Coordinating Center Updates -

04 Nov 2021

Introducing MVC Engagement Associate Chelsea Andrews, MPH

November 4, 2021 | 0 Comments

I would like to take this opportunity to introduce myself as the Michigan Value Collaborative’s (MVC) new Engagement Associate. As the Engagement Associate, I will work closely with the Site Engagement Manager and Site Engagement Coordinator to foster collaboration among members and other stakeholders and drive outreach efforts that facilitate statewide cross-institutional learning. I am excited to join the MVC Coordinating Center and look forward to getting to know our sites and members.

Colleagues would call me a well-versed health and wellness leader with an authentic and collaborative approach to program management who creates a positive and high-performing culture. I have worked in healthcare and health research in various capacities over the past 11 years, ranging from direct patient care to administration, and have co-authored multiple medical encyclopedia entries and actively contributed to NIH research. I’m a Michigan State University alumna with a pre-medical Bachelor of Science in human biology; a specialization in bioethics, humanities, and society; and a Spanish minor. After working as a nurse assistant in various specialties, I left the state of Michigan to earn my Master’s in Public Health in health systems, management and policy at the University of Colorado. While in Colorado, I was part of the administrative team for Colorado Medicine’s Department of Obstetrics and Gynecology - Division of Maternal Fetal Medicine. Since my return to Michigan in 2019 and prior to joining the MVC, I worked at the University of Michigan School of Nursing as Program Coordinator for the Alliance to Advance Patient-Centered Cancer Care, where I defined and executed project goals and acted as a liaison between the national program office teams, grantees, and board members.

I am passionate about comprehensive patient-centric operational procedures, community engagement, and reducing healthcare disparities. When I’m not working, you can find me playing with my dog and three cats, adventuring outside, working on cars, or reading next to a fire (I’m always accepting book recommendations). If you have any questions, please reach out to me at andreche@umich.edu.

28 Oct 2021

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October 2021 MVC Semi-Annual: Virtual Meeting Recap

October 28, 2021 | 0 Comments

The Michigan Value Collaborative (MVC) held its second virtual semi-annual meeting of 2021 on Friday, October 22^nd. A total of 221 leaders from a variety of healthcare disciplines attended Friday’s virtual meeting, representing 70 different hospitals and 23 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 Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program for Program Year 2021 in light of COVID-19 and to discuss “the social risk and health equity dilemma” - a growing priority within the healthcare system generally, as well as within the MVC Coordinating Center.

MVC’s Director, Dr. Hari Nathan, started Friday’s meeting with an update from the MVC Coordinating Center, welcoming new collaborative members Munson Healthcare Manistee and Paul Oliver Memorial Hospital, and MVC’s newest Coordinating Center team members: Jana Stewart, Kristen Palframan, and Carla Novak. Dr. Nathan also highlighted some of the recent successes achieved by the Coordinating Center, including the launch of MVC’s new health equity report, increased custom analytic reporting, and the completion of over 50 virtual site visits with members this year.

Dr. Mike Thompson, MVC’s Co-Director, then shared information on the MVC Component of the BCBSM P4P Program with attendees. In investigating the impact of COVID-19 throughout the state in 2020, the MVC Coordinating Center found that 223 of the 25,627 (0.9%) episodes included in the P4P conditions from the first half of 2020 had a code for confirmed COVID-19 infection in the index event or other inpatient settings. The MVC Component of the BCBSM P4P program rewards hospitals for either making improvements over their baseline episode payment or for being less expensive than peer hospitals. The MVC team found that episodes of COVID-19 patients are generally more expensive than typical episodes. In addition, COVID-19 was not present in the baseline year of 2018 that hospitals stand to be evaluated against. Therefore, with approval from BCBSM, Dr. Thompson announced that, for Program Year 2021 only, the Coordinating Center will be removing any 2020 episode with a COVID-19 diagnosis on an inpatient facility claim during the 30-day episode if the COVID-19 ICD code is one of the first three diagnosis codes on the claim (see Figure 1). Looking ahead, a summary of participant selections for Program Years 2023 and 2024 were also shared, showing joint replacement as the most common condition selection, closely followed by congestive heart failure (CHF).

At MVC’s last semi-annual meeting in May, the Coordinating Center announced that Michigan Medicaid data had been added to MVC data sources and that the MVC Coordinating Center would be spending the subsequent months validating the data and getting it ready for member use. This work has now concluded and MVC’s Manager of Data Analytics shared what this new data source looks like. Michigan Medicaid now represents MVC’s third-largest data source, accounting for over 319,000 episodes since 2015, covering 256,889 beneficiaries, and making up 19.4% of all MVC episodes. With this new addition, MVC data sources now comprise over 80% of Michigan’s insured population, all of which are available for members to utilize on the MVC registry.

To set the scene for our guest speakers, MVC Analyst Bonnie Cheng provided an overview of MVC’s recent health equity report (see Figure 2), highlighting racial, ethnic, and dual-eligibility variation across Michigan. The MVC Coordinating Center will look to build on this new report and undertake new activities in this area to support member activity moving forward. This will be supported by the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) collaborative – a new group recently launched as part of the Collaborative Quality Initiative (CQI) portfolio. With this in mind, MVC was joined by MSHIELD Program Manager Carol Gray to introduce this new collaborative and describe how MSHIELD will seek to interface with the health system and local communities to drive change (see Figure 3).

After hearing from MSHIELD, MVC welcomed guest speaker Dr. Nicole J. Franklin from McLaren Flint hospital. Dr. Franklin provided insight as to how McLaren Flint has devoted time and effort to bridge the gap between health and social care. This placed particular emphasis on the use of six representative sub-committees (employee resource, patient outcomes, community outreach, employee education, talent acquisition, and cultural calendar) to achieve McLaren Flint’s commitment to creating an inclusive and equitable environment where everyone is valued and empowered for success. Representing the Integrated Health Association (IHA), Leah Corneail shared how IHA has worked to actively screen and address patient social influencers of health (SIOH). This emphasized the importance of collecting actionable data through IHA’s SIOH questionnaire and the use of these data through an interactive population health dashboard (see Figure 4). The last guest speaker of the day was Melissa Gary, Community Liaison for Great Lakes Physicians Organization (GLPO). As well as providing an overview of GLPO, Melissa detailed how the organization has used a social determinants of health questionnaire and monthly tracking log to address the needs of over 2000 patients in 2020 alone.

To conclude Friday’s meeting, MVC Communications Specialist Jana Stewart 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 is available here. If you have questions about anything that was discussed at the semi-annual or are interested in finding out more about MVC’s offerings, 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.

21 Oct 2021

Cardiac Rehab value coalition campaign

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MVC Efforts to Improve Cardiac Rehab Enrollment in Michigan

October 21, 2021 | 0 Comments | Cardiac Rehab, value coalition campaign

Cardiac rehabilitation (CR) is designed to improve cardiovascular function and mitigate risk factors for future cardiovascular events through monitored exercise, patient education, lifestyle modifications, smoking cessation, and social support (1). For over a decade, CR has been a Class I indication in clinical guidelines for patients who have had a heart attack, chronic stable angina, chronic heart failure, or have undergone a percutaneous coronary intervention (PCI), surgical (SAVR) or transcatheter aortic valve replacement (TAVR), or coronary artery bypass grafting (CABG). The evidence supporting CR as a high-value therapy for patients is clear: better long-term survival, fewer secondary cardiovascular events, fewer readmissions, improved quality of life, and lower healthcare utilization (2–6).

Unfortunately, only a fraction of Michigan residents eligible for CR attend a single session following hospitalization for a qualifying condition, with rates as high as 59% for patients undergoing CABG and as low as 4% for patients with congestive heart failure (CHF) (see Figure 1). These data highlight that we as a state are well short of the national goal set by the Million Hearts Initiative of 70% enrollment for all eligible patients. Data from Michigan also suggests wide variation in CR enrollment across hospitals that are not fully explained by differences in patient case-mix (7).

Since 2019 the MVC Coordinating Center sought to equitably increase participation in CR for all eligible individuals in Michigan in partnership with the Blue Cross Blue Shield Cardiovascular Consortium (BMC2) and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). In an effort to drive improvement in this area across the collaborative’s membership, MVC developed a number of resources and strategies. For example, the MVC Coordinating Center built hospital-level reports that provide members with information on CR enrollment across eligible conditions benchmarked against all MVC hospitals. This week the newest iteration of this CR report was distributed to members. The previous version of the report was sent in March 2021 with a reporting period of 1/1/17 – 12/31/19. The latest version shifted that reporting period by six months (7/1/17 – 6/30/20), included Medicaid episodes for the first time, expanded the time horizon from 90 days to one year, and added information on CHF and acute myocardial infarction (AMI) episodes.

With the addition of CHF and AMI (both “high-volume” MVC conditions), the number of hospitals eligible to receive a CR report doubled from 47 to 95, so many MVC hospitals received this report for the first time this month. The most significant methodological change compared to the previous report was the expansion of the episode window from 90 days to 365 days (one year). Previous reports undercounted the number of CR visits by using the standard MVC episode length of 90 days when a full CR program consists of 36 sessions, which are often not feasible to complete in 90 days. Therefore, it was important to expand the time horizon to achieve a fuller count. The report instead looked one full year beyond the index event (either PCI, TAVR, SAVR, CABG, CHF, or AMI) to calculate CR utilization rates and number of visits.

The MVC team also convened a multidisciplinary stakeholder group of CR practitioners, physicians, and CQI leaders to foster discussion around barriers and facilitators to CR enrollment. Many of the recent changes to the CR reports were a direct result of suggestions from this stakeholder group. Quarterly seminars have also provided opportunities for local facilities to share ongoing quality improvement activities and to learn from national leaders about innovations in the delivery and quality of CR.

More recently, the MVC team conducted virtual site visits with several CR facilities around the state to learn about their programs, the successes and challenges they have encountered, and ways to improve collaboration in Michigan around CR enrollment. Common themes emerged as barriers to CR enrollment, including lack of patient or physician engagement, geographical and/or technological gaps in care between the hospital and CR facility, and insurance coverage and reimbursement. Through collaborative learning and dissemination of best practices, the MVC Coordinating Center believes that its members can begin to address many of these challenges moving forward.

These efforts are all the more important as CR facilities begin to recover from the effects of the COVID-19 pandemic. Many facilities had to reduce capacity and staff as a result of the pandemic, and the number of CR visits declined significantly compared to pre-pandemic months (see Figure 2). While many CR facilities are back to operating at full capacity, continued efforts will be needed to return CR enrollment to pre-pandemic levels. Some sites in Michigan have adopted virtual, home-based, or hybrid versions of CR to continue providing care to patients throughout the pandemic, and its place as a substitute for facility-based CR will require continued exploration that can be supported through collaborative efforts.

14 Oct 2021

physician organizations

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MVC Releases New Physician Organization Joint Report

October 14, 2021 | 0 Comments | physician organizations

Taking care of patients is the most important responsibility of the healthcare industry. To achieve optimal care, providers require robust and valuable resources that support their efforts. At MVC’s inception in 2013, the primary focus was the development of hospital-based metrics to improve patient outcomes, reduce healthcare costs, and encourage hospitals to collaborate in best practice sharing. MVC has since expanded its focus outside the hospital walls, recruiting all 40 physician organizations (POs) to participate as MVC members and collaborate to improve the health of Michigan through sustainable, high-value healthcare.

In April of 2021, MVC released its first PO population-level report containing data on health care utilization, allowing POs to benchmark themselves against all MVC PO members. To ensure the continued provision of the highest quality information, MVC engages regularly with PO members to solicit feedback on MVC outputs and to understand their priorities. For example, feedback from MVC’s first PO-specific report resulted in the MVC Coordinating Center updating its patient attribution process to align with that of its Blue Cross Blue Shield of Michigan (BCBSM) partners and their Physician Group Incentive Program (PGIP). As a result, MVC members are attributed to their respective POs with Blue Cross attribution methodology. The MVC Coordinating Center continues to leverage input from these stakeholders to drive the formation of PO-specific reports (see Figure 1).

A new PO report released this week focuses on episode-based metrics related to joint replacement surgery. This report utilizes updated methodologies and is comprised of administrative claims from attributed members spanning 1/1/19 – 12/31/20 for BCBSM PPO Commercial and BCBSM Medicare Advantage. Reports were prepared for all POs that participate in MVC and had at least 11 joint replacement surgeries per year in 2019 and 2020, respectively. The selection of metrics contained in this report is a result of feedback from PO members and BCBSM.

The new PO Joint Replacement Report includes:

Top five facilities where attributed patients had a joint replacement surgery
Percent of joint replacement surgeries performed in an inpatient setting by six-month interval
Percent of joint replacement surgeries performed in the inpatient setting
Utilization rate after a joint replacement surgery in the inpatient/outpatient setting for the following:
- Home health care
- Skilled nursing facility (SNF)
- Emergency department (ED)

The MVC Coordinating Center is stratifying metrics by employed vs. independent PO using BCBSM’s Summer 2021 PGIP physician list. Therefore, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with fewer than 50% are considered independent.

The report indicates a downward trend over time in the percent of surgeries performed in the inpatient setting (see Figure 2). This is a positive finding given the push for joint replacements to occur in the outpatient setting; however, it is unclear whether COVID-19 was a factor in this decrease given that the reporting period includes 2020.

07 Oct 2021

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MVC Component of the BCBSM P4P Program Year 2021 Update

October 7, 2021 | 0 Comments

The COVID-19 pandemic impacted hospitals throughout the state in 2020 and the MVC Coordinating Center deemed it necessary to evaluate the effect of COVID-19 on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) program. The goal was to determine if adjustments needed to be made to maintain fairness across the collaborative for index admissions in the calendar year of 2020, which will be used to score the 2021 program year.

The MVC Coordinating Center found that 223 of the 25,627 (0.9%) episodes included in the P4P conditions from the first half of 2020 had a code for confirmed COVID-19 infection in the index event or other inpatient settings. Pneumonia and congestive heart failure (CHF) were the most common conditions to have a COVID-19 diagnosis.

The MVC Component of the BCBSM P4P program rewards hospitals for either making improvements over their baseline episode payment or for being less expensive than peer hospitals. The MVC Coordinating Center has also found that episodes of COVID-19 patients are generally more expensive than typical episodes. Additionally, COVID-19 was not present in the baseline year of 2018 that hospitals will be evaluated against and hospitals were impacted differently.

Therefore, with approval from BCBSM, the MVC Coordinating Center will remove any 2020 episode with a COVID-19 diagnosis on an inpatient facility claim during the 30-day episode if the COVID-19 ICD code is one of the first three diagnosis codes on the claim. Please contact the MVC Coordinating Center with any questions at michiganvaluecollaborative@gmail.com.

30 Sep 2021

Michigan Value Collaborative Semi-Annual Event

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Fall Semi-Annual Meeting Agenda Highlights Health Equity Topics

September 30, 2021 | 0 Comments | Michigan Value Collaborative, Semi-Annual Event

The MVC Coordinating Center recently released the full agenda for its forthcoming fall Semi-Annual Meeting on Friday, October 22, 2021, from 10:00-11:30 am. The MVC Coordinating Center holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This year’s theme of “the social risk and health equity dilemma” is reflective of a growing priority within the healthcare system generally, as well as newer activities within the MVC Coordinating Center.

Speakers at semi-annual events are often members who share their stories of success, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers outlined on October’s agenda showcase the breadth and depth of knowledge that exists within the collaborative in the health equity space. They also represent a variety of stakeholder groups, including hospitals, physician organizations (POs), Collaborative Quality Improvement (CQIs) programs, and of course MVC Coordinating Center leadership.

The first guest speaker will be Carol Gray, Program Manager of the new Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) CQI. She leads the overall management, performance, and coordination of the MSHIELD program and Coordinating Center 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 in Detroit and academic faculty at the University of Michigan. Her presentation on, “Aligning Partnerships to Achieve Health Equity,” will speak to that expertise.

The meeting also features the expertise of Dr. Nicole J. Franklin, Assistant Medical Director at the McLaren Bariatric and Metabolic Institute. She provides psychological support to bariatric patients before and after weight loss surgery. In addition, Dr. Franklin is the chair of the Diversity and Inclusion Committee at McLaren Flint and has co-facilitated the Diversity Committee within all three local hospitals’ psychology training programs for the last 10 years. She is an Air Force veteran and a graduate of Wright State University’s School of Professional Psychology. Referencing her work within the greater Flint community, her session will address, “The Health Gap: An Exploration of how one hospital is working to bridge the gaps between health care and social care.”

Another perspective will be brought by Leah Corneail, Director of Utilization and Population Health at the Integrated Healthcare Association (IHA). In this role, she is responsible for leading utilization and cost improvement efforts, ensuring success in risk-based contracts and CMS demonstration programs, and collaborating with community partners to improve population health. Corneail has several years of experience in population health and health policy. Prior to joining IHA, she served as a Senior Project Manager in the Michigan Medicine Population Health Office, where she managed Michigan Medicine’s portfolio of value-based payment models and partnered with operations to implement care transformation initiatives. Leah received her Master of Public Health degree from The George Washington University’s Milken Institute School of Public Health. She will speak to, “IHA Efforts to Screen and Address Patient Social Influencers of Health (SIOH).”

Also representing the approach of a PO will be Melissa Gary, Community Liaison with the Great Lakes Physician Organization (GLPO). In this role, Melissa is responsible for bridging the gap between healthcare providers of GLPO and the local community agencies to better align the mission of GLPO. Utilizing her several years of experience in healthcare and nonprofit organizations, she has built the GLPO social determinants of health process. She is a passionate community servant with the ability to motivate and inspire individuals to identify their own potential and shares in the passion to serve others. Melissa is a graduate from Ferris State University where she studied nuclear medicine and healthcare administration. She has minors in science, biology, pre-pharmacy and paralegal.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about MVC’s Medicaid data, the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and general program updates.

These presentations could be informative and useful for any of the following stakeholders who are welcome to attend:

MVC Hospital Site Coordinators and Champions
MVC Physician Organization Site Coordinators
Quality Leadership
Clinicians
Managers and front-line staff in the following clinical areas:
- Population health
- Chronic disease management
- Post-acute care
- Value-based care
- Care coordination
- Discharge planning
- Social work
- Others whose work addresses health equity or social risk factors

In addition, hospitals that have attended both of MVC's 2021 Semi-Annual Events (May 2021 and October 2021) will be eligible for one additional bonus point toward Program Year 2021 of the MVC Component of the BCBSM P4P Program.

Those interested in attending this informative and collaborative meeting should register here. The MVC Coordinating Center looks forward to a fantastic meeting. See you there!

02 Sep 2021

Joint, CHF Top Members’ Selections for MVC P4P Program

September 2, 2021 | 0 Comments

The MVC Coordinating Center recently distributed condition selection reports for Program Years 2022 and 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The reports were provided in conjunction with details pertaining to the condition selection process, as well as changes to the scoring methodology, cohort assignments, and bonus points available. More details about those changes was published in a previous MVC Coordinating Center blog.

Eligible members were tasked with reviewing these reports and returning their condition selection form at the end of August. Each participating hospital selected two of the seven available conditions for PY22 and PY23: spine surgery, joint replacement, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafting (CABG), congestive heart failure (CHF), colectomy (non-cancer), and pneumonia. The condition that was selected by the most participants was joint replacement with 41 hospitals selecting it, followed closely by CHF with 40 selections. COPD was selected by 32 hospitals. See Figure 1 for a depiction of the total selections for each condition.

Conversely, larger hospitals that perform more complex procedures made up the totality of selections for spinal surgery, colectomy, and CABG. Still, joint replacement and CHF were the most commonly selected conditions among all hospital sizes.

Similarly, CHF and joint replacement were popular among all hospitals regardless of location type, such as urban or rural (see Figure 3), or location within the state (see Figure 4), with the exception of Region 4 hospitals selecting COPD more frequently than joint replacement.

With the majority of hospitals focusing on both joint replacement and CHF, the MVC Coordinating Center hopes that continued participation at the joint and CHF workgroups will result in meaningful collaboration among members. MVC will also continue to offer events for virtual networking with facilities and physician organizations (POs) within a member’s geographic region (see Figure 5). These regional networking events provide additional opportunities to connect and share knowledge with peers who may share your hospital’s priorities. For instance, the next Coffee, Chat, and Collaborate virtual networking event takes place among hospitals and POs in Region 1 on Monday, September 13, at noon. Members from Region 1 interested in attending can register here.

P4P cohorts were reassigned for PY22 and PY23. These changes were also detailed in the new technical document, and the new cohort assignments were published on the MVC website. The cohorts were not intended to group hospitals that are exactly alike; rather, they created a reasonably comparable grouping from which MVC can complete statistical analyses.

This program began in 2018, when BCBSM allocated 10% of its P4P program to an episode of care spending metric based on MVC data. This metric measures hospital performance using price-standardized, risk-adjusted 30-day episode payments for BCBSM Preferred Provider Organization (PPO), Medicare Fee-for-Service (FFS), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), and BCN Medicare Advantage.

If you would like to receive notices about the MVC workgroups or have questions about any aspect of the MVC Component of the BCBSM P4P Program, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

26 Aug 2021

health equity social determinants of health social risk

MVC Coordinating Center Launches Health Equity Report

August 26, 2021 | 0 Comments | health equity, social determinants of health, social risk

As hospitals begin to identify lessons learned since the start of the pandemic, providers are keenly aware of the prevalence and exacerbation of existing health inequities. Despite the fact that many providers are increasingly interested in addressing the social determinants of health (SDOH) and equitable access to care, communities of color and other minorities that are statistically more impacted by SDOH and socioeconomic status (SES) have endured even wider gaps in health outcomes and care this past year. For many hospitals and physician organizations, the way forward requires the application of a health equity or social risk lens across the board, so that basic healthcare and quality improvement decision-making can be maximized for all patient populations, not just those with fewer social risk factors. The MVC Coordinating Center is, therefore, proud to have released its first MVC Health Equity Report to its membership on Wednesday morning.

MVC began developing metrics for its membership in this area over the past year so providers might better understand where inequities are materializing within the four walls of their hospitals and beyond. One popular method for identifying low-SES patients is by determining where someone lives and applying population-level metrics to the individual. Examples of this would be using the Area Deprivation Index (ADI) or Social Vulnerability Index (SVI). Both indexes are based on census tract data and provide SES characteristics about a population within a specific geographic location (i.e., a census tract), including risk factors such as poverty, education level, transportation access, and housing security. However, in developing the MVC Health Equity Report, the MVC Coordinating Center elected to utilize a patient-level metric of SES that is compatible with MVC claims data. As a result, the report identifies low-SES patients using dual-eligibility status.

Dual-eligible beneficiaries are patients that are eligible for both Medicare and Medicaid. In the MVC Health Equity Report, dual eligibility is defined as having been eligible for both Medicare and Medicaid at any point during the year of the index admission and is limited to patients that were at least 65 years old at the time of admission. Medicaid eligibility is a good indicator of SES when using claims data since it is income-based, and studies have shown that there is a strong association between low-income status and adverse health outcomes. Dual eligibility allows MVC analysts to identify Medicaid-eligible patients within its more extensive Medicare data set for analyses. Medicare data on the MVC registry currently includes claims data from 1/1/2015 through 9/30/2020. The resulting reports prepared for members focuses on episodes occurring between 2017 and 2020, or between 2017 and 2019 if the circumstances of 2020 resulted in unusual case counts by facility.

In developing this report, there was a conscious decision to exclude any sort of comparison group alongside each individual hospital's metrics. This is because the socioeconomic factors of a hospital’s patient population cannot be changed, and there is great diversity between hospitals throughout the state and within geographic regions. For those reasons, benchmarking was not the intention of this report. However, it is important to note that across the state, the data analyzed by the MVC Coordinating Center consistently indicates that dual-eligible patients have poorer outcomes than their non-dual-eligible counterparts, including longer lengths of stay, higher readmission rates, higher post-discharge emergency department utilization, lower rates of office visits post-discharge, higher rates of post-discharge outpatient procedures, and higher utilization of skilled nursing facilities. Blinded sample graphs for length of stay (Figure 1) and readmission rates (Figure 2) were created using data from three distinct, large hospitals in order to showcase some of these differences.

Members receiving reports will see a variety of graphs depicting, for example, total episode payment trends, 30-day readmission rate trends, and post-acute care utilization. Also provided is a table outlining a hospital or region’s highest volume of conditions within its dual-eligible population (see Figure 3 for a blinded sample). The purpose of this table is to help members better understand the proportion of dual-eligible patients at their hospital and the prevalence of various conditions within that population. It will also help members to better understand their report overall by identifying the conditions and procedures driving the various metrics included within it.

MVC is eager to do more in this space in the months ahead. With the recently added Michigan Medicaid data on the MVC registry, the Coordinating Center has a new opportunity to more closely examine the types of disparities that are prevalent in healthcare. Additionally, with the addition of 13 rural or critical access hospitals to the collaborative in the past 12 months, the Coordinating Center aims to expand its metrics outside of the episode structure to examine population health metrics. This will allow for better understanding about healthcare delivery and how outcomes differ in rural regions compared to urban.

The MVC Coordinating Center wants to hear feedback from its members. With the addition of Medicaid data, we are working hard to develop more metrics and reports that focus on health equity. If you have any questions, comments, or suggestions, please contact the MVC Coordinating Center at michiganvaluecollabortative@gmail.com.

05 Aug 2021

Medicaid

MVC Registry Expands with Addition of Medicaid Episodes

August 5, 2021 | 0 Comments | Medicaid

The Michigan Value Collaborative (MVC) Coordinating Center recently added Medicaid data to its registry. This update reflects the culmination of many months of work to acquire, process, clean, and add the data, which became available on July 16 to MVC registry users. The current data set is from 1/1/15 through 9/30/19, which amounts to claims from 1/1/15 through 12/31/19. MVC data sources now comprise over 80% of Michigan’s insured population. This represents an additional 1.8 million covered lives (see Figure 1). MVC’s data sources now include Medicare FFS, Commercial Blue Cross Blue Shield of Michigan (BCBSM) PPO, Medicare Advantage BCBSM PPO, Commercial Blue Care Network (BCN) HMO, Medicare Advantage BCN, and Michigan Medicaid.

MVC currently serves 97 participating hospitals, including critical access members, and 40 physician organizations in Michigan. The proportion of Medicaid episodes in MVC data by facility (Figure 3) varies significantly across MVC’s membership, with some members attributing less than 5% of their episodes to Medicaid and some near 60%. For the bulk of MVC’s membership, between 10% and 30% of their episodes are in Medicaid, which represents a significant increase in the total episodes they can now utilize. For some MVC hospitals, the number of episodes they have in MVC data may double if they have a large share of Medicaid patients.

MVC currently provides data on 40 defined conditions. The addition of Medicaid data is likely to impact certain conditions more than others in keeping with the types of procedures and conditions most prevalent with Medicaid-eligible populations. The top five Medicaid conditions include sepsis, C-section, vaginal delivery, cholecystectomy, and chronic obstructive pulmonary disease (COPD), so members are more likely to see changes to their utilization data for those conditions. The number of episodes being added for each condition is outlined in Figure 4.

The Medicaid data will also allow for the creation of new data visualizations and reports that capture information not previously available. For example, MVC analysts recently generated two new Medicaid-based maps (Figures 5 and 6) that help visualize utilization and location information for the Medicaid population. Figure 5 represents the patient Zip codes that can be attributed to Medicaid episodes in MVC data, with Zip codes appearing darker if a larger percentage of Medicaid patients reside there. This allows members to see those communities near their own facilities that are likely home to the Medicaid patients they serve.

Figure 6 also represents the percentage of episodes attributed to Medicaid patients, with darker colors representative of higher percentages; however, Figure 6 connects these Medicaid episodes to MVC member facilities rather than Zip codes and visualizes the total number of episodes in addition to the percentage. Together, these two figures provide MVC members with more information about their Medicaid populations as well as the extent to which utilization varies between peer facilities in the same region.

These maps are the first example of new outputs that are possible with the addition of Medicaid data. The MVC Coordinating Center plans to produce additional reports for members that leverage the new data set. One area of interest is the social determinants of health. Since Medicaid provides medical assistance to disabled and low-income individuals, statistical analysis using this data often reflects trends tied to low socioeconomic status populations. Ideally, this data set will allow MVC and its members to invest more attention and resources into equity-based quality improvement projects.

The MVC Coordinating Center is eager to learn which topics are of greatest interest to members that integrate Medicaid claims. If your team has specific ideas that could help guide this work, please contact MVC at michiganvaluecollaborative@gmail.com.

22 Jul 2021

Condition Selection Process Announced for MVC Component of BCBSM P4P Program

July 22, 2021 | 0 Comments

In the announcement, hospitals were tasked with selecting two conditions for which they will be evaluated and returning their condition selection form to the Coordinating Center by Friday, August 13, 2021. The announcement also outlined changes to the scoring methodology, cohort assignments, and bonus points available.

The Coordinating Center’s recent announcement included condition selection reports with targets for each condition option that may help inform hospitals’ selection decisions. Each participating hospital will choose two of the seven available conditions for PY22 and PY23: spine surgery, joint replacement, chronic obstructive pulmonary disease (COPD), coronary artery bypass grafting (CABG), congestive heart failure (CHF), colectomy (non-cancer), and pneumonia. When selecting conditions, the Coordinating Center recommends reviewing your data in the registry and considering several factors for each condition, including case counts and identifiable areas with the greatest cost opportunities. The Coordinating Center also recommends considering where resources are currently being directed in your facility and potentially aligning with those efforts.

One notable change from prior program years is the methodology by which hospitals earn achievement and improvement points. Hospital scores will continue to be based on a hospital’s risk-adjusted, price-standardized total episode payments for two selected conditions, and they can still earn a maximum score of 10 points. However, the improvement and achievement scores will become more similar in order to be placed on the same scale. As such, the achievement equation will change from being based on rank within MVC cohort at performance year to being based on distance from MVC cohort mean at baseline year. Similarly, the improvement equation will utilize the distance from the hospital’s mean at baseline. These new equations (see Figure 2) as well as complete descriptions of the updated methodologies are reviewed at length with examples in the technical document.

P4P cohorts have also been reassigned for PY22 and PY23. These changes are also detailed in the technical document, and the new cohort assignments can be found on the MVC website. The cohorts are not intended to group hospitals that are exactly alike; rather, they create a reasonably-comparable grouping from which MVC can complete statistical analysis.

The final change is to the awarding of bonus points. In place of the previous 5% cohort reduction bonus, participants can instead earn bonus points by completing two questionnaires (one per selected condition) and submitting these to the Coordinating Center by November 1st of each program year. The purpose of this is to gather examples of quality improvement initiatives in operation at MVC member hospitals to share with the Collaborative. Moving forward, this will help support members in reducing costs through collaboration.

Each of the changes mentioned above are designed to deliver a more transparent, intuitive, flexible, and fairer P4P program. The Coordinating Center will offer an explainer webinar to answer questions and walk through the details of these changes in more detail. The webinar will be offered on two dates: the first is scheduled for Thursday, July 29 from 11:00-12:00 pm, and the second is on Tuesday, August 3 from 1:00-2:00 pm. Both webinars can be accessed using the following Zoom link: https://umich.zoom.us/j/95502303999. Participants can also call +1 301 715 8592 (meeting ID #955 0230 3999). For those interested in the explainer webinar who are unavailable on both dates, a recording of the first webinar will be available. If you are interested in receiving a link to this recording, please email the MVC team at michiganvaluecollaborative@gmail.com.

Archive

Figure 1. MVC Slide on Updates to MVC Component of BCBSM P4P Program for PY21

Figure 2. MVC Slide on New MVC Health Equity Report

Figure 3. MSHIELD Slide on MSHIELD's Role as a CQI

Figure 4. IHA Slide on Social Influencers of Health Dashboard

Figure 1. Collaborative-wide CR enrollment rates for qualifying conditions (01/2017-12/2019)

Figure 2. Changes in CR enrollment from 2019 to 2020 over time and by qualifying condition

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