve the health of Michigan through sustainable high-value healthcare. The primary focus at inception in 2013 was the development of hospital based metrics to improve patient outcomes, reduce healthcare costs, and encourage hospitals to collaborate in best practice sharing. With the knowledge that hospitals are not the healthcare entity capable of such changes, MVC invited Physician Organizations (POs) to join the collaborative towards the end of 2018.

To date, PO members have been able to see hospital level data for their attributed facilities. This has proved helpful for our PO members but we have heard consistent feedback that being able to view metrics that display a PO’s specific attributed patient population would be welcome. This value added request was appreciated by MVC, and so the Coordinating Center began a collaboration with representatives from the Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) to develop new PO patient specific metrics. MVC has also engaged other parties in the development of these new metrics, including the Michigan Data Collaborative (MDC) and hearing directly from our PO members.

As a result of this collaboration, the first MVC PO population level report, containing data for both BCBSM PPO Commercial (Comm) and BCBSM Medicare Advantage (MA) between 1/1/19 and 12/31/19, was sent out to all 40 MVC PO members on Tuesday, April 20, 2021. The report contains data on health care utilization and allows POs to benchmark themselves against all MVC participating physician organizations for the metrics listed in Table 1.

Table 1. Initial PO Reporting Metrics

Each metric was stratified by payer to account for differences in patient populations, as well as to serve as a proxy for age stratification (Figure 1).

Figure 1. Sample PO Metric: Percent of Attributed Members with at Least One Inpatient Stay

As engagement with our PO members builds, and further feedback and requests are processed, MVC plans to continue to build on the metrics highlighted in this report. As the most recent reports are at a population level, the Coordinating Center intends to delve further into the metrics for more granular level detail.

If you are interested in sharing feedback about the PO reports, have any specific analytic requests, and/or would like more information about the Michigan Value Collaborative,  please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

 

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Cardiac Rehab Stakeholder Meeting Motivates Improvements in Care

Cardiac Rehab Stakeholder Meeting Motivates Improvements in Care

On Monday, March 22, 2021, a “stakeholder meeting” was hosted by the Michigan Value Collaborative (MVC) Coordinating Center with multiple key players in cardiac rehabilitation (CR) from around Michigan. As MVC has written about before, cardiac rehabilitation is a highly valuable but underutilized service and is the focus of one of MVC’s ongoing value coalition campaigns. The goal of the stakeholder meetings is to bring together key constituents to work towards solving the problem of underutilization. Attendees included managers of cardiac and pulmonary rehab facilities, quality improvement leaders and executives from  several MVC members, our payer partners from Blue Cross Blue Shield of Michigan, and representatives from the Michigan Society for Thoracic and Cardiovascular Surgeons (MSTCVS), the Michigan Society for Cardiovascular and Pulmonary Rehab (MSCVPR), and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

The stakeholder meeting occurred the week after MVC distributed new Master Cardiac Rehab reports, which detail several metrics on cardiac rehabilitation after percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), transcatheter aortic valve replacement (TAVR), and surgical aortic valve replacement (SAVR) procedures. The collaborative-wide average cardiac rehab utilization varied by procedure: 52.6% for SAVR, 30.1% for TAVR, 56.3% for CABG, and 32.3% for PCI (see Figure 1). The mean days to first cardiac rehab visit also varied by procedure: 46 days for SAVR patients, 43 days for TAVR patients, 45 days for CABG patients, and 34 days for PCI patients (see Figure 2).

Figure 1

Figure 2

The Master Cardiac Rehab reports were also distributed by our partners at MSTCVS and BMC2. The aim is to increase awareness of hospital-level CR utilization and encourage as many players as possible (cardiologists, cardiac surgeons, cardiac rehab staff, quality improvement staff, and executive leadership) to work together to increase CR utilization at every hospital. These reports were well-received at the March 22nd stakeholder meeting, with one attendee emphasizing that the information contained in the reports was “the envy of other states,” speaking to the utility of MVC data and the success of BCBSM Value Partnerships. Attendees also provided excellent suggestions for improvement which will be taken into account during the next report refresh later this year.

The data is distributed, and the stakeholder meeting is over, but the value coalition campaign is just getting started.  There’s still a lot of work to do in order to equitably increase cardiac rehabilitation use in our state, including studying barriers to entry, exploring the intricacies of benefit design, and making various operational changes hospital by hospital, health system by health system. Nevertheless, that Monday afternoon showed that sometimes, when you have the right people around the same (virtual) table, everyone can walk away connected, motivated, and ready to carry out their respective roles to improve health care.

The next cardiac rehab stakeholder meeting is scheduled for Monday, June 28, 2021 from 4:00-5:00pm. If you have an interest in joining this group, or if you have not received your Master Cardiac Rehab report, please email michiganvaluecollaborative@gmail.com.

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Introducing Bradley Raine, MVC Analyst

Introducing Bradley Raine, MVC Analyst

I am happy to join the Michigan Value Collaborative (MVC) in the role of Analyst and am looking forward to working with the MVC team to help improve the quality and value of healthcare provided in the state of Michigan.

I graduated from the University of Michigan with my Bachelors of Science in Biology in 2015, and spent nearly three years working in the prep lab for the Michigan Clinical Research Unit (MCRU) based at the Cardiovascular Center. There I developed an interest in research methodology and wanted to learn more about how research teams use their data to publish their findings. Therefore, I decided to pursue a degree in Statistics, and graduated from Central Michigan University in August 2020 with a Master’s of Science degree.

In order to complete my graduate degree, I worked on a visualization project for COVID-19 data using Tableau. I found this product to be a great tool for creating dashboards to tell stories about data, and am hoping to take the skills learnt and implement them in a professional setting.

As an analyst for MVC, I am excited to learn how to analyze data using medical claims information to identify areas for improvement in quality of care. This has been important to me ever since having worked at MCRU and seeing how much data can do towards improving patient outcomes.  I am looking forward to taking the knowledge and experience gained at Central Michigan University and using it for this purpose. If you have any questions or wish to get in touch, please feel free to email me at bjraine@med.umich.edu.

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Michigan Value Collaborative Value Coalition Campaign. Introducing the Preoperative Testing VCC and Report Series.

Michigan Value Collaborative Value Coalition Campaign. Introducing the Preoperative Testing VCC and Report Series.

In 2020, the Michigan Value Collaborative (MVC) introduced the Preoperative Testing Value Coalition Campaign (VCC) with the aim of reducing the use of unnecessary preoperative testing for surgical procedures.  As part of this new campaign to improve quality, reduce cost, and improve the equity of care delivery in Michigan, the Coordinating Center developed and distributed preoperative testing reports to collaborative members earlier this week. The goal of these reports is to introduce the VCC and provide benchmarking data for some of the common preoperative tests to members.

Currently, the VCC is focused on three elective, outpatient, low-risk surgeries. This includes cholecystectomy, lumpectomy, and inguinal hernia repair. These surgeries were chosen to identify a population unlikely to require much, if any preoperative testing. Metrics included in the reports evaluate hospital testing rates for electrocardiography (EKG), trans-thoracic echocardiography (TTE), cardiac stress tests, chest X-ray (CXR), urinalysis, complete blood count (CBC), basic metabolic panel, coagulation tests, and pulmonary function tests (PFT).  As shown in Figure 1, there is wide variation across the collaborative for overall preoperative testing rates, ranging from 20% to 96%.

Whilst the report provides the MVC all and regional averages as benchmarks, the variation suggests that there is significant room for improvement among Michigan hospitals, and even facilities that are average likely have the possibility to reduce preoperative testing. Furthermore, to allow hospitals to identify areas of opportunity, a more granular grouping of laboratory testing including CBC, basic metabolic panel, coagulation tests, and urinalysis for the three low-risk surgeries is depicted in Figure 2.  To allow hospitals and physician organizations to view more comprehensive preoperative testing data, the MVC Coordinating Center is in the preliminary stages of developing a new preoperative testing report for the MVC registry.

Although many preoperative tests are relatively low cost, large-scale overuse when not necessary can increase episode costs. For these three low-risk procedures, an annual preoperative testing payment of $3.2 million dollars was noted in 2019 across MVC hospitals and according to MVC data, annual preoperative testing payments for these conditions has increased steadily over the last 5 years. In addition, overuse of preoperative testing has the potential to harm patients. Patients with borderline or false positive tests may be subjected to additional testing, have their surgeries postponed, or even experience unnecessary harm from invasive follow up tests.  Questions about appropriate preoperative testing  guidelines can be answered at the Choosing Wisely website.

Please provide us with your feedback on the utilization of these or any other MVC reports, or if you would be interested in joining the MVC Preoperative Testing Stakeholder Group, please reach out to MichiganValueCollaborative@gmail.com.

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Opportunity to Share your Perspective in Institutional Participation in the MVC Component of the BCBSM P4P Program

Opportunity to Share your Perspective in Institutional Participation in the MVC Component of the BCBSM P4P Program

MVC Senior Advisor and former Director, Dr. Scott Regenbogen recently received funding from The Donoghue Foundation to lead a team of investigators to learn more about institutional participation in the MVC Component of the BCBSM P4P Program.

As part of this study, Dr. Regenbogen is interested in conducting virtual interviews with lead administrators who were involved with selecting service lines for performance year 2017-2018

What is the value of participating? While participation in this study is completely voluntary and does not carry any bearing on P4P scoring, the insights gleaned from this work will help us to continue improving the MVC measure for the benefit of our members, and improve our understanding of successful strategies in commercial episode-based payment incentives.

What is The Donoghue Foundation? The Foundation supports a diverse portfolio of research projects, from understanding the mechanisms of disease, to improving clinical treatments, to public health initiatives that prevent illness – all founded on excellent science. To learn more about the organization and their mission, please visit https://donaghue.org/

Meet the Key Study Personnel

  • Scott Regenbogen, MD, MPH.  Dr. Regenbogen is an Associate Professor of Surgery and Chief of the Division of Colorectal Surgery at the University of Michigan (UM), and a Senior Advisor of the Michigan Value Collaborative (MVC). His research has focused on the role of perioperative care protocols in the costs, outcomes, and value of care around episodes of inpatient surgery, with a particular focus on older adults.
  • Shelytia Cocroft, PhD.  Dr. Cocroft is an applied medical sociologist and mixed-methodologist (qualitative and quantitative research designs).  She is currently a qualitative research analyst at the University of Michigan’s Center for Healthcare Outcomes and Policy (CHOP) and is collaborating on qualitative centric projects designed to identify systemic and structural mechanisms within surgical care that perpetuate inequalities in access, quality, and delivery of care.
  • Ashley Duby, MS.  Ms. Duby is the Research Director for the Division of Colorectal Surgery within the Department of Surgery and has been working with Dr. Regenbogen for the past 6 years. She has extensive experience in development and deployment of fieldwork protocols in diverse settings – including patient and provider populations.

If you have any questions or would like further information related to this project, please contact Ashley Duby, Research Director at agay@med.umich.edu.

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MVC Component of the BCBSM P4P Program: PY20 in Review

MVC Component of the BCBSM P4P Program: PY20 in Review

In early January, the Michigan Value Collaborative (MVC) distributed 2020 Program Year (PY) scores to hospitals for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay for Performance (P4P) program. This marked the completion of the first year of a two-year cycle for which hospitals have selected two service lines (out of seven) to be scored on their episode spending using MVC data. These service lines include chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure 1 shows the frequency of hospital service line selections for the two-year program cycle.

Figure 1.

The program evaluates hospital’s risk-adjusted, price standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points in the program is by reducing their payments from the baseline period (index admissions in 2017) to the performance period (index admissions in 2019). These are termed ‘improvement points’. Alternatively, hospitals are able to 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, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each service line. Hospitals are also eligible to earn a bonus point for each service line provided all hospitals in their respective cohort who selected the same condition reduce spending by five percent. A maximum of ten points can be awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for Program Year 2020.

Figure 2.

On average, hospitals earned six points, an increase of around one point from the 2019 program year average. Twenty-four hospitals received bonus points within the COPD, colectomy, joint replacement, and pneumonia service lines. Consistent with previous years, joint replacement had the average points, with pneumonia coming in a close second (see Figure 3).

Figure 3.

If you have any questions regarding the MVC Component of the BCBSM P4P program, please refer to the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021 . If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at MichiganValueCollaborative@gmail.com.

 

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MVC Coordinating Center

MVC Coordinating Center

First of all, let me begin by wishing you all a happy new year on behalf of everyone at the MVC Coordinating Center. I started my last recap in January last year with the same line and proceeded to share what the MVC team had in store for the year ahead…little did we all know what was just around the corner. The year 2020 has been one like no other and the whole MVC team is truly grateful to each of our collaborative members, and those hospitals and physician organizations across the country who have worked tirelessly to tackle the current pandemic.

Like many organizations around the world, the MVC team has now been working remotely for over ten months. During this time, we have adapted to new ways of working, wrestled with the zoom mute button on a daily basis, and got to know each other’s families and pets very well. However, the one thing that has remained constant during this time is the support on offer to each of our member sites.

Over the past ten months, the MVC team has used our current infrastructure to help MVC hospitals and physician organizations navigate the pandemic. This included the creation of a new statewide and hospital level Resource Utilization Report, providing historical resource utilization metrics for 17 different elective surgical procedures to inform surgical ramp-up at member facilities. The MVC Coordinating Center has also been working closely with the wider CQI community on the Mi-COVID19 initiative - a joint CQI venture collecting extensive clinical data on COVID-19 patients to provide insight into best practices in treating patients with the virus.

In addition to these efforts, MVC Coordinating Center activity has continued to expand. In 2020, the MVC team held two virtual collaborative wide meetings, facilitated 32 workgroups, delivered 30 tailored registry webinars, undertook 18 virtual site visits, disseminated

We look forward to continuing this growth in 2021 as we strive to improve the health of Michigan through sustainable high-value healthcare. There a number of new developments in the pipeline for the coming year and I excited to be able to share some of these with you.

Data Expansion: Medicaid Data

The MVC Coordinating Center is committed to expanding patient populations on the MVC registry to increase the level of meaningful, timely, benchmarked performance data that is available to aid our member’s quality improvement activities. Over the last two years, the MVC team has been working to add Medicaid claims data to the MVC registry. This dataset was received in late November 2020 and will add approximately 1.8 million covered lives to the MVC registry. As a result, this means that MVC data sources now comprise over 80% of Michigan’s insured population. It is projected Medicaid data will be available on the MVC registry for members to access by the end of Q1 2021.

New Push Reports

A number of new reports will be added to MVC’s portfolio in 2021, focusing on topics such as COVID-19, Preoperative Testing, and Social Determinants of Health. The Coordinating Center will work closely with members, the wider CQI community, and other stakeholders to ensure the introduction of other new and novel approaches to sharing our data. As always, the Coordinating Center is here to help so please let us know if you have any custom data requests or reports you would like to see.

New Physician Organization Metrics and Reports

As part of MVC’s organizational strategy and planned growth, Jeffrey Jameel (MD, MHA) joined the MVC team in the role of Site Engagement Coordinator in early November. In the coming year, Jeff will be working closely with each of our physician organization members to develop new measures and metrics to support ongoing activities.

Value Coalition Campaigns

In October 2020, the MVC Coordinating Center launched two new Value Coalition Campaigns (VCCs) focused on Cardiac Rehabilitation and Preoperative Testing. These VCCs can essentially be thought of as specific focus areas in which member collaborations are concentrated to drive improvement. By using our 90-day episode claims data to provide time-specific hospital-level information on CR enrollment and completed visits, and partnering with the Blue Cross Blue Shield Cardiovascular Consortium (BMC2), the Coordinating Center is aiming to equitably increase participation in cardiac rehabilitation for all eligible individuals in Michigan. In addition, the MVC team also plans to use claims data and engagement with MVC members to reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve the equity of care delivery in Michigan.

The MVC team will develop these new campaigns further in the coming year, sharing new push reports and launching new reports on the MVC registry to support member activity in this area. If you are interested in taking part in the development of MVC’s new VCCs, please reach out to the MVC Coordinating Center (michiganvaluecollaborative@gmail.com).

Collaborative Wide Meetings

The MVC team will continue to hold two flagship semi-annual collaborative wide meetings. These will take place on Friday, May 7th and on Friday, October 29th. As part of the MVC Component of the BCBSM P4P Program, hospitals will now be awarded an additional bonus point for attending BOTH semi-annuals in 2021. More details on each of these meetings will follow in the coming months.

Virtual Site Visits

MVC site visits are designed to provide members with a more in-depth understanding of MVC and its offering, as well as providing the opportunity to learn about best practices in operation at Michigan hospitals to share with the rest of the collaborative. Feedback is also sought from sites to ensure the Coordinating Center is able to continually improve the data, analytic support, and engagement resources available to members. This offering will continue in 2021.

As with attending both collaborative wide meetings, hospitals will now be awarded an additional bonus point for undertaking a virtual site visit with the Coordinating Center as part of the MVC Component of the BCBSM P4P Program. If you are interested in setting up a virtual site visit, please let us know (michiganvaluecollaborative@gmail.com).

If you have any questions on the above, please do not hesitate to contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com. Happy New Year, and we look forward to a great 2021 together.