04 Oct 2023
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MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

October 4, 2023 | 0 Comments |

I feel fortunate to have the opportunity to become a part of the impactful work that MVC began a decade ago. Joining a team that is so committed to improving healthcare quality across Michigan has renewed my passion for driving change to achieve equity in healthcare.

I began my career in healthcare as a nurse over 21 years ago. I have worked as a clinical nurse in the adult and pediatric emergency departments, labor and delivery, and ambulatory care.  In 2018, I earned my Master of Science in Nursing (MSN) from the University of Michigan before transitioning into the quality improvement realm of healthcare in 2019 as a site engagement coordinator for the Obstetrics Initiative (OBI). During my time with OBI, I supported hospital quality improvement teams by applying data analytics to support the implementation and sustainability of health equity initiatives. I believe that healthcare cannot achieve optimal quality without equity in service delivery.

In my time between OBI and MVC, I worked within the care management department at Michigan Medicine, developing workflow processes to launch the University of Michigan Physician Advisor Program, and provided strategic planning support to the nursing and medical directors.

When I am not working, I enjoy cheering on my youngest daughter’s softball team, kayaking, and traveling to new places as much as possible. Please don’t hesitate to reach out to me at jlbishop@med.umich.edu if you have any questions.

28 Sep 2023
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MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

September 28, 2023 | 0 Comments | ,

MVC will soon distribute the 2023 version of its chronic disease management follow-up reports to members. This refreshed version provides summary data on patients eligible for follow-up care after discharge from hospitalizations for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

MVC defines timely follow-up care as receipt of an in-person or remote outpatient follow-up visit within 30 days of hospital discharge to home or home health care and before any readmission, emergency department (ED) visit, or procedure. Patients admitted to a skilled nursing facility, long-term acute care hospital, or inpatient rehab within the 30-day episode were excluded. MVC’s follow-up analyses was performed using claims-based episodes of care with index hospital admissions between 7/1/2019 and 06/30/2022 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial and MA, and Medicare Fee-for-Service insurance plans. For each of the two chronic conditions included in the report, hospitals with at least 11 episodes per year for a given condition received that condition-specific data.

The report offers a comparison of demographic characteristics for CHF and COPD patients who received a follow-up visit within 30 days versus those who did not receive follow-up. Demographic characteristics tabulated for each condition include the percent of patients living in “at-risk” or “distressed” Zip codes as defined by the Economic Innovation Group’s Distressed Community Index, patients’ average number of comorbidities, the mean age of patients, and the distribution of race and ethnicity. MVC recently refined and expanded its reporting of race and ethnicity identities, and these updates were reflected in the report. Patients are grouped as Hispanic if their insurance provider categorized their combined race/ethnicity as Hispanic or their ethnicity as Hispanic. Additionally, MVC no longer combines smaller groups and discontinued its use of the terms “other” and “unknown.”

On the first page provided for each condition, hospital follow-up rates are provided for three windows of time compared to those at other MVC hospitals (Figure 1), as well as trends over time for each follow-up window (Figure 2). For CHF, follow-up rates are provided in 3-day, 7-day, and 14-day time windows. For COPD, follow-up rates are provided in 7-, 14-, and 30-day time windows.

Figure 1.

Figure 2.

The second page of condition-specific feedback includes a summary of average 30-day risk-adjusted, price-standardized total episode payments by follow-up status compared to statewide and regional averages. Among general acute care hospitals included in the analysis, the statewide total average payment for CHF episodes was $17,235 for patients who received follow-up and $20,069 for those who did not; for COPD episodes, the statewide average payments were $13,815 among those with follow-up and $16,056 among those without. In reports generated for Critical Access Hospitals (CAHs), payments were compared to averages across all MVC CAH members. Rates of 30-day follow-up were also compared by payers across the same groups.

The final figure (Figure 3) in the report for each condition is a summary of follow-up method among those who received any follow-up care. Patients who received follow-up were categorized as having received only in-person follow-up visit(s), only remote follow-up, or both in-person and remote follow-up. MVC found that more than 80% of CHF and COPD patients statewide exclusively received in-person follow-up after a hospitalization.

Figure 3.

If you have any questions or feedback about this report, please contact the MVC Coordinating Center.

21 Sep 2023
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MVC Implements a Variety of Data Updates to Episode Methodology

MVC Implements a Variety of Data Updates to Episode Methodology

September 21, 2023 | 0 Comments | , , ,

Throughout the past few months, the MVC team has made several methodological updates to its claims-based episodes of care data underlying the metrics shared via MVC’s online registry and push reports. Some of these updates were part of regular claims data maintenance, whereas others were improvements identified and implemented by the MVC team.

Long-Term Acute Care Hospital Utilization Added as Post-Acute Care Category

A new category of post-acute care utilization was generated within MVC episodes of care: long-term acute care hospital (LTACH) stays. Previously, facility claims were grouped into seven major categories: inpatient, inpatient rehab, outpatient rehab, emergency department, skilled nursing facility, home health, and outpatient/other. An area of opportunity was identified by the MVC Coordinating Center and MVC members to add LTACH to this list. Formerly in MVC data, claims for stays at LTACH facilities were grouped in with inpatient claims and thus counted towards “inpatient readmissions” in the context of an MVC episode of care. LTACH is now its own category of care within MVC episodes and is assessed separately from inpatient stays at general acute care hospitals and Critical Access Hospitals. To count towards post-index LTACH care in an MVC episode, a facility claim must contain bill type 011X and the billing facility NPI for the claim must be primarily affiliated with taxonomy code 282E00000X. LTACH claims will continue to be price standardized in the same manner as other inpatient claims.

As a result of LTACH being added as a separate category of care in MVC episodes, MVC members can now also look at their patients’ use of LTACHs on the MVC registry. By index condition, members can view their attributed episodes’ rate of post-index LTACH utilization as well as their average LTACH payment per episode within the Payment by Condition reports for all payers. To do so, users must navigate to the Payment by Condition report, scroll down to the “Payment Measure” filter on the left side of the registry, and select “LTACH ($)” or “LTACH (%)” to look at average payments or utilization rates, respectively.

Updates to Hierarchical Condition Category (HCC) Identification

Another update made to MVC data this year was the application of components from the most recent specifications around hierarchical condition categories (HCC) from the Centers for Medicare & Medicaid Services (CMS). HCCs are patient comorbidities that both CMS and MVC use as part of risk-adjustment processes. When creating episodes of care, MVC uses each patient’s claims data in the 180 days prior to a given index event to retrospectively assess the comorbidities diagnosed for that patient prior to their MVC episode of care. Formerly, diagnoses indicated as “present on admission” on a patient’s index claim were also used to ascertain a patient’s HCCs, but MVC has updated its methodology such that no diagnoses from the index claim will be used in the assessment of patient HCCs going forward. MVC continues to create 79 HCCs according to HCC V22, with new diagnosis codes added each year.

Furthermore, we note that the category hierarchies created by CMS have been applied to the HCC comorbidities that MVC assesses and displays on the registry. The “hierarchical” aspect of the condition categories is applied to groups of similar diagnoses with a goal that patient comorbidities are not over-counted. For example, a patient diagnosed with diabetes may have multiple similar diagnoses reported on claims over a six-month period, such as diabetes without complications, diabetes with chronic complications, and diabetes with acute complications. Rather than describing that patient as having all three diagnoses, a hierarchy is applied so this patient will simply be described as having the most severe of the group of diagnoses (i.e., diabetes with acute complications). To look at the prevalence of HCC comorbidities among your patient population for one of MVC’s 40+ inpatient or surgical episodes of care, members can navigate to the “Comorbidities” report on the registry.

New Medicare Severity Diagnosis-Related Group (MS-DRG) Version

As part of annual maintenance to accommodate newly introduced billing codes, MVC recently updated the version of Medicare Severity Diagnosis Related Codes (MS-DRGs) being used to re-group inpatient claims into categories of similar inpatient stays. MS-DRG v40.1 is now being used by MVC to categorize all inpatient claims containing ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes.

Inpatient Claim Outlier Length of Stay Methodology

MVC updated the method by which inpatient claims with a particularly long length of stay are identified and price standardized. MVC price standardizes each inpatient claim by adding up three components: a standard DRG-based payment, an inpatient transfer payment (if applicable), and a length of stay-based outlier payment (if applicable). An outlier payment is added to the total price-standardized payment amount for a given inpatient claim if the covered patient remained in the hospital significantly longer than an average patient with the same DRG. In the past, MVC identified these “outlier” long length of stay inpatient hospitalizations using publicly available national long length of stay thresholds for every DRG from TRICARE, the uniformed services healthcare program. MVC’s updated outlier methodology uses Medicare Fee-for-Service (FFS) claims to identify the 99th percentile in length of stay (days) among inpatient claims for each MS-DRG. The hospitalization length of stay on each inpatient claim is then compared against the newly identified 99th percentile threshold for the corresponding DRG. Claims with stays exceeding that length threshold are considered outliers. The outlier payment added to that claim’s price-standardized payment amount is then calculated with an unchanged formula as follows: Outlier Payment = (Number of Days Over DRG-Specific Length of Stay Threshold) * $2,500.

All-Cause Readmissions Assessed for All MVC Conditions

New this year, all-cause inpatient readmissions following index hospitalizations will be assessed for all MVC conditions whenever readmission metrics are shown. Specifications around the identification of readmissions will not vary by index condition.

Episodes Containing COVID-19 Care Now Identified by Primary Diagnosis Codes Only

Finally, MVC has modified the identification of episodes containing care for COVID-19. Episodes are now flagged as containing significant COVID-19 care if they meet the following criteria: at any point during the 30- or 90-day episode, a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim categorized as inpatient, inpatient rehab, skilled nursing facility, or LTACH. These episodes are often excluded from metrics displayed in MVC push reports. To exclude episodes containing COVID-19 care from metrics shown on the registry, members can use the registry filter called “COVID Cases.” Users should select “Exclude 30-Day COVID” to exclude episodes in which COVID-19 was found within the index event or 30 days post-index. Selecting “Exclude 90-Day COVID” will exclude episodes where a primary COVID-19 diagnosis was found within the index event or 90 days post-index.

For more information on MVC episodes of care data, please refer to MVC’s data guide. MVC members with questions not covered within the data guide are welcome to reach out to the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

14 Sep 2023
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MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

September 14, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce open registration for its upcoming Fall Collaborative-Wide Meeting on Friday, Oct. 20, 2023, from 10 a.m. – 3 p.m., in Lansing, MI. This meeting’s theme is “High-Value Care for All: Collaborative Approaches to Equitable Healthcare,” and will focus on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

This meeting will include presentations on health equity frameworks for quality improvement, insights from claims-based data, and inter-organizational partnerships to improve patient outcomes. MVC is thrilled to be joined by Renée Branch Canady, PhD, MPA, CEO of the Michigan Public Health Institute (MPHI), as its keynote speaker. Dr. Canady has extensive experience in diversity, equity, and inclusion (DEI) efforts, and was recognized as Crain’s 2021 Notable Executives in DEI. She received this honor for her work implementing incremental changes in health equity and social justice at MPHI. Under her leadership, MPHI established the Staff of Color Affinity Group, the Center for Health Equity Practice (CHEP), and the Center for Culturally Responsive Engagement (CCRE). She also recently published a new book titled Room at the Table: A Leader’s Guide to Advancing Health Equity and Justice.

The MVC Coordinating Center will also present MVC data linked with supplemental social determinants of health data sets, updates about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and other Coordinating Center updates.

MVC’s fall collaborative-wide meeting will also feature a new roundtable format with insights from a wide variety of guest speakers, including Nora Becker, Michigan Medicine; Diane Hamilton, Corewell Health Trenton; Matthias Kirch, Michigan Social Health Interventions to Eliminate Disparities (MSHIELD); Laura Mispelon, Michigan Center for Rural Health; Amanda Sweetman, the Farm at Trinity Health; Larrea Young and Noa Kim, Healthy Behavior Optimization for Michigan (HBOM); and Thomas West, U-M Health West. Attendees will rotate through several mini-presentations and discussions about specific health equity topics, such as demographic data collection and patient screening practices, developing and funding community benefit programs, addressing transportation access barriers, support programs within rural communities, tobacco cessation interventions, financial toxicity risks for patients, and more.

Attendees will have multiple opportunities to network and learn from their peers. The meeting includes a mid-day poster session to highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions through 10/5/2023 that feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to health equity or MVC conditions/data, authored by clinicians and non-clinicians alike, or presentations already shared at a recent conference or event. Instructions for submitting a poster are available on MVC’s events page. The meeting also includes breakout sessions in the afternoon focused on regional trends and opportunities using MVC data and member insights, as well as an optional networking reception at the conclusion of the event, from 3-4 p.m.

Those able to attend MVC's fall collaborative-wide meeting may register here. MVC hosts two collaborative-wide meetings each year to bring together healthcare quality leaders and clinicians from across the state.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

Hari Nathan, MD, PhD; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH; Kristy Degener, MPH

06 Sep 2023
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MVC Publishes its 2023 QECP Public Report as a Qualified Entity

MVC Publishes its 2023 QECP Public Report as a Qualified Entity

September 6, 2023 | 0 Comments | , , ,

Today the MVC Coordinating Center published its annual Qualified Entity Certification Program (QECP) public report for 2023. One of the requirements of being a qualified entity (QE) with the Centers for Medicare & Medicaid Services (CMS) through the QECP is the annual dissemination of a public report created using claims data. MVC shared its first public report last year, making the 2023 report the second iteration.

As with last year, the 2023 MVC QECP Public Report provides unidentified aggregated data on Michigan hospitals for two measures: rates of 30-day rehospitalizations following start of home health care, and rates of outpatient follow-up received after hospitalization for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Both measures were created using data from episodes of care initialized by inpatient hospitalizations or surgeries between 1/1/2018 and 12/31/2021.

For 2018-2021, the overall rate of 30-day unplanned rehospitalizations from home health among MVC member hospitals in Michigan was 11.3%. Risk-adjusted rates by index hospital ranged from 1.6% to 18.5% (Figure 1). By home health provider, risk-adjusted rates ranged from 2.0% to 23.6%. Patients whose episode of care began with an index event for endocarditis, COPD, CHF, or percutaneous coronary intervention (PCI) were more likely than patients with other index conditions to experience an unplanned rehospitalization in the 30 days after they started home health care.

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

Across the 102 MVC hospitals with attributed episodes of care data underlying this report, the unadjusted rates of patients receiving outpatient follow-up were higher following index hospitalizations for CHF than for COPD (Figures 2 and 3). This was the case whether follow-up occurred three days (16% vs. 13%), seven days (45% vs. 37%), 14 days (63% vs. 54%), or 30 days (72% vs. 64%) after discharge.

Figure 2. 30-Day Follow-Up After CHF by MVC Hospital

Figure 3. 30-Day Follow-Up After COPD by MVC Hospital

For more information and the entire set of findings, we invite you to read the full report, which is available online to any member of the public on the MVC Resources page or directly here.

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

MVC members representing one or more MVC-participating hospitals can send an email to Michigan-Value-Collaborative@med.umich.edu to learn more about data available through MVC’s QECP reports and to receive the forms necessary to gain access to those registry reports.

29 Aug 2023
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MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

August 29, 2023 | 0 Comments | , , ,

After childbirth, all individuals should have access to patient-centered counseling about birth spacing, and, if desired, contraceptive methods to help fulfill their personal reproductive goals. Promoting patient-centered contraceptive care and equitable access to contraceptive methods for those who desire them may improve population health outcomes.

Researchers and medical professionals are increasingly recognizing the impact of social determinants of health (SDOH) on individuals’ access to care and overall health outcomes. Unmet social needs may affect contraceptive initiation after childbirth by influencing individuals’ preferences for future childbearing, as well as individuals’ access to high-quality contraceptive care. To better understand this relationship, a group of clinician investigators used MVC data in a paper published in the American Journal of Obstetrics and Gynecology to evaluate the association between living in a neighborhood with high social vulnerability and the use of long-acting reversible contraception (LARC) and sterilization methods during the postpartum period.

Lead author Michelle H. Moniz, MD, MSc, Program Director of the Obstetric Initiative (OBI), and her colleagues utilized MVC administrative claims data to identify childbirth episodes from Jan. 2016 to Dec. 2019 with outcomes including LARC and sterilization use by 60 days into the postpartum period. Social vulnerability was determined using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). The SVI measures a community’s economic and social resilience by integrating 15 U.S. Census variables to generate composite scores across 4 themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.

In 140,345 delivery episodes at 79 hospitals, 8% of patients initiated LARC devices, and 8.3% initiated sterilization by 60 days postpartum. Dr. Moniz and colleagues observed independent associations between social vulnerability and postpartum contraceptive use. It appeared that different SVI themes such as socioeconomic status, minority status and language, household composition and disability, and housing type and transportation aligned with varying use of LARCs or sterilization (Figure 1). Individuals living in neighborhoods with the highest socioeconomic vulnerability and minority status/language vulnerability were more likely to utilize LARC methods. Individuals living in neighborhoods with the highest household composition vulnerability were less likely to initiate LARC methods.

Figure 1. Adjusted LARC and Sterilization Use by 60 Days Postpartum (Using SVI Theme)

Conversely, sterilization was more likely among populations living in neighborhoods with highest housing/transportation vulnerability and less likely among those living in neighborhoods with highest socioeconomic vulnerability and minority status/language vulnerability.

Dr. Moniz and colleagues suggest that “structural factors—such as distance to clinic, fees for parking and transportation, clinic hours, childcare access, ability to miss work to seek healthcare, and out-of-pocket costs for healthcare—may affect postpartum contraceptive use.” They also note that more research is needed to fully understand the means by which SDOHs influence an individual’s healthcare preferences and choices. Additional investigations could shed light on the mechanisms by which unmet social needs influence reproductive wishes and access to patient-centered contraceptive counseling and methods after childbirth.

In all sectors of healthcare and medical research, but especially in maternal health where inequities in health outcomes have worsened in recent years, further studies must be done to better understand the impact of SDOHs. While medical advancements and the pursuit of best practices are critical to ensuring improvement in healthcare delivery, these innovations cannot impact outcomes for all patient populations until we understand the structural factors affecting patient access and goals.

MVC is committed to using data to improve the health of Michigan through sustainable, high-value healthcare. Therefore, one of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. MVC shares its data with clinical, administrative, and CQI experts for investigative analyses to help identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Michelle H. Moniz, MD, MSc; Alex F. Peahl, MD, MSc; Dawn Zinsser, BA; Giselle E. Kolenic, MA; Molly J. Stout, MD, MS; Daniel M. Morgan, MD

Full Citation

Moniz, M. H., Peahl, A. F., Zinsser, D., Kolenic, G. E., Stout, M. J., & Morgan, D. M. (2022). Social vulnerability and use of postpartum long-acting reversible contraception and sterilization. American Journal of Obstetrics and Gynecology, 227(1). https://doi.org/10.1016/j.ajog.2022.03.031

24 Aug 2023
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Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

August 24, 2023 | 0 Comments |

This week the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. PY2023 scores achievement and improvement points for each hospital’s selected episode spending conditions using index admissions from 2022 as the performance year against admissions in 2020 as the baseline year. Hospitals can earn up to five points for each condition using the higher of a hospital's achievement and improvement point scores. This is the second year of a two-year (PY22-23) P4P cycle.

This cycle also offers hospitals bonus points for completing and submitting a survey for each selected condition by November 15, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and support practice sharing between members. The full methodology for this program cycle can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the current distribution of total hospital points out of 10. The average points scored across the mid-year scorecards was 6.4/10 before including the survey bonus points. This is 0.4 points higher than the average points scored at the conclusion of PY22 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition. Hospitals could earn up to five points for each condition. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.6 points. Much of the success observed for the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than two points on average.

Figure 2.

These mid-year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2022 claims are incorporated. Hospitals can track their score through the P4P PY22-23 reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points in one place (bonus points are not reflected on the registry). These registry reports can be filtered by selected conditions to make the tracking of P4P points easier. Contact the MVC Coordinating Center for a walkthrough of your hospital’s PY23 mid-year scorecard or P4P registry reports.

03 Aug 2023
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MVC Develops PO Post-Discharge and ED-Based Episode Reports

MVC Develops PO Post-Discharge and ED-Based Episode Reports

August 3, 2023 | 0 Comments | ,

The Michigan Value Collaborative (MVC) recently completed the development of two new push reports tailored to physician organizations (POs). Both reports mirrored hospital-level push reports distributed earlier this summer and reflect MVC’s ongoing approach to refining and tailoring its analytic offerings to the patient populations and needs of its diverse membership. The first new PO report of 2023 was released in July and focused on post-discharge care, and the second is set to be released next week using new emergency department (ED)-based episodes.

PO ED-Based Episodes Report

The forthcoming PO ED-based episode report features MVC’s new ED-based episode data for five high-volume ED conditions: chest pain, abdominal pain, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cellulitis. A hospital-level version was distributed in June.

ED-based episodes are a new episode of care structure developed by MVC in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC). These episodes are initialized by a patient’s visit to the ED and include all claims-documented care received in the 30 days following a patient’s index ED visit.

For each of the five index conditions included in this forthcoming report, POs will receive information on risk-adjusted and price-standardized 30-day total episode payments, same-day inpatient admission rates over time, utilization of healthcare services across an attributed patient’s 30-day episode of care, and the hospitals where a PO’s attributed patients most frequently presented to the ED for a given index condition. Patient claims data were included for adult patients aged 18 and older who had an ED visit between 1/1/21 and 8/31/22 and were insured by Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage (MA), or Medicare Fee-for-Service (FFS).

Among POs receiving a report, average risk-adjusted, price-standardized 30-day total episode payments for the five reported conditions were highest for CHF ED-based episodes ($16,936) followed by COPD ED-based episodes ($10,286), and lowest for unspecified chest pain ($3,714). Within each condition, MVC 30-day total episode payments were consistently higher for episodes in which the attributed patient had a same-day inpatient admission compared to episodes in which the attributed patient did not have an inpatient stay begin on the date of their ED visit.

A key goal for these ED-based episode reports was to provide insight into healthcare utilization following index ED visits. Therefore, reports included a dot plot (Figure 1) comparing each PO’s post-ED utilization for their attributed patients compared to the average across all 40 MVC member POs.

Figure 1.

PO Skilled Nursing Facility & Home Health Report

In July, MVC distributed PO-level reports on post-discharge care that included metrics on skilled nursing facility and home health utilization. A hospital-level version was distributed in June. The purpose of this report was to support understanding of care coordination opportunities and benchmark post-discharge care utilization.

This report highlighted various SNF and home health utilization metrics using 30-day claims-based episodes for MVC’s medical conditions: acute myocardial infarction (AMI), atrial fibrillation, COPD, CHF, endocarditis, pneumonia, sepsis, small bowel obstruction, and stroke. A PO’s attributed patient episodes were included if they had an inpatient admission between 1/1/2021 and 6/30/2022 and were insured by BCBSM PPO Commercial, BCBSM MA, or Medicare FFS.

As with other PO-level push reports, MVC included several comparison groups to aid individual POs in benchmarking their performance for select report metrics. Each PO can compare their data to the average for POs of a similar size, the average for POs located within the same geographic region of Michigan according to MVC’s region designations, and the collaborative-wide average for all MVC member POs. Only POs with 20 or more episodes in 2021 and 11 or more in 2022 received a report and were included in comparison group calculations.

Similar to the hospital-level version, the first page of the report contained a SNF and home health profile table (Figure 2), which provided an overall look at post-discharge utilization patterns by payer as well as information about a given PO's patient population. The first three metrics reflected all attributed patients treated for medical conditions in this time period for the included payers and the metrics in gray were comprised only of attributed patients who utilized SNF in the 30 days post-discharge from their episode's index hospitalization. Overall, MVC found that Medicare FFS patients utilized SNF and home health services more often.

Figure 2.

Measures in this report include SNF and home health utilization rates overall and by condition, SNF and home health utilization rates among patients discharged to their home, inpatient readmission rates for SNF and home health utilizers, and a list of the most frequently utilized SNFs and home health providers to help POs understand where their attributed patients are going when receiving SNF or home health care after discharge. MVC presented 30-day overall SNF and home health utilization rates in a caterpillar plot format to showcase variation across POs. These rates varied between roughly 9% and 16% for SNF utilization (Figure 3) and between 19% and 32% for home health utilization (Figure 4).

Figure 3.

Figure 4.

MVC observed average 30-day inpatient readmission rates of 21% among attributed PO patients discharged to SNF (Figure 5) and 17.2% among attributed patients discharged to home health (Figure 6).

Figure 5.

Figure 6.

New Report Distribution Process

MVC piloted a new method for distributing its push reports when sending out the PO SNF/HH reports and is continuing that method for the distribution of its PO ED-based episode reports. Over the summer, PO site coordinators received an email from Dropbox as well as from MVC with a link to their PO’s designated Dropbox folder. Since then, MVC has been working to confirm that contacts are able to successfully access their designated folder and reports.

This new report distribution process will allow MVC’S contacts to access all available MVC reports in a single, secure location, and address some of the email firewall issues experienced by some members. Going forward, members may access and download their individualized reports using Dropbox rather than receiving reports through email. When a new report is made available to members, MVC will still notify all recipients via email with the details of the report. MVC plans to launch this new report distribution process with its hospital partners in the coming months, beginning with Program Year 2023 mid-year scorecards for the MVC Component of the BCBSM Pay-for-Performance (P4P) Program.

If you have any follow-up questions about your site’s latest push reports or the new report distribution process, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

27 Jul 2023
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MVC Welcomes New Analyst, Kim Fox, MPH

MVC Welcomes New Analyst, Kim Fox, MPH

July 27, 2023 | 0 Comments |

It is a privilege to be welcomed to the Michigan Value Collaborative (MVC) team as a Senior Data Analyst! As a new member of the MVC team, I am excited to learn from and work alongside a talented team of MVC coordinators, administrators, and analysts to help improve the health of Michigan through creating sustainable, high-value healthcare.

My public health journey began after discovering the field of Medical Anthropology. Medical anthropologists show us that medical practices are shaped not only by scientific knowledge, but also by sociocultural, environmental, and economic factors. These factors lead to substantial variation in healthcare practices both globally and in our own neighborhoods. It is this principle that underlies my work in public health and keeps me inspired. My goal is to help find compassionate, creative, and robust healthcare approaches that consider and balance these factors to help improve the health and well-being of communities and populations.

Prior to joining MVC, I served in roles that have ranged from research operations and disease surveillance to global healthcare consulting. I received my Master of Public Health (MPH) degree in Epidemiology from the University of Michigan (U-M) School of Public Health and a Bachelor of Arts in Psychology with a minor in Medical Anthropology from U-M.

I am looking forward to working with MVC and its members to identify best practices and opportunities for continuous improvement through the analysis of clinical and claims data. If you have any questions or wish to get in touch, please feel free to email me.

20 Jul 2023
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MVC Calls Attention to Research, Resources During Week-Long Preoperative Testing Campaign

MVC Calls Attention to Research, Resources During Week-Long Preoperative Testing Campaign

July 20, 2023 | 0 Comments | ,

Prior to surgery, most Michigan patients will undergo a series of tests, such as blood draws, urinalysis, chest x-rays, or electrocardiograms (ECGs/EKGs). Many of these tests are unnecessary for healthy patients undergoing low-risk procedures such as groin hernia repair. Routine preoperative testing is widely considered a low-value service, and yet a majority of hospitals continue to order these tests. In an effort to drive improvement in this area, MVC hosted its second annual preoperative testing awareness campaign this week.

“For a patient, it is key they get the right amount of preoperative assessment,” said Dr. Michael Englesbe, professor of surgery at the University of Michigan, director of the Blue Cross Blue Shield of Michigan-funded Collaborative Quality Initiatives, director of the Michigan Surgical Quality Collaborative (MSQC), and co-director of the Michigan Opioid Prescribing and Engagement Network (Michigan OPEN). “Too little testing and important risks may be missed, too much and patients may be exposed to critical risks of unnecessary testing and delays in care.”

MVC’s Coordinating Center supports preoperative testing de-implementation in several ways. One is providing opportunities for MVC’s members to collaborate and learn from one another. This year MVC launched a workgroup series focused on preoperative testing, the first of which took place in March. As part of its campaign this week, MVC promoted the next session in this workgroup series, set to take place Tues., Aug. 1, from 1-2 p.m. featuring guest speaker Nick Berlin, MD, MPH, MS. Those interested in this topic should register to attend here.

Another key strategy MVC uses to support preoperative testing de-implementation is through data analysis and reporting. MVC analysts utilize administrative claims data to calculate testing rates in the preoperative period, and then share these results with members as reports or as unblinded data at collaborative-wide meetings. More recently, MVC partnered with MSQC to distribute these reports more widely to support cross-collaboration between clinical and quality personnel at a given site.

These reports are an invaluable resource in benchmarking the extent of the issue statewide, says Dr. Hari Nathan, MVC’s director and the chief of hepato-pancreato-biliary surgery at Michigan Medicine. “MVC data can be used by hospitals and providers to understand how their rates of preoperative testing compare to those of other hospitals in Michigan,” he said. “By focusing on a homogeneous cohort of healthy patients undergoing common, low-risk surgical procedures, MVC benchmarks can help all hospitals understand where they have an opportunity to improve, regardless of facility size, resources, or patient population.”

Across the collaborative, MVC sees wide variation in preoperative testing for low-risk elective surgeries like hernia repairs and lumpectomies, with testing rates among young, healthy patients ranging from 10% to 97% across MVC hospitals. This level of interhospital variation is evidence that many hospitals in Michigan are safely performing low-risk surgeries without widespread preoperative testing and that even those hospitals with average rates likely have room to safely reduce their testing further.

MVC also sees quite a bit of intrahospital variation, with certain surgeries driving the overall preoperative testing rate at a given site. Based on the findings of its latest report, one potential area of focus for sites may be reducing the rate of cardiac testing; the rate of ECGs is quite variable across the collaborative and could lead to a cascade of care.

MVC shared its refreshed preoperative testing push report with members in April and also held a report review webinar in June to review the measures included. This webinar also included advice from Dr. Nathan about how to take action using this data. Dr. Nathan promoted several new resources developed in partnership by MSQC, the Michigan Program on Value Enhancement (MPrOVE), and MVC. These include a customizable decision aid (Figure 1), which sites can download to add their branding or modify. It is accompanied by a similarly customizable preoperative testing reference chart (Figure 2).

Figure 1.

Figure 2.

Both of these resources are currently housed on a new Waive the Workup de-implementation resource website managed by MPrOVE, MSQC, and MVC. In addition to pages for the decision aid and chart, the site also offers talking points for debunking common myths about preoperative testing. For instance, one common counterargument to reducing preoperative testing prior to low-risk surgery is a perception that there’s no harm in ordering them, either because they are relatively inexpensive or because they are not invasive tests.

On the contrary, research has established substantial financial costs and risks to patient harm because of preoperative testing, which can and should be safely reduced. Mihir Surapaneni, BBA, a medical student at the University of Michigan Medical School, has been conducting research with MVC on preoperative testing and its impact. “One of the major theories for why there’s so much variability—and indeed just a high utilization rate—for preoperative testing is that there’s no perceived downside,” Surapaneni said. “Many of these tests are relatively cheap compared to the total cost of healthcare and indeed most of them cost no more to the patient than a stick of blood, but we really have to consider that there are costs. Preoperative testing costs billions of dollars in the United States healthcare system annually, and when you consider how strained the healthcare system is and how much of an onus there is on payers and the government to decrease costs, this really adds up. And secondly, we have to consider the possibility of testing cascades—which has been well-documented—in that a patient comes in having an abnormal lab value or test that actually had nothing to do with their intended surgery, and this leads to more and more tests which are expensive and potentially invasive. And finally, we have to consider that there’s established literature showing that even when an abnormality is found in a routine preoperative test, these abnormalities: 1) rarely impact the clinical course of the patient, and 2) rarely lead to actual substantive change in that patient’s care. And I think that we really have to consider these when we’re deciding whether or not we want to test our patients routinely.”

In addition to registering for the Aug. 1 workgroup, MVC has a third preoperative testing workgroup session scheduled for Oct. 26, 11 a.m. - 12 p.m. The Oct. session will be a forum for sharing current successes or initiatives underway across the collaborative. If your hospital has a current initiative underway on preoperative testing de-implementation or has a low average testing rate, MVC would love to learn from you. Please reach out to the MVC team if you’d be interested in sharing your site’s story on Oct. 26.