24 Feb 2022
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MVC Draws Attention to Cardiac Rehab in Promotional Week

MVC Draws Attention to Cardiac Rehab in Promotional Week

February 24, 2022 | 0 Comments | ,

Every February while the nation honors American Heart Month, a subset of heart health advocates spend one week paying tribute to the lifesaving value of cardiac rehabilitation. Last week the Michigan Value Collaborative (MVC) Coordinating Center joined in on Cardiac Rehabilitation Week by helping to increase awareness and promote MVC’s efforts to improve utilization. Over the course of the week, MVC distributed press releases, published a daily cadence of social media content on Twitter and LinkedIn, and launched a video about the importance of cardiac rehab – all in service of inspiring collaboration in this area.

Cardiac rehabilitation (CR) has a Class IA indication for recent cardiac-related events or procedures, meaning there is high-quality evidence that it is beneficial to patients. In fact, individuals who complete the full program of 36 sessions have a 25% lower risk of death and a 30% lower risk of heart attack than those who attend only one session. It also reduces hospital readmissions and saves thousands of dollars per patient per year of life saved. Nevertheless, CR is widely underutilized, with national utilization rates of only 25-50%. It is for this reason that MVC wishes to equitably increase CR participation for all eligible individuals in Michigan. Throughout CR week, therefore, MVC endeavored to define the value of CR, what it entails, and how the actions of MVC members impact CR participation.

MVC’s role in the CR space is two-fold. One is the preparation of reports using its unique multi-payer data sources, and the second is providing opportunities for MVC members to collaborate. The reports that MVC prepares for members analyze claims data with time-specific hospital-level information on CR enrollment and completed visits within one year of discharge. This allows hospitals to benchmark their performance against peers and identify areas for improvement. There’s a huge amount of variation in CR rates across many dimensions – hospitals, qualifying events, and payers. For example, the hospital with the highest rate of CR after coronary artery bypass graft surgery (CABG) succeeds at sending 75% of their CABG patients to CR, while another only sends 28% of their CABG patients. This variation shows that it is possible to reach high CR rates, and hospitals can learn from each other to make systemic improvements that get more patients into this life-changing (and cost-saving) program.

To support collaboration among its member base of 100 hospitals and 40 physician organizations, MVC hosted a special, one-time workgroup on CR last week as part of its newly launched “Health in Action” workgroup series. This series is meant to drive discussion and collaboration on special topics that rotate throughout the year. Last week’s session featured the expertise of two special voices in the world of CR: Steven Keteyian, Ph.D., Director of Cardiac Rehabilitation/Preventive Cardiology at Henry Ford Medical Group, and Greg Merritt, Ph.D., patient advocate and founder of Patient is Partner. The workgroup was well attended with over 100 guests, who benefitted from informative and inspiring presentations from both speakers.

Dr. Keteyian presented updates on the clinical effectiveness of CR as well as some of the key barriers facing the field. There is high-quality evidence that CR is beneficial to patients on a variety of physiological measures, including improved exercise tolerance, decreased risk of future hospitalization, and decreased cardiovascular mortality. He also reiterated the value of cardiac rehab relative to other recommended cardiac interventions, with CR demonstrating more lives saved per 1000 patients than ACE inhibitors, statins, and other common medications (see Figure 1).

Figure 1. Calculating the Value of Cardiac Rehab

The current quality measures for CR suggest a patient’s time to enrollment should occur within 21 days of discharge, and that the patient should attend at least 36 sessions to receive the greatest benefit. The current goal for CR participation set by the Million Hearts initiative is 70%. However, Dr. Keteyian found that of the CR-eligible beneficiaries, only 28.6% participated and only 27.6% of those participants completed all 36 sessions. This represents a significant utilization gap. While discussing related challenges, Dr. Keteyian suggested that hospitals implement EMR-driven automatic referrals, overt provider endorsements, and an inpatient liaison to bridge the gap between referral and enrollment. He also recommended the use of hybrid CR programs that leverage telehealth to offer remote options.

Dr. Merritt’s presentation included his own personal story of surviving a cardiac event and his ensuing participation in a CR program. Following his experience, he became a “patient questionologist” dedicated to finding opportunities for patient and provider collaboration. His story ultimately led to the founding of an organization called Patient is Partner, which is dedicated to the principles of patient-partnered care. Inspired by the writings of behavioral scientists as well as Why We Revolt by Victor Montori, Dr. Merritt outlined a vision for healthcare innovation that invites patients and their unique perspectives to help solve healthcare’s greatest challenges. He encouraged attendees to join the movement and invite more patient voices to contribute to their respective committees and teams.

At the conclusion of the week, the MVC team had helped its audiences connect to educational materials, data, specialists, former patients, and successful peers in this space. The Coordinating Center is eager to continue this momentum from CR Week in pursuit of a variety of goals for 2022 and beyond. If your hospital or physician organization is interested in improving CR utilization rates, you can learn more about how MVC supports members to increase CR enrollment or reach out directly at michiganvaluecollaborative@gmail.com. You can also view a recording of the full CR workgroup here.

17 Feb 2022
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MVC Shares New Pneumonia Push Report with Hospitals

February 17, 2022 | 0 Comments | ,

The Michigan Value Collaborative (MVC) introduced its first ever pneumonia push report this week when the Coordinating Center shared individualized reports with 89 hospitals across Michigan. This report was created in response to member interest and incorporated 30-day claims-based episodes with index admissions from 1/1/18 – 12/31/20 for the following payers: Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM MA, BCN MA, and Medicaid. Reports were created for all MVC member hospitals that had at least 11 pneumonia episodes per year in 2018, 2019, and 2020.

One goal for this report was to provide data that would be useful for a broad range of MVC’s increasingly diverse membership. Critical Access Hospitals (CAHs), for example, are some of MVC’s newest members and differ in several meaningful ways from other hospitals in the collaborative. Therefore, MVC distributed two different versions of the pneumonia report in order to refine comparison groups and provide a more tailored view of the data. As a result, 81 general acute care hospitals received a pneumonia report comparing their performance to 1) all other eligible general acute care hospitals in the collaborative and 2) acute care hospitals in their geographic region. The second version of the report was shared with eight eligible CAHs, which compared their performance to other MVC CAHs. By providing hospitals with tailored comparison groups when appropriate, MVC hopes to strengthen the usability of its claims-based data to inform quality improvement initiatives.

After much consideration, the MVC team decided to remove any pneumonia episodes containing a confirmed diagnosis of COVID-19 (U07.1) in the first three diagnosis positions of an inpatient facility claim from this report. Members can now replicate this approach on the MVC registry for episodes from April 2020 or later using the new COVID-19 filter, which allows users to include or exclude episodes that contained an inpatient facility claim with a confirmed COVID-19 diagnosis. For the purposes of this push report, the Coordinating Center further excluded all pneumonia episodes from March 2020 in order to remove COVID-19 hospitalizations that occurred in Michigan before an official COVID-19 diagnosis code was available and were coded as pneumonia.

Measures included in the pneumonia report were trends in average price-standardized risk-adjusted total episode payments, average index length of stay, index in-hospital mortality rates, trends in 30-day readmission rates, rates of 30-day post-acute care utilization, and rates of seven-day outpatient follow-up. Overall, the Coordinating Center found that the in-hospital mortality rate for both groups of hospitals was about 2%. One noticeable difference between the two report groups was that CAHs had a shorter average length of stay for index pneumonia hospitalizations (4.6 days, see Figure 1) than general acute care hospitals (5.8 days, see Figure 2).

Figure 1. Average Index Length of Stay at CAHs

Figure 2. Average Index Length of Stay at Acute Care Hospitals

Post-acute care utilization rates were stratified by emergency department (ED), home health, rehabilitation, and skilled nursing facility (SNF). In general, the most frequently utilized category of post-acute care for pneumonia episodes was home health at a rate of 20% for acute care hospitals (see Figure 3) and 24% for CAHs (see Figure 4). Furthermore, there was wide variability in seven-day outpatient follow-up rates for both types of hospitals, but the average for acute care hospitals was higher at 39.7% (see Figure 5) compared to 24.4% (see Figure 6) for CAHs.

Figure 3. 30-Day Post-Acute Care Utilization Rates at Acute Care Hospitals

Figure 4. 30-Day Post-Acute Care Utilization Rates at Critical Access Hospitals

Figure 5. Seven-Day Outpatient Follow-Up Rates at Acute Care Hospitals

Figure 6. Seven-Day Outpatient Follow-Up Rates at Critical Access Hospitals

By understanding the unique needs of its members, MVC can improve future reports for use in quality improvement activities. If your hospital is interested in sharing feedback about the new pneumonia report or has a specific follow-up request, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

03 Feb 2022
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New Report on Colectomy Distributed to Member POs

February 3, 2022 | 0 Comments | , , ,

The Michigan Value Collaborative introduced its first colectomy physician organization (PO) report this week. A colectomy is the surgical removal of a section of the large intestine (colon) or bowel and is performed to treat diseases of the bowel (i.e., Crohn’s disease, ulcerative colitis, and colon cancer).

The report incorporated administrative claims of attributed members from 1/1/19 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage, and 1/1/19 – 9/30/20 for Medicare Fee-for-Service. Reports were created for all POs that currently participate in MVC and had at least 11 colectomies per year in both 2019 and 2020.

There were significant differences in the anticipated clinical course and the likelihood of complications between elective (planned) and emergent colectomy. Therefore, MVC provided a stratified summary of planned versus emergent colectomies (Figure 1), and some metrics in the report were stratified by planned and emergent status to highlight when there was an emergency department revenue code on the episode. For example, there were notable differences in post-acute care utilization between planned and emergent colectomies (Figures 2 & 3).

Figure 1. PO A Colectomy Report Table

Figure 2. PO A Risk-Adjusted Payments: Planned Colectomies

Figure 3. PO A Risk-Adjusted Payments: Emergent Colectomies

In an effort to provide valuable data to MVC POs, the Coordinating Center continually meets with key stakeholders, BCBSM, and PO members to drive MVC PO report development. The contents of this report were developed based on that feedback. For example, this report allowed POs to individually compare their organization to new comparison groups.

The comparison groups in the new colectomy report include:

  • All MVC POs
  • EMPLOYED VS. INDEPENDENT POs: As defined in the BCBSM Physician Group Incentive Program (PGIP) 2021 physician list, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with less than 50% are considered independent.
  • PO SIZE: These groups were based on the number of attributed members at each PO (Figure 4). Member POs would see the PO size comparison group in which they belong so they can compare their performance to other POs of a similar size.

Figure 4. PO Size Grouping

Other components included in the report were a list of the top 10 facilities where a PO’s attributed patients had a colectomy performed, the five most common comorbidities among attributed colectomy patients, median length of stay, 30-day risk-adjusted total episode payment, 30-day readmission rate, and the utilization rate for post-acute care services (emergency department, skilled nursing facility, and home health). General findings included that diabetes was the most common comorbidity across all colectomies (planned and emergent) performed at POs and was frequently one of the top two comorbidities for individual POs. In addition, home health services had the greatest variation in post-acute care utilization (see Figure 5).

Figure 5. PO A Home Health Utilization Rate

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

28 Jan 2022
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New Health Equity Workgroup Has Successful Launch

New Health Equity Workgroup Has Successful Launch

January 28, 2022 | 0 Comments | ,

Health equity has captured the attention of healthcare. It was a top trend for healthcare providers in 2021, and surveys indicate it will be one of the main priorities for large healthcare employers in 2022. It is also a key strategic focus of the MVC Coordinating Center in the years ahead. As such, MVC is building out offerings for its members in this space, which began with the launch of its new health equity report and was followed by a semi-annual meeting dedicated to the topic in October 2021. Most recently, MVC launched a new health equity workgroup, which will continue to meet on a bimonthly basis in 2022.

The first health equity workgroup took place this week featuring speakers from the MSHIELD (Michigan Social Health Interventions to Eliminate Disparities) collaborative—one of the newer teams in the Blue Cross Blue Shield of Michigan Collaborative Quality Initiative (CQI) portfolio. MSHIELD Co-Director Dr. John Scott co-presented with MSHIELD Program Manager Carol Gray. They were joined by 72 attendees representing hospital teams, physician organizations, fellow CQIs, and other areas. The presentation focused on the role of MSHIELD in addressing social risk factors in healthcare as well as members’ approaches to health needs screening, referral, and linkage.

The social determinants of health (SDOH) have a tremendous impact on patient health outcomes, resulting in Healthy People 2030 naming it one of its five priorities. With thousands of journal articles confirming the impact of the SDOH, there is now a shared understanding across healthcare providers that this area is a priority. In fact, it affects patient health outcomes significantly more than clinical care (see Figure 1). MSHIELD’s presenters highlighted this fact and used it as an opportunity to define a common language for the discussion. They said health equity is achieved when every person can attain their full health potential and no one is disadvantaged from achieving this because of socially determined circumstances.

MSHIELD will serve as a link between the healthcare system, the community resources that can reliably serve patients’ social needs, and the communities that are home to those patients. To that end, MSHIELD will help establish partnerships with key healthcare and community entities and promote the exchange of data and services in a way that helps achieve health equity.

Unlike some of the “legacy” CQIs that are clinically focused, MSHIELD will fill a consulting role with other CQIs to help them set and meet goals related to health behaviors and social needs. Since health equity is a multi-faceted issue affecting all areas of health, MSHIELD also has an unlimited population and practice focus. For the time being, however, the speakers identified that MSHIELD is particularly interested in food access, housing instability, and transportation since those are areas with the strongest evidence for impact in a clinical setting.

MSHIELD’s presenters also summarized their findings from an environmental scan of the larger CQI portfolio. Last year they surveyed the other CQIs in the BCBSM Value Partnerships portfolio to identify what types of SDOH data they may collect and how. Of the 16 SDOH domains (see Figure 2), MSHIELD found that almost all CQIs collect data on demographics, insurance status, and health-related behaviors. However, only three CQIs currently collect data related to material hardship (e.g., food insecurity, housing insecurity, transportation, medication affordability, access to technology, childcare, etc.). MSHIELD hopes to help build on what has been collected so far and assist providers and CQIs alike in their pursuit of health equity initiatives.

Figure 2. Domains of the Social Determinants of Health from MSHIELD Presentation

The workgroup concluded with an active discussion about current practices and challenges experienced by providers in identifying, referring, linking, and following up with patients. Representatives from physician organizations and hospitals alike shared examples about how they integrate screening and capture this data, which led to conversations about the technologies used to assist with this process and the value of universal versus targeted screening strategies. Most of the participants who shared their experience expressed that whichever strategy they adopted, there were efforts to make the screening questions accessible for those with language or literacy barriers. Examples of this that were provided by members included translating materials to common languages from their local community and utilizing the professional abilities of social workers on site. There were also discussions about how to best identify resources within a given community for the purposes of referrals, with some thoughtful suggestions about partnering with community health needs assessment teams and social workers from within hospitals.

To hear the full discussion and learn more details about MSHIELD, the full recorded workgroup can be viewed here. MVC looks forward to continuing this health equity conversation on March 16. Register for the next MVC health equity workgroup here. If you would like to receive future MVC workgroup invitations or you have an idea for a future speaker, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com.

Speaker Biographies:

Dr. Scott is an Assistant Professor of Surgery in the Division of Acute Care Surgery at the University of Michigan. His health policy and health services research interests are focused on improving access to timely, affordable, high-quality surgical care for the acutely ill and injured.

Carol Gray leads the overall management, performance, and coordination of the MSHIELD program and team. She has extensive experience managing public health research teams, communicating across and coordinating with multiple partnerships, and linking and engaging with community-based organizations.

21 Jan 2022
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Special Consideration Needed for Older Patients Using Telecare

January 21, 2022 | 0 Comments | , , ,

When most people think about healthcare, the images that come to mind include a trip to their local provider’s office, lab, or hospital for services such as physicals, blood tests, and procedures. However, medical professionals and their patients are increasingly transitioning to more remote services that leverage our advances in communication technologies, resulting in the burgeoning “tele” world of healthcare. But are these services reaching everyone?

Telemedicine, telehealth, and telecare are three examples of remote, interactive services that allow patients to receive healthcare from within their own homes. Although these terms are often used interchangeably, they in fact refer to different aspects of healthcare delivery. Telemedicine applies to physicians who use technology to support the delivery of medical, diagnostic, or treatment-related services. Telehealth is like telemedicine but applies to a broader collection of providers, such as nurses or pharmacists. Telecare (see Figure 1) is generally more consumer-oriented by providing the patient with technology to manage their own care safely from home, such as health apps or digital monitoring devices.

Figure 1. Telecare Slide from MVC Workgroup Presentation

The adoption of “tele” services saw incredible growth in 2020 in response to the pandemic. A report found that Medicare telehealth visits increased 63-fold recently, from 840,000 in 2019 to 52.7 million visits in 2020. However, now that adoption of these services (and the platforms needed to host them) are more commonplace, providers are asking whether it benefits their most vulnerable patients and who may be left behind.

These questions drove the discussion of the most recent MVC workgroup on chronic disease management. Over the course of the session, attendees were particularly interested in how telecare improves elderly care, and whether patients over the age of 65 could adequately access such services. For those older adults utilizing telecare, evidence from the ongoing COVID-19 pandemic identified convenience and affordability as telecare’s primary strengths. In addition, research evidence suggests that the two most effective telecare interventions in this population are automated vital sign monitoring and telephone follow-up by nurses.

Some of the challenges often cited for this population include lack of appropriate internet access or devices, limited digital literacy, medical conditions that may impede participation (i.e., hearing or vision impairments, dementia, etc.), and the need to regularly monitor vitals in very high-risk patients. Although the authors compiling these challenges specifically reference older adults, they could just as easily apply to people experiencing poverty, people with disabilities, and people with more limited language and literacy skills.

Some recommended strategies to address common challenges include tablet delivery services, “mobile medical assistants” who perform video set-up for the patient, assistance from an on-site caregiver, practice or “mock” video visits prior to the appointment date, partnerships with community health workers to support or train patients in their homes, and providing self-monitoring devices. Other simple considerations include the size of the text displayed on the page (use larger text to enhance readability), providing adequate instructions in advance and in multiple languages, and engaging experts in user experience design.

In addition to these considerations, some researchers suggest that, in general, the adoption of new technologies can be predicted in part by Everett Rogers’ Diffusion of Innovation Theory. One study incorporating this theory found that the chances of telecare adoption were highest for three types of older adults: those already receiving long-term or nursing care, those living alone, and those who have fixed daily telecare points of contact.

Increased integration of technology in healthcare is inevitable as advancements continue and we shift to a more digital world. Since the number of people in the U.S. who are age 65 or older will more than double over the next 40 years, it is imperative that older adults are not left behind when transitioning to such services. Rather than fear the challenges, researchers and practitioners are seeking ways to find solutions and help all patients benefit from healthcare access within their own homes.

The MVC Coordinating Center encourages its members to collaborative with one another to benefit from peers’ success stories and lessons learned. If your hospital or physician organization has developed an age-friendly telecare protocol, please consider sharing your story with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com. To catch up on the recent MVC workgroup discussion about telecare, watch the chronic disease management workgroup recording here.

13 Jan 2022
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2021 Surviving Sepsis Campaign Guidelines Reviewed at Workgroup

January 13, 2022 | 0 Comments | ,

On December 7, 2021, the Michigan Value Collaborative (MVC) held its bi-monthly virtual workgroup on sepsis featuring Dr. Hallie Prescott, Associate Professor at Michigan Medicine and the physician lead on the Michigan Hospital Medicine Safety Consortium (HMS) Sepsis Initiative. For this MVC and HMS co-sponsored workgroup, Dr. Prescott presented Updates in Sepsis: What is new in 2021 SSC Guidelines. Dr. Prescott is a pulmonary and critical care medicine specialist, and she practices clinically in the intensive care units at the University of Michigan Health and Ann Arbor Veterans Affairs hospitals. She is co-chair of the Surviving Sepsis Campaign Adult Guidelines and a council member of the International Sepsis Forum.

The workgroup began with an introduction to the International Surviving Sepsis Campaign (SSC) guidelines and bundles, which are resources and implementation tools used to reduce sepsis and septic shock worldwide. The SSC Guidelines were originally published in 2004 and have been updated every four years, with the most recent edition being published in October 2021. A large panel of experts collaborates to evaluate the evidence and make recommendations (scaled by the strength of recommendation). Since their initial publication, health systems from the United States to Spain have used the SSC guidelines and tools to improve sepsis and septic shock care and outcomes.

Dr. Prescott’s presentation describing the SSC 2021 Adult Guidelines highlighted several recommendations and detailed the reasoning behind some of the changes made since 2016. The highlighted guidelines included recommendations for infection (antibiotic timing, use of antimicrobials) (see Figure 1), hemodynamics (resuscitative fluids, vasopressor timing), ventilation (ECMO), and additional therapies (IV corticosteroids, IV Vitamin C). In addition, a new section for long-term outcomes (see Figure 2) was also added to the newest guidelines and reviewed during the workgroup, addressing patient education, health and social screenings, and post-discharge follow-up. Out of all the discussed recommendations, the MVC and HMS members in attendance were most interested in antibiotic use, resuscitative fluids, central line use, and treatment prioritization.

Figure 2.

The updated SSC Guidelines offer informative and valuable recommendations that can be used to improve sepsis care and outcomes. If you were unable to attend the workgroup or are simply interested in reviewing the presentation and discussion, a recording of the workgroup is available here. To read the full published SSC 2021 Adult Guidelines and review additional resources, click here.

The MVC Coordinating Center is interested in hearing how your organization has utilized the SSC 2021 Adult Guidelines to improve sepsis care and outcomes. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.

06 Jan 2022
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MVC Coordinating Center Looking Back at 2021 and Forward to 2022

January 6, 2022 | 0 Comments | , ,

Let me begin the first MVC blog of 2022 by wishing you all a very happy new year on behalf of everyone at the MVC Coordinating Center. I’ve started my last two recaps with this line and ended with the hope of seeing you all in-person sometime soon. Since we still haven’t quite managed to get together in-person yet, I’d like to reiterate our thanks and gratitude to each of our collaborative members and those hospitals and physician organizations across the country who have continued to work tirelessly against the ongoing pandemic.

The MVC team has remained remote throughout 2021 and not only have we mastered the Zoom mute button, but we’ve continued to provide support to help MVC’s 100 hospital members and 40 physician organizations during this time.  In 2021, the MVC team held two virtual collaborative wide meetings, conducted 62 tailored registry webinars, undertook 58 virtual site visits, delivered 56 custom analytic requests, facilitated 34 workgroups, disseminated 21 push reports, and held five virtual regional networking events. As a result of this activity, the collaborative has welcomed 13 new hospital members to the collaborative.

In addition to these efforts, the MVC Coordinating Center has continued to adhere to our commitment to provide hospitals and POs with increased access to meaningful benchmarked performance data. In May of this year, MVC’s data portfolio grew with the addition of Michigan Medicaid data, and this was recently refreshed in early October. The data range for this data source currently covers 1/1/2015 – 9/30/2020, reflecting index admissions from 1/1/2015 – 6/30/2020. MVC Medicaid claims (Fee-for-Service and Managed Care) account for a total of 319,140 episodes (19.4% of all MVC episodes) and cover 256,889 beneficiaries. Overall, MVC data sources now comprise over 80% of Michigan’s insured population.

We look forward to continuing this growth in 2022 as we strive to improve the health of Michigan through sustainable high-value healthcare. There are 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.

New Hospital Push Reports

A number of new reports will be added to MVC’s suite of reporting in 2022, focusing on topics such as COVID-19, Pneumonia, and Health Equity. 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.

New Physician Organization Reporting

Driven by continued communication with members, the Coordinating Center disseminated its first PO-specific report focused on joint replacement towards the end of last year and has identified two new conditions of interest for future development (gastroenterology and hysterectomy). The Coordinating Center will also be working closely with PO members to inform the development of new metrics for the MVC online registry.

Increased Custom Analytics

Over the last year, the MVC team has devoted effort to raising awareness of MVC’s custom analytic offering to members. This has proved successful, with 56 custom projects undertaken for members in 2021 alone. This support will continue into 2022 – if you are interested in learning more, please contact the MVC Coordinating Center (michiganvaluecollaborative@gmail.com).

Emphasizing Equity in Healthcare

Most measures of overall health are worse in the US compared to any other developed country. The state of Michigan in particular ranks poorly in measures of population health, including tobacco use and the inter-related issues of inactivity, poor nutrition, and obesity. The relationship between these poor health behaviors and social determinants of health are closely interlinked and represent a huge opportunity to improve health and healthcare outcomes for targeted patients. In the coming year, MVC will be exploring how best to use its data and engagement platforms to emphasize equity in healthcare.

Collaborative Wide Meetings

The MVC team will continue to hold two flagship semi-annual collaborative wide meetings. These will take place on Friday, May 13th and on Friday, October 28th. The MVC team will also be holding five regional networking events throughout the year and plans to pilot a new ‘Northern Meeting’ in Summer 2022. More details to come.

New MVC Workgroups

The Coordinating Center’s suite of peer-to-peer virtual workgroups will continue to provide a highly accessible online platform for hospital and PO leaders to come together, collaborate, and share practices. In addition to MVC’s Chronic Disease Management, Sepsis, Joint, and Diabetes workgroups, two new groups will be added in 2022. This includes forums focused on ‘Health Equity’ and ‘Health in Action’.

As these activities and other planned developments come to fruition, we will be sure to share updates with you through our various engagement platforms. If you have any questions in the meantime, please do not hesitate to contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com. Happy New Year, and we look forward to a great 2022 together.

16 Dec 2021
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MVC Shares National Action Plan with COPD Workgroup Attendees

December 16, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) held a bi-monthly virtual workgroup recently on chronic obstructive pulmonary disease (COPD), a condition that accounts for the majority of deaths from chronic lower respiratory diseases and is continuously a leading cause of death in the United States. Notably, COPD is nearly two times as prevalent in rural areas as it is in urban areas; therefore, MVC members in rural areas may be dealing with significant inequities within their patient populations. The workgroup presentation and discussion focused on the COPD National Action Plan (CNAP). To the Coordinating Center’s surprise, many workgroup participants had not previously heard of the CNAP, making this event a great opportunity for practice sharing and discussion among members.

Overcoming barriers to prevention, early diagnosis, treatment, and management of COPD is necessary to improve quality of life and reduce mortality. To address these barriers, the U.S. Congress; National Heart, Lung, and Blood Institute; and Centers for Disease Control and Prevention convened a town hall where they asked federal and nonfederal partners to develop an action plan. These partners were tasked with identifying the efforts needed to change the course of COPD. The result was the development of the COPD National Action Plan (CNAP), which was released in 2017 and updated in 2019. It consists of five goals, which were outlined and discussed during the workgroup (see Figure 1).

Figure 1. Slide from COPD Workgroup Presentation

Goal 1 calls for promoting more public awareness and understanding of COPD, especially among patients and their caregivers. Key opportunities include patient and caregiver education that is sustainable and culturally appropriate, technological support mechanisms, and connecting patients and caregivers to local and state resources.

Goal 2 focuses on increasing the skills and education of healthcare providers so they are better equipped to provide comprehensive care. This goal is supported by the development and dissemination of patient-centric, clinical practice guidelines for care delivery, the use of technological support mechanisms, and consideration of home-based pulmonary rehabilitation programs. It’s important to note that studies have found no statistically or clinically significant differences for health-related quality of life and exercise capacity among patients who have completed home-based vs. outpatient-based pulmonary rehabilitation.

Goal 3 encourages increased data collection, analysis, and sharing to create a better understanding of disease patterns. Opportunities within this goal include supporting pharmaceutical and clinical COPD research; identifying and delivering comprehensive, evidence-based, culturally appropriate interventions; and disseminating findings to a variety of audiences (from patients to national policymakers).

Goal 4 aims to increase and sustain COPD research to improve understanding of the disease and its diagnosis and treatment. It’s vital that clinicians, researchers, and health policy experts foster research across the COPD continuum (prevention, diagnosis, treatment, management). Workgroup attendees agreed that there are opportunities to improve equity among COPD patients through more data on diagnosed and undiagnosed COPD in disadvantaged patients. Another vital component of this goal is supporting and sustaining pharmaceutical research for COPD medications since none of the existing medications for COPD have been shown to reduce the progressive decline in lung function.

Goal 5 calls for federal and nonfederal partners to collaborate to meet the objectives of the CNAP and translate its recommendations into research and action. Workgroup attendees highlighted the importance of implementing CNAP equitably among both urban and rural regions and implementing COPD strategies at all health policy levels (national, state, local). Such opportunities could improve access to cost-effective and affordable COPD support services and expand support for and access to pulmonary rehabilitation services (including home-based PR), thus reducing health inequities among COPD patients.

Each of the five CNAP goals is equally important and vital in reducing COPD health disparities. Although many of the MVC workgroup participants had not heard of the CNAP before, they were interested in sharing its goals and opportunities with others in their healthcare organization. If you would like to learn more about this patient-centered national action plan, you can read the full published report here. If your organization has addressed the CNAP goals or implemented any of the discussed opportunities, the MVC Coordinating Center would like to hear about the successes, challenges, and lessons learned. If you would like to share this information or present at an upcoming MVC workgroup, please email MVC at michiganvaluecollaborative@gmail.com.

09 Dec 2021
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Reports Identify Opportunity to Reduce Preoperative Testing

December 9, 2021 | 0 Comments |

MVC distributed its final push report of 2021 this week when the Coordinating Center distributed preoperative testing reports to members. It provided recipients with refreshed data using only Blue Cross Blue Shield of Michigan claims in order to provide the most up-to-date and granular preoperative testing information available.

In general, the report demonstrated significant variation in testing rates between members, with preoperative testing rates ranging from 20% to over 90%. The average overall testing rate was 56% when looking at only the BCBSM payers, whereas the rate was 62% when looking at all payers in the earlier version of the report from February of 2021. The report included overall testing rate (Figure 1), preoperative testing rate trends over time (Figure 1), and rates for specific tests and procedures.

Figure 1. Blinded Preoperative Testing Push Report Graphs

Due to the amount of variation, MVC suspects that preoperative testing is overused at the state level such that even hospitals that are average or below average may still have significant opportunities to safely reduce preoperative testing.

Preoperative testing, especially in low-risk surgical procedures, often provides no clinical benefits to patients. Despite this, these services continue to be ordered regularly at hospitals across Michigan. Eliminating unnecessary and, in some cases, potentially harmful preoperative testing represents a clear opportunity to improve value in surgery. The MVC Coordinating Center uses administrative claims data and engagement with MVC members to try and reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve equity of care delivery throughout Michigan. The MVC Coordinating Center’s work on this issue is supported by a stakeholder working group to advise ongoing activity and provide insights on the best approaches to improve member awareness and practices.

This latest preoperative testing report also marked the conclusion of one year’s worth of activity in support of MVC’s Preoperative Testing Value Coalition Campaign. As part of MVC’s commitment to improve the health of Michigan through sustainable, high-value healthcare, the Coordinating Center developed specific focus areas to drive improvement. These are termed ‘Value Coalition Campaigns’ (VCCs).

In an effort to communicate progress on its Preoperative Testing VCC, the Coordinating Center recently compiled a 2021 Preoperative Testing Progress Report (see Figure 2) and included it as an attachment with the most recent report communications. Accomplishments included the development of educational flyers and resources, a published manuscript, partnerships with fellow Collaborative Quality Initiatives (CQIs), and custom analytics prepared for members. In addition, the Coordinating Center set several goals for 2022, such as developing provider-level reporting and hosting a dedicated symposium or workgroup, among others.

Figure 2. MVC 2021 Preoperative Testing VCC Progress Report

The Michigan Value Collaborative is eager to reduce unnecessary preoperative testing. If you are interested in a more customized report on preoperative testing practices at your hospital or physician organization or you want to learn more about the stakeholder working group, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

18 Nov 2021
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CHF Workgroup Discusses Value of Outpatient Intravenous Diuresis

November 18, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) holds bi-monthly virtual workgroups on six different clinical areas of focus. The goal of these workgroups is to bring collaborative members together to discuss current quality improvement initiatives and challenges. These six different clinical areas include chronic disease management (CDM), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, joint, and sepsis. At the most recent MVC CHF workgroup, the discussion centered around inpatient versus outpatient intravenous diuresis for the acute exacerbation of CHF.

The prevalence of heart failure in the United States is increasing, with one study indicating it affects more than 5.7 million people. The study reports that up to 80% of patients with acute decompensated heart failure (ADHF) visit their emergency departments and that 91.5% of those patients were thereafter readmitted to the hospital for diuresis.

With increasing prevalence comes greater direct and indirect healthcare costs associated with CHF, accounting for approximately $40 billion annually in the United States. For patients over the age of 65, it is a leading cause of hospitalization with annual costs of $11 billion.

Despite significant costs and healthcare burden associated with this condition, the same study finds that no official guidance exists regarding an appropriate location for therapy. Since hospital readmission reduction programs seek to incentivize reductions in readmissions, it is important to simultaneously provide guidance to providers and patients on safe and effective options for outpatient treatment and therapy.

To address this concern, the workgroup discussed the benefits and safety of outpatient intravenous (IV) diuresis and how the outpatient administration of furosemide can be safe and effective. MVC members shared their experiences with setting up these clinics, their inclusion criteria, and other protocols. A standard diuretic protocol could include each patient being given an IV furosemide bolus with continuous infusion within the most appropriate outpatient setting, which could include the patient’s home or in a mobile clinic.

While in the outpatient setting, patients undergoing this treatment would be monitored via cardiac telemetry and appropriate blood panels before and after the infusion. Patients on maintenance medications are instructed to continue their standard dose in the outpatient setting as appropriate based on their individualized treatment protocol. Patients should follow up with their cardiology and primary care teams to maintain their treatment and care maintenance plans. Following the outpatient IV diuresis encounter, the study reported patients had lower costs, fewer hospital stays, and lower mortality risk than CHF patients who did not receive outpatient IV diuresis.

Overall, studies indicate that outpatient CHF IV diuresis treatment is a safe and effective method of relieving CHF symptoms with a low risk of adverse events. The MVC members in attendance had positive thoughts and experiences regarding outpatient IV diuresis clinics and would recommend further discussion on them. The outpatient mobile CHF diuresis clinic was of notable interest to the MVC members in attendance and will be considered for a specialty topic in future workgroups and blog posts.

The MVC Coordinating Center is interested in hearing how your organization is improving CHF patient care and reducing CHF hospital readmissions. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.