Coordinating Center Updates -

04 Jan 2024

MVC Coordinating Center Looking Back at 2023 and Forward to 2024

January 4, 2024 | 0 Comments

On behalf of the MVC Coordinating Center, I’d like to start by wishing you all a very happy and healthy new year! MVC had an outstanding 2023, which included celebrating our 10th anniversary and continued support of our hospital and physician organization members along with CQI partners.

Throughout 2023, MVC welcomed three new hospital members to the collaborative, distributed 17 push reports, grew its analytic offerings by adding ED-based episodes of care, delivered 24 custom analytic requests, hosted 24 virtual workgroups across six focus areas, advanced both of its value coalition campaigns, completed 37 member meet and greets, and hosted two collaborative-wide meetings. Additionally, several exciting improvements were made to the MVC registry, including new reports for payment and value metrics for Program Year (PY) 2024-2025 of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program along with new measures and filters for long term acute care hospital utilization.

As MVC begins its 11^th year, the Coordinating Center is excited to continue to advance the vision of more sustainable, high-value healthcare in Michigan. As highlighted in a recent blog outlining MVC’s refreshed strategy, there are a number of developments planned to advance our work in the areas of population health management, sites of care across the continuum, patient-centeredness, and equity. In addition to these strategic pillars, MVC has several operational plans for the coming year that I am excited to share with you.

New Engagement Point Menu for PY 2024

For hospital members participating in the MVC Component of the BCBSM P4P program, PY 2024 kicks off the new engagement point component of the program cycle’s scoring structure, which was developed as a mechanism for increasing and enhancing collaborative learning across the MVC network. Using MVC’s engagement point menu, participating members can choose the MVC engagement offerings that best meet the needs of their site to earn up to two points toward their PY 2024 score. Please visit MVC’s PY 2024 Engagement Point Menu for a complete list of offerings. For additional information on MVC’s PY 2024 engagement point component, you may access the MVC PY 2024 Engagement Point Webinar.

Actionable Data through MVC Push Reports

In 2024, MVC will continue to provide members with site-specific push reports to support quality improvement. Several new reports will be added to MVC’s suite of reporting in 2024, focusing on topics such as statewide health equity, pharmacy utilization, and alternative sites of care. The Coordinating Center will work closely with members, the broader CQI community, and other stakeholders to ensure the continued distribution of novel and valuable reporting.

Collaborative-Wide Meetings and Virtual Workgroups

The MVC Coordinating Center will host two collaborative-wide meetings in 2024. MVC’s spring 2024 meeting will take place on Friday, May 10 at the H Hotel in Midland, and the fall 2024 meeting will be held on Friday, October 25 at the VistaTech Center in Livonia. We are in the process of planning engaging agendas and are excited to see you in person at these events. Keep an eye on MVC’s blog as additional details are announced throughout the year.

Additionally, the Coordinating Center’s suite of peer-to-peer virtual workgroups will continue to provide a highly accessible online platform for hospital and PO members to come together, collaborate, and share practices. The 2024 workgroups will include series focused on MVC’s PY 2024-2025 P4P value metrics – cardiac rehabilitation, post-discharge follow-up, preoperative testing, and sepsis – along with a health in action series and a newly launched rural health series. To review the complete list and register for specific workgroup dates, please visit MVC’s 2024 Events Calendar.

Assessing Value and Site-Specific Opportunities

The MVC Coordinating Center continued its efforts in 2023 to help partners measure the impact of their initiatives from an investment and value perspective. MVC’s expertise in this area and its strong relationships throughout the CQI portfolio led to the commission and completion of three value assessment exercises last year with additional value assessments underway for 2024. Similarly, MVC continues to offer its members the ability to request custom analyses to better understand site-specific areas of interest and opportunity. If you are interested in a custom report, please submit a Custom Analytics Request and a member of the MVC team will follow up.

As we kick off 2024, I’d like to thank our hospital members, PO members, and CQI partners for their continued collaboration and support. We look forward to working with you throughout the coming year!

14 Dec 2023

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MVC Looks to the Future in Launch of Refreshed Strategy

December 14, 2023 | 0 Comments

You may have noticed MVC celebrating something special this year. If you haven’t guessed from our celebratory blogs, collaborative-wide meeting spotlights, and rather subtle email signatures, MVC is now 10 years old. It’s something as a Coordinating Center that we are incredibly proud of, and we thank each of you for your partnership in helping to grow the collaborative over the years.

MVC’s evolution as a collaborative has been informed by continued member insights and driven by dedicated strategic planning and considered implementation. As we look ahead to the next 10 years of operation and ensure MVC’s support offering continues to align with the future of value-driven healthcare, this practice of leveraging member feedback to shape development will continue to take center stage.

Over the last six months, we engaged with our members and other stakeholders to gather input on what is working well and needs to be protected, as well as taking time to identify where there are opportunities to introduce new service offerings. If we haven’t engaged with you directly and you have ideas, we’d love to hear them. The insights we received to date helped inform our collective vision as to what value-driven healthcare truly looks like and ultimately where MVC fits into this puzzle. I’m excited to share some of this thinking and highlight a number of new related developments we will tackle in the coming years.

As we see it, the pursuit of value in healthcare requires recognizing and embracing three key imperatives. First, although fee-for-service reimbursement will persist for the foreseeable future, population health management will continue to be the chief lever used by policymakers, payers, and providers to manage risk and cost. As payment arrangements further embrace two-sided risk, healthcare providers will need to refine internal processes to strengthen their understanding of their patient population, appreciate its heterogeneity, and respond nimbly to anticipate and optimize resource utilization. Understanding the entirety of the patient’s care pathway across providers and facilities is critical to identifying opportunities to optimize health, coordinate care, and mitigate utilization for acute illness, especially for patients with chronic conditions.

Inpatient care will continue to be a major driver of expenditures, and benchmarking of hospital-based services will continue to be a valuable tool to improve quality and control costs. However, there is an opportunity to conceptualize care delivery more broadly. Developing a more holistic approach to understanding utilization will not only allow for a more complete assessment of where expenditures occur but will also help better identify opportunities for savings. Sites of care exist along a continuum that includes large referral hospitals on one end but stretches as far as the patient’s home on the other. There are multiple options on this continuum—including community hospitals, physician offices, community health centers, ambulatory surgery centers (ASCs), hospital outpatient departments (HOPDs), pharmacies, skilled nursing facilities (SNFs), hospital-at-home, telehealth, and even wearable technology. All must be considered as options to rationalize sites and providers of care and right-size resources to the needs of the patient.

Finally, morbidity and mortality will continue to be important quality metrics, but our definition of quality needs to expand to include patient-centeredness and equity. We need to avoid adverse outcomes and promote positive behaviors, attitudes, and interactions with the healthcare system. Inadequate attention to the social and physical context in which patients live and work will diminish the effectiveness of health interventions and lead to waste. More importantly, understanding and accounting for social influencers of health is a critical element in the shift from treating illness to promoting health.

These three elements will be used to help shape our activity moving forward, both in terms of strengthening existing analytic and engagement platforms and delivering new innovative offerings to help drive member quality improvement efforts. Here’s a sneak peek of some of MVC’s future development areas:

Incorporating Pharmacy Claims

To better understand utilization, pinpoint where expenditures occur, and identify where savings can be made, we will look to consider all sites and providers of care that exist along the continuum. This includes pharmacies and related prescription drug spending. MVC now possesses pharmacy-level data for all sources, and efforts will be directed toward successfully integrating these claims across our existing infrastructure and future planned activity.

Integrating Michigan Medicaid and ED Episode Data

To help strengthen member understanding of their respective patient populations, MVC will leverage the recent receipt of Medicaid data to develop new value-add data offerings in the areas of health equity, women’s health, and pediatric care. Similarly, the creation of new episodes initiated by emergency department (ED) visits will be built upon to provide actionable information on care transitions and the trajectory of care for patients visiting the ED.

Broadening Beyond Inpatient Episodes

The various avenues a patient may take as part of their care pathway highlight the challenges of delivering and understanding coordinated care delivery. An episode-based approach helps to navigate these problems but only takes us so far, with some patients (e.g., those with ambulatory care-based events) still being overlooked. To reflect the importance of population health management, sites and providers of care, patient-centeredness, and equity in all MVC work, efforts will be directed to creatively broaden our data offering beyond inpatient episodes.

Incorporating Ambulatory Surgical Centers

To achieve our aim of considering all sites that exist along the care pathway, our efforts will first be directed towards incorporating ASCs into the collaborative. Many questions regarding the cost and quality of care provided at ASCs remain unanswered. This effort will aim to leverage MVC’s existing infrastructure and explore the introduction of innovative activities to answer such questions and encourage ASC participation.

Reflecting System Level Activity

In recent years, there has been a notable rise in hospital consolidation across Michigan. These developments have placed increased emphasis on the need for MVC to explore, develop, and implement new approaches aimed at supporting quality improvement efforts at the system level. This will look to build on our existing system reporting and engagement activity to better understand how these entities approach care delivery, what the related patient pathway looks like, and how this impacts other pieces of operation, including related incentive programs.

Emphasizing Equity in Healthcare

MVC has successfully integrated health equity and social risk measures into its existing reporting infrastructure. Moving forward, the Coordinating Center will look to discuss these different offerings and their perceived value with members to better understand their priorities and gaps in knowledge. From our discussions with members to date, it has been evident that many are still in an information-gathering phase and desire consensus around best practices. MVC will seek to identify differing approaches to health equity across the collaborative. Through enriching its understanding of member initiatives in the health equity space, MVC can identify common ground and communicate those findings through existing engagement platforms.

As always, we want each of these new developments to be reflective of member needs and feedback. If you have a particular interest in any of these areas or have ideas on what would be most helpful to your daily activities, please get in touch (Michigan-Value-Collaborative@med.umich.edu). We look forward to hearing from you and continuing to work together to improve the health of Michigan through sustainable, high-value healthcare.

08 Dec 2023

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MVC Announces Key Event Dates in 2024 Engagement Calendar

December 8, 2023 | 0 Comments

The Michigan Value Collaborative (MVC) offers several opportunities for hospitals and physician organizations (PO) to collaborate and share best practices, from collaborative-wide meetings and workgroups to regional networking events and virtual webinars. MVC is thrilled to share its 2024 event calendar with a full list of currently scheduled events and registration links. Some events have yet to be scheduled for 2024, such as networking events or ad hoc webinars. Once scheduled, the 2024 calendar will be updated to include those dates and posted to the MVC events page.

Collaborative-Wide Meetings

MVC holds collaborative-wide meetings twice each year to bring together quality leaders from across the state for networking and peer learning. MVC usually shares updates and unblinded data and invites guest speakers to share success stories on topics of interest to members.

MVC will host its spring collaborative-wide meeting on Friday, May 10, 2024, in Midland, MI. The fall collaborative-wide meeting is set for Friday, October 25, 2024, in Livonia, MI. Registration is not yet available for these two meetings and will be shared with members in the months leading up to each date.

MVC Workgroups

Workgroups consist of a diverse group of representatives from Michigan hospitals and POs that meet virtually to collaborate and share ideas. The 2024 workgroup topics include cardiac rehabilitation, health in action, post-discharge follow-up, preoperative testing, rural health, and sepsis. All MVC workgroups offered in 2024 will occur from 12-1 p.m.

Program Year 2024-2024 P4P Engagement Points

Many hospitals participating in the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program know that the program structure for Program Years (PYs) 2024-2025 includes up to two points for completed engagement activities. Many of the engagement offerings available to all members in 2024 will allow P4P hospitals to earn engagement points. One way that hospitals can earn engagement points is by presenting at a 2024 MVC workgroup, worth 0.5 points. Hospitals interested in presenting at a 2024 workgroup for P4P points must submit a presentation proposal form (link). For Q1 workgroup presentations in February or March, the deadline to submit presentation proposals will be extended to Dec. 15, 2023. MVC will review submissions on a rolling basis and communicate decisions and next steps as proposals are received.

The full MVC PY24 Engagement Point Menu is available here. Hospitals interested in earning P4P engagement points can mix and match from the included offerings to earn up to two points toward their PY24 scorecard. MVC hosted an Engagement Point Menu Webinar to introduce this menu and answer questions in November 2023. The webinar recording can be accessed here. In addition, MVC developed a Frequently Asked Questions guide available here.

Please email the MVC Coordinating Center at mailto:Michigan-Value-Collaborative@med.umich.edu if you have any questions.

30 Nov 2023

Cardiac Rehab Michigan Cardiac Rehabilitation Network

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Michigan Cardiac Rehab Network Hosts In-Person Stakeholder Meeting at Trinity Health

November 30, 2023 | 0 Comments | Cardiac Rehab, Michigan Cardiac Rehabilitation Network

The Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield Cardiovascular Consortium (BMC2) recently held a successful 2023 Fall Michigan Cardiac Rehab Network (MiCR) Stakeholder Meeting on Fri., Nov. 17. This was the second in-person MiCR Stakeholder Meeting since MVC and BMC2 founded the MiCR partnership in 2022. The meeting brought together 63 individuals representing 28 organizations and was co-hosted by Trinity Health Ann Arbor’s cardiac rehab team.

The day’s agenda accounted for a variety of topics, including updates and material releases by the MiCR team, presentations and panel discussions about the new MVC and BMC2 pay-for-performance measures for cardiac rehab (see slides), advice and updates about cardiac rehab billing (see slides), recent findings about liaison-mediated referrals and their impact on cardiac rehab participation after percutaneous coronary intervention (see slides), and breakout groups to help brainstorm opportunities within various focus areas.

One unique and memorable aspect of the day was the ability to learn from the meeting’s hosts, Trinity Health Ann Arbor. Professional representatives from the site included Frank Smith, MD, Medical Director of the Intensive Cardiac Rehabilitation Program for the Ann Arbor and Livingston locations, and Mansoor Qureshi, MD, Medical Director of the Cardiac Catheterization Lab and Structural Heart Program for Ann Arbor, who provided opening remarks about the importance of facilitating provider buy-in and referrals. They emphasized cardiac rehab as a key high-value service to improve patient lives. Their slides can be viewed here.

They were also joined by Amy Preston, BS, CEP, Cardiac Rehab Manager and Exercise Physiologist, who organized optional tours of the Trinity Ann Arbor rehab space. Nearly all the meeting’s attendees opted to participate in the tours to learn about the unique spaces and strategies utilized at Trinity.

The MiCR team was also thrilled to announce the launch of New Beat, a multi-component intervention developed in partnership with the Healthy Behavior Optimization for Michigan (HBOM) team (see slides). The New Beat program’s interventions address specific barriers to patient participation, such as gaps in patient or physician knowledge about benefits, the need for stronger physician endorsement, and access issues resulting from transportation barriers. The offerings developed by MiCR and HBOM to support these New Beat strategies include MiCR’s new website (MichiganCR.org), patient- and provider-facing educational materials, cardiac care cards that can be signed by providers and delivered to patient rooms prior to discharge (Figure 1), and an Uber Health pilot. In particular, please note that the interest form on the MiCR website is now open for those interested in accessing these resources or requesting others.

16 Nov 2023

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MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

November 16, 2023 | 0 Comments | health equity, MVC workgroup, rural hospitals, SDOH

Today is National Rural Health Day. Since 2010, the National Organization of State Offices of Rural Health set aside the third Thursday of every November to highlight the unique healthcare challenges facing residents within rural communities and celebrate providers who deliver innovative, affordable, and coordinated rural healthcare. MVC’s current membership includes 44 hospitals based in rural communities, 22 of which are designated as Critical Access Hospitals (CAHs). In tribute to National Rural Health Day and the needs of its growing rural membership, MVC hosted a special rural health workgroup yesterday.

The workgroup featured a guest presentation by Stephanie Pins, MSA, CPHQ. Pins is the Director of Quality, Risk, and Compliance for MyMichigan Medical Center Sault, formerly War Memorial Hospital, and is co-leading the Health Equity Council for MyMichigan Health. She led the creation of a transportation program for War Memorial Hospital by working with local transportation companies and applying for grants to cover the cost of the program.

This guest presentation focused on how MyMichigan is supporting rural communities through their Non-Emergency Medical Transportation (NEMT) Project, and the steps their team took to develop this program. Beginning in 2024, CMS will require that hospitals screen admitted patients for five social determinants of health (SDOH) domains. One of those five required domains is transportation needs since access to transportation and distance to care have a significant impact on healthcare outcomes.

MyMichigan Medical Center Sault primarily services the very rural communities of Chippewa, Luce, and Mackinac counties, located in the eastern Upper Peninsula of Michigan. A resident of Drummond Island—part of Chippewa County—may have to drive as many as 70 miles each way to get to an appointment at MyMichigan Medical Center Sault. Limited vehicle access in this part of the state was highlighted recently at MVC’s fall collaborative-wide meeting; the eastern Upper Peninsula had some of the highest rates in the state for housing units with no vehicle (Figure 1).

While presenting, Pins emphasized that once MyMichigan identifies a need through screening, the next step is to find a way to connect those patients with the assistance they need to access medical care. One transportation solution utilized by MyMichigan Medical Center Sault is the Road-to-Recovery program, offered in partnership with McLaren Northern Michigan in Petoskey. The MyMichigan Medical Center Sault location offers some oncology cancer treatment services, but not radiation, so patients may need to travel to Petoskey—a distance of over 90 miles—to receive radiation therapy as part of their cancer treatment. The fully funded Road-to-Recovery program is available five days a week free of charge to anyone in the eastern Upper Peninsula. A hospital-owned van is driven by a volunteer driver from the MyMichigan Medical Center Sault location to scheduled pick-up locations along the I-75 corridor to Petoskey. Service times are coordinated with McLaren Northern Michigan’s oncology group so all the patients using this service have aligned appointment times. Pins shared that one noteworthy ancillary benefit of this program has been the peer support and relationship building that resulted from patients traveling together for extended periods while going through a similar treatment experience.

A second transportation solution utilized by MyMichigan Medical Center Sault is the Rides-to-Wellness Program, a partnership effort with local transportation companies and Connect UP. Patients can use this service to travel to other appointments or patient care services and serves as a critical stopgap in ensuring patients have somewhere to turn for time-sensitive transportation needs. Pins shared that the patient testimonials from those utilizing the service are helpful evidence of its value to the eastern Upper Peninsula (Figure 2).

09 Nov 2023

MVC Push Reports preoperative testing

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Members to Receive Refreshed Preoperative Testing Reports

November 9, 2023 | 0 Comments | MVC Push Reports, preoperative testing

MVC hospital members will soon receive their second preoperative testing push report of 2023, providing an opportunity to benchmark progress on reducing low-value testing rates within their facility. MVC first introduced its preoperative testing push reports in 2021 to support members in reducing this low-value practice. Ordering these tests before low-risk elective and outpatient procedures often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan.

Similar to the report distributed earlier this year, members will continue to see their rates across various tests for three elective and outpatient procedures: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated in the 30 days before the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic and comprehensive metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function with index admissions from 1/1/2021 through 12/31/2022. This refreshed push report exclusively utilizes claims from the Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans. Members will receive reports if they have at least 11 index admissions in one of the three conditions and at least 20 admissions across all three conditions during the reporting period.

Like other MVC push reports, members will see a patient population snapshot table that identifies rates for preoperative testing and no preoperative testing in patients with varying demographic characteristics (Figure 1). Compared to the version received by hospitals this summer, the latest version of this report now also includes testing rates among patients who identified as Hispanic or American Indian/Alaska Native. On average, patients who had preoperative testing were older and had more than one comorbidity than patients who had no preoperative testing.

Members will see their average testing rate across all three procedures, as well as their rate for each specific procedure (Figure 2). A hospital’s combined rate can easily be compared with the average for that hospital’s geographic region within the state of Michigan as well as the collaborative-wide average. This figure showcases the wide variability across the collaborative in average testing rates across procedures—some in the collaborative have an average testing rate close to 10% and some nearly 100%.

Although the overall rate across the collaborative has been steady, MVC has identified shifts in testing rates for individual members. To support members in tracking these changes, a caterpillar plot is also included that depicts the absolute change in any preoperative testing from 2021 to 2022 (Figure 4). Members can see the percentage change—positive or negative—in their annual testing rate from 2021 to 2022 for a specific procedure, as well as how their absolute change compares to the rest of the collaborative. This figure showcases that although the collaborative is not seeing much change in its overall rates for any testing over time, individual members might see greater variability over time for specific tests or procedures, especially in instances of low case counts. Overall, MVC observed slight reductions in the average collaborative-wide procedure-specific testing rates from 2021 to 2022 for all three surgical procedures, with the highest reduction observed among lumpectomy episodes (-6.2%).

03 Nov 2023

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MVC, MUSIC Estimate Significant Reduction in Opioid Spending After Kidney Stone Surgery

November 3, 2023 | 0 Comments | kidney stone surgery, MUSIC, opioid prescribing, opioids

In 2019, more than 71,000 people died from drug overdoses, making it a leading cause of injury-related death in the United States. Nearly 70% of those overdoses involved a prescription or illicit opioid. The economic cost of the U.S. opioid epidemic was estimated to be $1,021 billion as of 2017 and rising. It is for this reason that clinicians and health systems have adopted evidence-based practices for reducing the number and amount of opioid prescriptions ordered for their patients. It is both clinically and economically significant, then, that the Michigan Value Collaborative (MVC) was recently part of an analysis that estimated over $4.8 million in avoided opioid prescription spending after kidney stone surgery.

MVC identified these savings in partnership with the Michigan Urological Surgery Improvement Collaborative (MUSIC), a physician-led quality improvement collaborative comprised of urology practices across the state of Michigan. MUSIC works to evaluate and improve the quality and cost-efficiency of urologic care. Since 2011, the MUSIC team has led prostate-related quality improvement activities such as improving patterns of care in the radiographic staging of men with newly diagnosed prostate cancer, reducing prostate biopsy-related hospitalizations, and enhancing the appropriateness of treatment decisions. In 2016, MUSIC expanded its scope of work to kidney stone surgery and in 2017 to small renal masses.

With kidney stone incidence on the rise affecting both men and women, MUSIC created a program focused on Reducing Operative Complications from Kidney Stones (ROCKS). It focuses on improving the quality of care for kidney stone patients, particularly by decreasing modifiable emergency department (ED) visits for expected symptoms and side effects of ureteroscopy (URS) or shockwave lithotripsy (SWL) surgeries that are typically avoidable. MUSIC ROCKS aims to minimize these by developing resources that help patients manage their pain and urinary tract symptoms following kidney stone surgery.

Since its formation, the MUSIC ROCKS initiative led to the development of stent omission appropriateness criteria, a URS vs. SWL patient-provider shared decision aid, standardized patient education, and recommendations for postoperative pain control regimens. The ROCKS pain control optimization (POP) guidelines were developed in 2019 and recommended prescribing no opioids following kidney stone surgery. The goal of these guidelines is to minimize opioid use in patients undergoing kidney stone surgery while maintaining patient safety and satisfaction.

The MUSIC Coordinating Center reached out to MVC in 2022 to help assess the impact of its ROCKS initiative on opioid prescription use following surgery. The goal was to estimate MUSIC ROCK's impact on opioid utilization and prescribing rates following URS or SWL kidney surgeries in Michigan, as well as the related impact on the value of care.

METHODOLOGY

Data Sources & Study Population

MVC kidney stone surgery episodes were used for this analysis, which compared outcomes between URS and SWL procedures for MUSIC and non-MUSIC providers. It was restricted to kidney stone surgery claims for Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) Commercial and Medicare Advantage plans between Jan. 1, 2015 and July 31, 2022. The cohort was further restricted to BCBSM/BCN-insured patients with no opioid prescription fills in the 90 days prior to their surgery who were continuously enrolled in a prescription sub-plan 90 days prior to surgery through 30 days post-surgery. The final cohort used in the opioid analysis included 14,967 Michigan patients.

Methodological Approach

The study population was identified using professional claims for MVC kidney stone surgery episodes that occurred within the index dates of the surgery. All professional claims missing a provider NPI on the claim were excluded. The remaining NPIs were characterized by information derived from the National Plan and Provider Enumeration System (NPPES) data set. Claims of providers or facilities outside of the state of Michigan were also excluded. The remaining NPIs were then categorized into MUSIC and non-MUSIC categories. Opioid utilization was assessed through the presence of paid outpatient opioid prescription claims in the 30 days following surgery.

Limitations

Approximately 90% of Michigan urologists participate in MUSIC. However, only 58% of all MVC kidney stone surgery episodes were identified as being performed by a MUSIC provider via National Provider Identifier (NPI). Some MUSIC providers may be performing these procedures on patients with an insurance plan not reflected in MVC data. It could also be related to MVC's episode structure. Episodes are mutually exclusive; therefore, if a patient were to have a hospitalization prior to their surgery that resulted in an MVC episode creation, their care would not be classified as a kidney stone surgery episode. It is also possible that billing NPI was not always a reliable field.

Second, MVC only has outpatient prescription claims for BCBSM and BCN patients with a prescription sub-plan. For this analysis, only BCBSM-insured patients were assessed. As a result, only about 35% of MVC's URS and SWL episodes were included in assessing opioid utilization. Furthermore, the analysis is of opioid utilization, not provider prescribing patterns. Given that a claim is only generated once a prescription is filled, this analysis cannot provide a full picture of changes in provider prescribing patterns.

FINDINGS & NEXT STEPS

Among the BCBSM/BCN-insured patients who underwent kidney stone surgery between 2015 and 2021, 50.3% of patients on average filled an opioid prescription within 30 days of surgery, with a higher average opioid utilization rate among SWL patients (54.9%) than among URS patients (47.4%). There was a strong decline in opioid utilization after 2017 across Michigan for both types of procedures (Figure 1), with lower utilization following URS.

Notably, the rate of opioid utilization after kidney stone surgeries performed by MUSIC providers is consistently lower than those performed by non-MUSIC providers (Figure 2). For example, among URS procedures performed by MUSIC providers after 2016, 43.8% resulted in an opioid fill on average, whereas an average of 53.8% of procedures performed by non-MUSIC providers resulted in an opioid fill. In addition, the absolute decrease in opioid prescription fill rates was greater for MUSIC providers. These trends were similar for SWL surgeries, with consistently lower average opioid utilization rates among patients treated by MUSIC providers (52.1%) vs. non-MUSIC providers (60.9%).

MVC further estimated cost savings from the reduction in opioid prescription fills by examining differences in 365-day prescription payments among the MUSIC cohort. The changes in opioid prescribing resulted in an estimated yearly average savings of $2,712 per patient from reduced opioid prescription fills post-surgery. Using this estimated savings, MVC multiplied the number of URS procedures performed each year by MUSIC providers combined with the yearly percent reduction from baseline in opioid prescribing to further estimate a savings of over $4.8 million from avoided opioid prescription payments since 2016.

The notable decreases in both prescribing rates and prescription payments demonstrate the substantial impact of the MUSIC ROCKS initiative on opioid utilization after kidney stone surgery, including a likely reduction in the total number of filled opioids circulating in the Michigan community as a result of fewer patients receiving prescriptions. MVC completed a similar analysis in partnership with MUSIC looking at prescribing patterns after prostate surgery, and estimated that MUSIC providers helped avert an estimated $1.6 million in avoided opioid prescription spending.

MVC’s expertise and data frequently result in partner projects like this; MVC completed several CQI impact assessments last year, as well as several more so far in 2024. MVC also participates in collaborative activities with peer CQIs through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data. To request a copy of any of MVC’s completed CQI impact assessments, please contact the MVC Coordinating Center.

26 Oct 2023

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MVC Fall 2023 Collaborative-Wide Meeting Summary: Members Focus on High-Value Care for All

October 26, 2023 | 0 Comments | collaborative-wide meeting

The Michigan Value Collaborative (MVC) held its second collaborative-wide meeting of 2023 last Friday. A total of 98 leaders registered, representing 56 different hospitals, 9 physician organizations (POs), and 7 stakeholder organizations from across the state of Michigan. This meeting’s theme of “High-Value Care for All: Collaborative Approaches to Equitable Healthcare” focused on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

MVC Director Hari Nathan, MD, PhD, kicked off Friday’s meeting with an update from the MVC Coordinating Center (see slides). He welcomed MVC’s newest team members - Data Analysts Jiaying “Janet” Zhang and Kushbu Narender Singh, Senior Data Analyst Kim Fox, and Engagement Manager Jessica Souva – and highlighted the successes delivered by the Coordinating Center since May’s collaborative-wide meeting. One highlight was the release of MVC’s 2023 Qualified Entity Public Report with refreshed data for 30-day unplanned rehospitalization for patients discharged to home health after high-volume medical and surgical episodes, as well as measures of post-discharge outpatient follow-up for congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). To reflect MVC's ongoing commitment to providing meaningful data in a way that reflects best practices for diversity, equity, and inclusion, Dr. Nathan also shared MVC’s revised approach to race and ethnicity reporting, which lists racial and ethnic identities in alphabetical order, removes the categories of “other” and “unknown,” and includes two additional categories in MVC reporting. Finally, Dr. Nathan highlighted MVC’s recent push report offerings. Hospital and PO members received the new emergency department-based episode report as well as the new skilled nursing facility and home health utilization report. Hospital members received their Mid-Year Scorecard for Program Year 2023 of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program, as well as refreshed versions of the CHF and COPD follow-up report, common conditions report, and sepsis report.

Following the MVC Updates, Dr. Nathan introduced its keynote speaker, Renée Branch Canady, PhD, MPA, who serves as CEO of the Michigan Public Health Institute (MPHI) and is a recognized national thought leader in the areas of health inequities and disparities, cultural competence, and social justice. Rooting the advancement of health equity in a systems-thinking approach, Dr. Canady encouraged attendees to address upstream change (Figure 1) by seeing differently, saying differently, and doing differently (see slides).

Following Dr. Canady’s presentation, Senior Data Analyst Julia Mantey, MPH, MUP, led a presentation about combining MVC claims data and social determinants of health (SDOH) data sets for regional equity analyses (see slides). The session began with a review of statewide heat maps for the following MVC measures: 1) follow-up after hospitalization for CHF, 2) emergency department visits after CHF hospitalization, and 3) readmission after CHF hospitalization. Then, Ms. Mantey introduced the SDOH database managed by the Agency for Healthcare Research and Quality (AHRQ), a public database linkable to MVC data by county and Zip code (Figure 2).

From the AHRQ SDOH database, MVC incorporated data from the American Community Survey (U.S. Census Bureau), Homeland Infrastructure Foundation-Level data (U.S. Department of Homeland Security), and Provider of Service Files (U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services) to illuminate potential barriers to care. Statewide heatmaps were presented for 1) the percentage of households with no internet access, 2) the percentage of households with no computing device, 3) the percentage of households with no vehicle available, and 4) the percentage of households with public assistance income or SNAP benefits. Following Ms. Mantey’s presentation, Nora Becker, MD, PhD, explained the value of area-level SDOH metrics and how such data can be used in partnership with healthcare utilization data to provide a more robust picture of factors influencing patient outcomes (see slides).

Following Dr. Becker’s remarks, a poster session began, providing an opportunity to highlight recent quality improvement successes and encourage networking across the collaborative. The MVC Coordinating Center would like to thank the poster presenters. Electronic copies of the posters are available in batches of four each here, here, and here.

Following a networking lunch, attendees participated in one of three breakout sessions (Group 1, Group 2, or Group 3). The breakout sessions were geographically based and focused on regional snapshots of the American Community Survey data along with unblinded data for readmissions after CHF hospitalization. In each breakout session, hospital and PO members discussed opportunities to support patients and explored how MVC could support hospital and PO members going forward (Figure 3).

Following the breakout sessions, the group reconvened for roundtable discussions. During the session, attendees visited three tables of their choosing, where they learned about the work of the roundtable speaker, asked questions, and discussed the table topic with their peers. The MVC Coordinating Center would like to thank its roundtable speakers (Figure 4) for sharing their work and expertise: Nora Becker, MD, PhD, University of Michigan (association of chronic disease and patient financial outcomes); Diane Hamilton, BAA, CEP, Corewell Health Trenton (transportation barriers for cardiac rehabilitation patients); Noa Kim, MSI, HBOM (jumpstart grocery delivery program for patients with Type 2 diabetes); Matthias Kirch, MS, MSHIELD (best practices for anti-racist data collection and patient screening); Laura Mispelon, MHA, Michigan Center for Rural Health (supporting healthcare needs in rural communities); Thomas Pierce, LMSW, MPA, U-M Health West (SOGI data collection); Amanda Sweetman, MS, Trinity Health Michigan (hospital-based farm programs to support healthy food access); and Larrea Young, MDes, HBOM (tobacco cessation resources for providers and patients).

Following the roundtable session, MVC Co-Director Michael P. Thompson, PhD, MPH, concluded the meeting with an update on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program (see slides). It was noted Program Year 2023 bonus point surveys are due on Wednesday, November 15, 2023, and MVC will be hosting a Program Year 2024 engagement point webinar to review the new engagement point menu on Thursday, November 9, 2023, at 12 p.m.

If you have questions about any of the topics discussed at MVC’s fall 2023 collaborative-wide meeting or are interested in following up for more details, contact the Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Friday, May 10, 2024, in Midland.

19 Oct 2023

MVC Push Reports sepsis

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MVC Refreshes Sepsis Push Reports for Hospital Members

October 19, 2023 | 0 Comments | MVC Push Reports, sepsis

The Michigan Value Collaborative distributed refreshed sepsis push reports this week, providing its hospital members with updated figures and measures using the latest MVC episode data. In addition, the latest reports were also distributed to members of the Michigan Hospital Medicine Safety Consortium (HMS), a valued partner in the initial development of this service line within MVC's registry.

This week’s reports included MVC’s updated race and ethnicity categories, which were modified and expanded to ensure greater inclusivity and accuracy. MVC also recently adopted a methodological change to its identification of patients admitted with COVID-19 that impacted the episode data used in this analysis. MVC episodes were flagged as containing significant COVID-19 care if a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim during the 90-day episode. Previously, MVC looked for COVID-19 diagnosis in the first three diagnosis code positions. These episodes are often excluded from MVC’s push reports but have historically been included in sepsis reporting to help hospitals gauge the impact of COVID-19 diagnosis on their sepsis metrics. Combined with the natural decline in disease prevalence, there was a significant reduction in the percentage of patients with a COVID-19 diagnosis who were treated for sepsis, compared to the previous reporting period.

The version shared with MVC members this week continued to provide price-standardized, risk-adjusted benchmarking for total episode payments, as well as length of inpatient stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality or discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. MVC’s general acute care hospital (GACH) and Critical Access Hospital (CAH) members were provided with tailored versions using comparison groups most suitable to their hospital category.

Sepsis is currently the third leading cause of death in U.S. hospitals, so inpatient mortality and discharge or hospice were included in MVC’s sepsis reports as important quality checks. The average inpatient mortality rate among patients hospitalized for sepsis was 13.3% across member GACHs (Figure 1) and 6.5% for CAHs (Figure 2). Rates for discharge to hospice at home or a medical facility were lower.

The latest report also investigated differences in 90-day readmission rates for patients hospitalized for sepsis. Within GACH, patients with Medicare FFS coverage exhibited the highest average readmission rate (30.4%), followed by patients insured by BCBSM/BCN MA plans (25.6%) and BCBSM/BCN Commercial plans (16.4%), respectively (Figure 3). BCBSM/BCN Commercial patients had a younger average age and lower average comorbidity count than patients with Medicare or MA plans. Within CAHs, the average 90-day readmission rate was 22.4%.

The report also included benchmarking for average index length of stay by specific payer groups as well as for all payers combined. The average index length of stay across all payers was 8.7 among GACH patients and 5.5 among CAH patients.

Another significant finding was the difference in post-acute care utilization by service type among patients hospitalized for sepsis (Figure 4). On average across GACHs in the collaborative, outpatient services had a noticeably higher utilization rate (59.3%) compared to home health (29.4%) or skilled nursing facility (21.9%). The same was true for CAHs (Figure 5), with a much higher average utilization rate for outpatient services (75.2%) compared to home health (29.5%) or skilled nursing facilities (18.6%).

These reports were prepared using 90-day MVC episode data with index admissions from 7/1/19 – 6/30/22 for the following insurance plans: Medicare Fee-For-Service (FFS), Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage (MA), and BCN MA.

MVC welcomes your recommendations for enhancing these reports and welcomes your feedback on how collaborative members are using these data to support their quality improvement efforts. Please don't hesitate to contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.

12 Oct 2023

MVC Push Reports

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MVC’s Refreshed Common Conditions Report Coming to Hospital Members Soon

October 12, 2023 | 0 Comments | MVC Push Reports

MVC members will receive their next batch of updated push reports in the coming days with a refreshed version of MVC’s common conditions report. These reports provide insight into episodes of care for eight medical and surgical conditions that are commonly a focus for quality improvement efforts at MVC hospitals: acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), total knee and hip (joint) replacement, pneumonia, and spine surgery. MVC’s general acute care hospital and Critical Access Hospital (CAH) members will receive tailored versions of the report, with each group receiving benchmark data specific to their own category of hospitals.

Although the metrics provided vary by condition and case count, report pages generally focus on 30-day total episode payments, readmission rates, common reasons for readmissions, and post-acute care utilization. MVC price standardizes total episode payments to Medicare FFS amounts so that comparisons can be made across hospitals and over time. Payments are risk adjusted for patient age, gender, payer, comorbidities, and high or low prior healthcare utilization/payments.

Post-acute care utilization benchmarking for each of the eight medical and surgical conditions includes graphs displaying the percentage of each hospital’s patients who used home health care, inpatient/outpatient rehab, skilled nursing facility care, outpatient services, or emergency department care in the 30 days following their index hospitalization or surgery. Across the collaborative, reports show high use of 30-day home health care and outpatient services for these common conditions. For patients initiating their episode of care at a general acute care hospital within the collaborative, the home health care utilization rate was highest following CABG (69%) and joint replacement (50%).

Patients with a CABG episode were also high utilizers of outpatient services in the 30 days post-index (Figure 1), with a 73% average utilization rate. Patients with episodes for CHF (58%) and AMI (53%) were also high utilizers of outpatient services. Across conditions, use of outpatient services in the 30 days post-index was generally higher among episodes originating at CAHs than among episodes originating at general acute care hospitals.

The patient population in these reports comprises adult patients who had surgery or an inpatient hospitalization at an MVC-participating hospital between January 2021 and September 2022. Measures are based on 30-day inpatient and surgical-based episodes of care data, incorporating paid claims from Blue Cross Blue Shield of Michigan and Blue Care Network Commercial and Medicare Advantage plans as well as paid claims from Medicare Fee-for-Service. Episodes meeting any of the following criteria were excluded from calculations: patients transferred to another acute care hospital or to hospice, patients who died during their index stay, and patients with a primary diagnosis of COVID-19 received in an inpatient setting at any point during their 30-day episode.

We hope our collaborative participants find these reports valuable, and as always, we welcome MVC members to contact MVC with any questions or analytic requests.

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