04 Aug 2022
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MVC Launches New Push Report on ED and Post-Acute Care Use

August 4, 2022 | 0 Comments | , , ,

The emergency department (ED) is a unique and critical component of the healthcare system in the U.S., treating acute injuries or illnesses and acting as a safety net for patients who are uninsured or low income. ED visits are also very expensive, and that spending is growing according to a recent retrospective study of ED trends. This week the Michigan Value Collaborative (MVC) is distributing its newest push report on ED and post-acute care (PAC) utilization to support members' efforts in this space.

Since the ED serves as a safety net for patients experiencing barriers to healthcare access, the Coordinating Center report purposefully integrates measures tied to social determinants of health and health equity. Reports contain a patient population snapshot table showcasing several patient characteristics by payer (see Figure 1), including age, race, comorbidities, zip code, dual-eligibility status, and economic distress scores. Dual-eligible patients are those who qualify for both Medicaid and Medicare; these patients tend to have a higher prevalence rate for chronic conditions, disabilities, and other care needs that substantially increase healthcare utilization.

Figure 1.

Economic distress scores range from 0-100 with a higher score indicating greater economic distress. These scores come from the Economic Innovation Group’s Distressed Communities Index (DCI), which is derived from the U.S. Census Bureau’s Business Patterns and American Community Survey. The DCI combines seven complementary economic indicators (see Figure 2) to provide a single, holistic, and comparative measure of economic well-being across communities in the U.S. In MVC’s report, there is a proportion of patients living in an “at-risk” or “distressed” zip code across all payers, as classified by the DCI. However, as the literature often indicates, the Medicaid population has the highest average distress score and a larger proportion of patients living in an “at-risk” or “distressed” zip code.

Figure 2.

The bulk of MVC’s latest report aims to provide its members with more granular insights into PAC utilization in the 30-day post-discharge period than is available on the MVC registry. Using index admissions for medical conditions from 1/1/18 through 12/31/20, the report focuses predominantly on ED utilization, which is categorized as either “ED to Home” or “ED to Readmission.” ED to Home represents ED visits that do not occur on the same day as readmission, and ED to Readmission refers to those visits occurring on the same day as readmission.

The report includes figures illustrating trends in 30-day ED to Home rates between 2018 and 2020, top reasons for ED visits at a given hospital, the number of ED to Home visits within 30 days post-discharge, the number of days until the first ED visit post-discharge, the ED to Home rate and the breakdown of total PAC spending for a hospital’s three highest-volume conditions, and the average ED facility payment. MVC included the following payers in this report: Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service, and Medicaid.

Overall, the MVC report confirms published findings that Medicaid patients utilize the ED at a higher rate than patients insured by other payers. The Coordinating Center also finds that ED use differs between types of providers. For acute care hospitals, for example, over half of ED visits occur on the same day as readmission, whereas these visits account for 40% at Critical Access Hospitals (CAHs).

MVC also finds that ED to Home visits most often occur once in the 30 days following discharge for most of the collaborative (see Figure 3). There are some members, however, with three or more ED to Home visits within the 30-day post-discharge period.

Figure 3.

The Coordinating Center envisions this report being of particular importance to its CAH members, whose structures, services, and patient populations make the ED and PAC a top priority. As such, MVC prepared versions of this report for both CAHs and acute care hospitals using their respective comparison groups throughout. In other words, the CAH version of the report includes comparison points for all other CAHs in the collaborative. Acute care hospitals can see their traditional collaborative-wide and regional comparison data, not including hospitals with a CAH designation.

As members review and discuss the findings in their report(s), MVC encourages providers to utilize the Michigan Emergency Department Improvement Collaborative (MEDIC), which is dedicated to improving the quality of ED care across the state of Michigan. In addition, if members wish to discuss additional custom analyses on ED and PAC utilization, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

28 Jul 2022
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Latest MVC Preop Testing Report Features New Figures and Data

Latest MVC Preop Testing Report Features New Figures and Data

July 28, 2022 | 0 Comments | ,

This week MVC distributed its second preoperative testing push report of 2022, providing members with another opportunity to benchmark their testing practices. MVC first introduced its preoperative testing push reports in 2021 to help members reduce the use of unnecessary testing for surgical procedures. Preoperative testing, especially for low-risk surgeries, often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan.

The report distributed this week had many similarities to the version distributed earlier this year in April, namely that members continued to see their rates across a variety of tests for three elective, low-risk procedures performed in outpatient settings: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated for the index event as well as 30 days prior to the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

The latest report has a few key differences from the spring version, the most significant of which is that it utilizes claims from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans exclusively. This allows members to see MVC’s most up-to-date data; the report includes index admissions from 1/1/2019 through 12/31/2021. In addition, since the report contains BCBSM/BCN data only, there is no case count suppression, whereas members would only see their data in the spring version if they had at least 11 cases in each year of data for the three combined conditions.

The reports received by members this week included several new figures. Similar to other MVC push reports, members will now see a patient snapshot table that provides additional information about the report’s patient population. For this, MVC chose to include patient characteristics such as age, zip code, and comorbidities. Generally speaking, there were more comorbidities among patients who underwent preoperative testing compared to patients with one or no comorbidities (see Figure 1). However, the majority of patients who complete a preoperative test do not have multiple comorbidities. There were also observed differences in testing rates by age. In general, patients who had preoperative testing were older on average than patients who had no preoperative testing.

Figure 1.

Another new figure showcased the overall preoperative testing rates by year. This trend graph showed members how their overall rate for any preoperative testing compared in 2019, 2020, and 2021, and it included data points for the MVC average and regional comparison groups (see Figure 2). The key finding for this figure was that there has been very little change in testing rates over time when looking at overall preoperative testing practices. This means that, in general, the prevalence of low-value preoperative testing has remained consistently high overall across the collaborative for three years and likely longer.

Figure 2.

The latest report also included a new figure for absolute change in any preoperative testing from 2019 to 2021. For each hospital, this appears as a caterpillar plot of absolute change percentages for their highest-volume procedure among the three low-risk surgeries in the report. Members can see the percentage change—positive or negative—in their testing rate for that surgical condition, as well as how their absolute change compares to the rest of the collaborative. For example, hospitals that perform more cholecystectomies than hernia repairs or lumpectomies saw a wide range of both increases and decreases in preoperative testing rates from 2019 to 2021 (see Figure 3).

Figure 3.

The blinded hospital in this example observed very little change in its testing rate for cholecystectomy (-1.6%), and the MVC average was similar (-2.2%). This showcases that although the collaborative is not seeing much change to 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.

Members will be able to take those deeper dives into their rates for specific tests in the figures that make up the remaining pages of the report. Viewing one’s preoperative testing rates for each specific test can help members understand if any specific tests are driving their overall testing rate. One area of opportunity, for example, could be to reduce one's rate of cardiac testing, specifically ECGs; the rate of ECGs is very variable across the collaborative (see Figure 4) and could lead to a cascade of care.

Figure 4.

MVC is eager to drive improvement in this area. For more information on how MVC is working to reduce unnecessary preoperative testing, visit its Value Coalition Campaign webpage here. If you are interested in a more customized report or would like information about MVC’s preop testing stakeholder working group, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

14 Jul 2022
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Reflecting on MVC’s Accomplishments: January-June 2022

July 14, 2022 | 0 Comments

As we start the second half of 2022, the MVC Coordinating Center is taking a moment to pause and reflect on the tremendous work that has been accomplished over the past six months. Here is a look back at some of the highlights.

JANUARY

MVC Workgroups consist of a diverse group of representatives from Michigan hospitals and POs that meet virtually to collaborate and share ideas related to various topics. January kicked off with the launch of MVC’s new Health Equity Workgroup! The inaugural meeting featured speakers from the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) Collaborative. The Health Equity Workgroup has two more meetings in 2022 and we’d love to see you there! Visit the MVC 2022 Events Calendar to register and check the calendar for additional Workgroup offerings focused on Chronic Disease Management, Diabetes, Health in Action, Joint Replacement, and Sepsis.

FEBRUARY

MVC launched two new push reports in February, with the release of the new Physician Organization (PO) Colectomy Report, shared with 35 of MVC’s PO members, and the first-ever Pneumonia Push Report, distributed to 89 MVC hospital members[1]. To meet the needs of MVC’s growing hospital members, a subset of the Pneumonia Push Reports was tailored to meet the specific data needs of our Critical Access Hospital members.

MARCH

After completing 58 hospital site visits in 2021, MVC announced the creation of a robust quality improvement (QI) initiatives database, developed to track QI initiatives across the collaborative. The database, searchable by QI focus area and project status, allows MVC to understand common themes and challenges among all its members as well as within subgroups such as hospital size or region. In 2022, the MVC team is hosting site visits with our PO members and will be gathering QI initiatives to add to the QI initiatives database. The database is being used as a resource for custom analytic requests and a library of practice standards for members. If you are an MVC PO interested in participating in a virtual site visit, please contact the MVC Coordinating Center to schedule.

APRIL

In April, MVC distributed a refreshed Sepsis Push Report, developed in collaboration with the Michigan Hospital Medicine Safety Consortium. These customized reports provide hospitals with new insight on demographics for their sepsis patients, including the percentage of COVID-positive patients to illustrate how COVID has impacted their sepsis data, along with race, top comorbidities, and most common zip codes, stratified by payer.

MAY

MVC held its first collaborative-wide meeting of 2022 in May, with a focus on “Turning Data into Action.” Held virtually, a total of 158 leaders representing 68 different hospitals and 15 physician organizations (POs) from across the state of Michigan participated in the event. Save the Date for our next in-person collaborative-wide meeting, scheduled for Friday, October 28th at the Radisson Hotel Lansing!

JUNE

In June, the MVC Coordinating Center hosted its first in-person event since 2019, with a Regional Networking Dinner for our Eastern Michigan sites (Region 3). The dinner provided an opportunity for MVC hospital and PO members to come together to network, share ideas and discuss key priorities, including health equity initiatives. MVC’s next Regional Networking Event for Southeast Michigan (Region 4) is scheduled for Tuesday, September 27th. For identification of your MVC designated region, please see the MVC Regions Map here.

AND COMING SOON…

Along the way, the MVC team has been hard at work preparing for two new exciting developments:

  • MVC’s first Northern Summer Meeting (RSVP here) is scheduled for Thursday, August 18th at Traverse City’s Great Wolf Lodge. The agenda is tailored to highlight unique opportunities and challenges facing the Northern Michigan healthcare community. Interested MVC members serving Northern Michigan, the Upper Peninsula, and small/rural communities are encouraged to The University of Michigan Medical School designates this live activity for a maximum of 3.75 AMA PRA Category 1 Credit(s)™.  This meeting will feature presentations from:
    • Michigan Center for Rural Health
    • MyMichigan Medical Center – Sault
    • Munson Healthcare Grayling Hospital
    • Region 9 Area Agency on Aging

To learn more about these initiatives and other MVC happenings, visit the MVC blog!

Footnote

[1] Hospitals and POs not meeting case count thresholds did not receive a report.

07 Jul 2022
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MVC Coordinating Center Team Volunteers at Member Hospital

MVC Coordinating Center Team Volunteers at Member Hospital

July 7, 2022 | 0 Comments

As employers and managers endeavor to invest in their company’s culture, there is one often overlooked activity that can positively impact job satisfaction: volunteering. According to a study from Deloitte, cultivating a culture that encourages volunteerism can boost employee morale, workplace atmosphere, and brand perception. It found that 89% of employees believe companies with sponsored volunteer activities offer a better overall work environment and that 70% felt volunteering was a stronger boost to morale than company-sponsored happy hours. Since team culture and the retention of skilled employees have become increasingly important in the current job market, there has never been a better time to help staff feel connected to their community and teammates.

The Michigan Value Collaborative (MVC) experienced some of these benefits recently when the Coordinating Center team spent several hours volunteering together at a local MVC member hospital. This was the first time MVC had organized an official service day for its team. It took place at the Farm at Trinity Health, located at the Trinity Health St. Joseph Mercy Ann Arbor Hospital in Ypsilanti, MI. The MVC team spent several hours weeding, planting, and harvesting vegetables. After harvesting, the MVC team helped wash and pack fresh greens, salad mix, kale, and radishes for the Farm’s community-supported agriculture (CSA) program and patient produce boxes.

Selecting the Farm at Trinity Health as MVC’s service day location was an exciting opportunity due to its many connections to MVC’s priorities. The produce boxes distributed by the Farm help feed members of the community who experience food insecurity or hunger, as well as hospital patients who participate in programs like cardiac rehabilitation (CR). MVC has identified health equity as a strategic priority for 2022 and beyond, and also currently has a Value Coalition Campaign that encourages members to increase patient utilization of CR programs. The MVC team was excited to learn about this direct connection to CR patients and the program’s overall impact on community health. In addition, the Farm at Trinity Health is a participating site in the Washtenaw County Health Department’s Prescription for Health Program, which was a featured topic at MVC’s health equity workgroup earlier this year.

This service day also coincided with an overall shift in how MVC staff members interact. As MVC grew over the past two years, multiple new employees had only ever interacted with coworkers virtually because of the pandemic’s impact on in-person activities. That changed this past spring with MVC’s part-time return to in-person work and some in-person team-building events. The service day was intended to bring teammates together after many months apart to get to know one another, connect, and give back to the wider community.

If you have a story about an impactful program that could be shared with the Collaborative or wish to connect your team with local community volunteering, contact the MVC Coordinating Center for assistance at michiganvaluecollaborative@gmail.com. Learn more about the Farm at Trinity Health (formerly the Farm at St. Joe’s) here.

23 Jun 2022
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MVC Registry to Soon Include Patient-Level Medicare Data

MVC Registry to Soon Include Patient-Level Medicare Data

June 23, 2022 | 0 Comments | ,

In the coming weeks, MVC registry users will receive communications outlining several required steps related to implementing the Coordinating Center’s new data use agreement (DUA) as a qualified entity (QE) with the Centers for Medicare and Medicaid Services (CMS). The QE DUA permits MVC to display Medicare Fee-For-Service (FFS) claims data with fewer data suppression limitations than its research DUA within its online registry. As a result, authorized users of the MVC registry may gain access to identifiable Medicare beneficiary data.

These changes are the result of years of work by the MVC team to earn its QE status through the Qualified Entity Certification Program (QECP), which is also known as the Medicare Data Sharing for Performance Measurement Program. The QE application includes multiple phases before an entity is permitted to show patient-level data. The MVC Coordinating Center has been working through the final phase (see Figure 1) of the application, which involves developing and documenting measures for public reporting.

Figure 1.

The QE Medicare data will be contained in a separate tab on the MVC registry. Authorized users will have access to both the existing Medicare FFS reports as well as the QE reports. The QE data will be available for the most recent 18 months of index admissions only and will not have any case count suppression, allowing users to see the more granular data that is censored in the Medicare FFS reports.

The QE reports also have additional patient population filters to view the data by patient comorbidities, patient age, and more granular date options. These reports also feature trend graphs that can be viewed monthly, quarterly, or annually. In addition to uncensored data, the QE data will allow for patient-level drill-down as is currently available in the Blue Cross Blue Shield of Michigan data. The drill-down includes detailed information on the patient’s comorbidities, price standardized episode payments, and claim level walk-through. Although patient drill-down is available, the provider identifiers have been removed in conjunction with the QECP regulations. Additionally, the skilled nursing facility report is not available in the QE reports to avoid identifying providers.

For those with access, the QE reports should be used when evaluating the most recent years of data. The Medicare FFS reports can still be useful for historical trends and the Coordinating Center may be able to provide custom reports to fill in information that isn’t available through the registry. The patient-level drill-down can be used in conjunction with a hospital’s clinical information to understand what led to high-cost patients. The QE data should make Medicare data more useful to hospital members. However, QE data is only to be used for quality improvement rather than for marketing purposes. Additionally, authorized users are prohibited from disclosing or redistributing data provided in these reports outside of their institution.

Next week MVC member hospitals will receive a new QE DUA to be reviewed and signed by an authorized representative from their institution. This signed DUA is a prerequisite for receiving access to the new QE pages once they are available. MVC’s current CMS research DUA will remain in effect on non-QE registry pages and will continue to utilize data suppression for fewer than 11 episodes to protect patient identities. The MVC registry will also implement multifactor authentication (MFA) upon login for all registry users regardless of QE access in order to comply with the new DUA's security and data privacy requirements.

In the coming weeks, MVC members and registry users are encouraged to be attentive to any communications containing additional details or requests. In the meantime, please contact the MVC Coordinating Center with any immediate questions at michiganvaluecollaborative@gmail.com.

16 Jun 2022
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New MVC Northern Summer Meeting Planned for August

New MVC Northern Summer Meeting Planned for August

June 16, 2022 | 0 Comments | , ,

MVC will launch a new in-person event this summer when it hosts members and speakers from Northern Michigan. This new MVC Northern Summer Meeting is modeled after the collaborative-wide semi-annual meetings, but it aims to focus on unique challenges and opportunities in delivering healthcare in this part of the state. The event will take place on August 18, 2022, from 12-5 p.m. at the Great Wolf Lodge in Traverse City, MI.

As MVC has gained new members, it has also diversified with the addition of more rural and critical access hospitals. These types of sites – many of which are located in the upper peninsula or northern half of the lower peninsula – play an integral role in the health system and have a unique care delivery experience. According to the Centers for Medicare and Medicaid Services (CMS), these types of hospitals have higher performance quality measures than their urban counterparts for areas such as safety, community engagement, efficiency, and cost reduction. At the same time, however, they also face unique challenges related to low patient volumes, higher rates of chronic disease, insufficient workforce recruitment and retention, and low reimbursement rates, among others.

It is these unique strengths and challenges that will be the focus of the day’s agenda, which will include speakers representing area hospitals, rural health organizations, community agencies, and the MVC Coordinating Center. The event’s keynote speaker will be Crystal Barter, MSA, Director of Programs and Services for the Michigan Center for Rural Health. Her presentation on “Michigan’s Rural Health Landscape: Challenges and Opportunities” will set the stage for the afternoon and be followed by speakers on specific topics, such as Hospital at Home care models and the aging population.

The other speakers include Stephanie Pins, MSA, Director of Quality Management, Risk, and Compliance, and Kristine Boyer, MSN, RN, Clinical Quality Manager, of MyMichigan Medical Center - Sault; Dr. Aditya Neravetla, MD, Chief Medical Officer at Munson Healthcare Grayling Hospital; and Jenna Lindholm, RN, CCM, Clinical Quality Supervisor at the Region 9 Area Agency on Aging.

The MVC Coordinating Center will also provide its latest updates as well as unblinded data to encourage member collaboration. The event includes dedicated networking sessions at the start and end of the day’s agenda when members can compare notes and glean ideas from peers.

MVC distributed invitations to northern members at the beginning of June and plans to share the full agenda with additional event specifics in the coming weeks. Those members who received invitations are encouraged to RSVP now.

If you have any questions about the upcoming event, contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

02 Jun 2022
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MVC Welcomes Associate Program Manager Erin Conklin

MVC Welcomes Associate Program Manager Erin Conklin

June 2, 2022 | 0 Comments |

Inspired by the Michigan Value Collaborative’s (MVC) vision and mission, I am thrilled to join the team as Associate Program Manager. In this newly created role, I will be responsible for supporting the management, performance, and daily operations of the MVC Coordinating Center.

After receiving my Master of Public Administration degree from the University of Michigan-Flint, I began my first role in the healthcare space at the Greater Flint Health Coalition (GFHC), a collaborative, cross-sector organization dedicated to improving the health status of Genesee County residents. This experience provided me with a unique opportunity to learn about a wide range of public health issues, such as the impact of social influencers, the complexity of care navigation for patients with mental health and substance use disorders, and the role of systemic racism and racial disparities in care. I gained valuable skills in project management, strategic planning, sustainable implementation, and partnership development.

Following my tenure with the GFHC, my career focused on managing quality and operational improvement initiatives that aimed to improve health outcomes through patient-centered, value-based care at leading institutions, including Michigan Medicine and Massachusetts General Hospital. This work included implementing new payment and service delivery models, such as the Pioneer ACO Model initiative and the Innovation Advisors Program, in partnership with the CMS Innovation Center. I also had the opportunity to support provider engagement and the expansion of evidence-based care delivery models across Michigan with the Centering Healthcare Institute and Michigan Opioid Partnership.

I am excited to serve as MVC’s new Associate Program Manager. I look forward to learning and collaborating with members, key stakeholders, and partner organizations to advance the mission, vision, and values of MVC. If you have any questions or wish to get in touch, please feel free to email me.

19 May 2022
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Semi-Annual Summary: Turning Data & Collaboration into Action

Semi-Annual Summary: Turning Data & Collaboration into Action

May 19, 2022 | 0 Comments | ,

The Michigan Value Collaborative (MVC) held its first semi-annual meeting of 2022 last Friday. A total of 158 leaders joined the MVC Coordinating Center’s virtual meeting, representing 68 different hospitals and 15 physician organizations (POs) from across the state of Michigan. “Turning Data and Collaboration into Action” was the theme of this year’s first semi-annual, putting the spotlight on quality initiatives that successfully leveraged data or collaboration to bring about improvements in healthcare.

MVC’s Director, Dr. Hari Nathan, kicked off Friday’s meeting with an update from the MVC Coordinating Center. He welcomed two new collaborative members, McLaren Caro Region and UP Health System - Bell, as well as MVC’s newest team member, Engagement Associate Chelsea Andrews. Dr. Nathan also highlighted the successes delivered by the Coordinating Center during the first six months of 2022. This included the incorporation of Medicaid data into MVC’s suite of push reports to provide a more complete view of the collaborative’s patient population, the launch of three new push reports (colectomy, pneumonia, and P4P), and the incorporation of additional demographic data into MVC's reporting.

MVC’s recent Qualified Entity accreditation was also highlighted, representing a breakthrough for the collaborative that will allow the relaxation of certain data use agreement regulations and improve the granularity of data available to members. As part of extending this improved access, the Coordinating Center will reach out to site coordinators to have authorized representatives at each institution complete a new data use form. To align with the security requirements of the Qualified Entity program, the MVC registry will also begin requiring multi-factor authentication for users upon login. More information on each of these elements will be shared with the collaborative in the coming weeks. Chelsea Abshire Pizzo, MVC’s Manager of Analytics, rounded off the meeting welcome by sharing some highlights from Program Year 2021 of the MVC Component of the Blue Cross Blue Shield of Michigan Pay-for-Performance (P4P) Program.

Showcasing opportunities where MVC data can drive change was a focal point for the meeting. Utilizing unblinded data from the collaborative, MVC Analyst Jessica Yaser led attendees through a data session focused on MVC’s two Value Coalition Campaigns (VCCs): Preoperative Testing and Cardiac Rehab. This allowed attendees to see their preoperative testing and cardiac rehab utilization rates compared to their peers. Hospitals performing well were invited to offer insights as to how this was achieved and what mechanisms other hospitals could adopt to improve performance levels. Jessica also announced new collaborative-wide goals around cardiac rehab utilization rates (see Figure 1), which will continue to be promoted and highlighted in the months ahead.

Figure 1.

With the scene set, MVC welcomed guest speakers Mary Pool and Holly Gould from McLaren Port Huron hospital. Mary and Holly provided attendees with an overview of how they have used MVC data to help tackle high readmission rates for the congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) patient populations at McLaren Port Huron. Specifically, data provided by the Coordinating Center helped confirm the suspicion that although follow-up rates were high across the institution, this wasn’t being translated into a reduction in readmissions. Stratifying these data further helped McLaren Port Huron introduce tailored initiatives in the form of their COPD and Heart Failure Navigator Programs, aimed at driving the effectiveness of follow-up visits (see Figure 2).

Figure 2.

After hearing from McLaren Port Huron, Michelle Marchese from BCBSM provided an overview of how their Physician Group Incentive Program (PGIP) platform supports value-based care. As part of this, Michelle provided a walk-through of the current state of BCBSM data and report sharing, outlining how these all fit together to provide valuable healthcare insights for physician organizations (POs) (see Figure 3). MVC’s ongoing partnership with BCBSM to identify PO-level opportunities for improvement was also highlighted – a collaboration that will continue moving forward to enhance the level of support available to POs across the state. Michelle then passed the baton to Dr. Shannon Martin from MyMichigan Health who shared how MyMichigan has used its internal data to develop, implement, and assess its “Health Aging Program.” This initiative is aimed at decreasing the use of high-risk medications in the elderly population, saving many seniors from the harm of adverse drug effects.

Figure 3.

The meeting concluded with a summary of the day and key upcoming activities, led by MVC Engagement Associate Chelsea Andrews. The recording from Friday’s meeting is available here. If you have questions about any of the topics discussed at the semi-annual or are interested in finding out more about MVC, please reach out to the Coordinating Center. MVC’s next semi-annual meeting will be in person on Friday, October 28 at the Radisson in Lansing – we look forward to seeing you all then!

05 May 2022
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MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

May 5, 2022 | 0 Comments | , ,

This year in the United States, cardiovascular disease will be responsible for one in every four deaths. Despite its prevalence, few cardiac patients eligible for cardiac rehabilitation utilize this life-changing program. In response, the Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) recently established the new Michigan Cardiac Rehab Network (MiCR) to collaborate on efforts that heighten awareness of these programs and support meaningful improvement in Michigan.

Cardiac rehabilitation (CR) is a comprehensive program encompassing supervised exercise, nutrition education, smoking cessation, mental health resources, skills training for heart-healthy lifestyles, and peer support from others who are experiencing a similar life event. It has a Class IA indication for recent cardiac-related events or procedures, meaning there is high-quality evidence that it is beneficial to patients. In fact, individuals who complete the full program of 36 sessions have a 47% lower risk of death and a 31% lower risk of heart attack than those who attend only one session. The evidence is clear that CR extends life and improves quality of life for patients with a recent cardiac-related event or procedure. Unfortunately, only one in three eligible Michiganders participates—a rate well below the Million Hearts nationwide goal of 70% participation.

Using claims data, MVC can assess both initiation and adherence – whether and when someone starts CR, and how long they keep going. There is wide variability in CR rates between MVC’s member hospitals (see Figure 1 for a sample plot from a recent blinded report). The site with the highest rate of cardiac rehab after coronary artery bypass graft surgery (CABG), for example, succeeds at sending 75% of their CABG patients to CR, while another only sends 28% of their CABG patients. This variation shows that it is possible to reach high CR rates, and hospitals can learn from each other to make improvements that save lives and reduce costs.

Figure 1. Collaborative-Wide CR Use Following CABG Discharge

MiCR was developed for this reason and will work to equitably increase CR participation for all eligible individuals in Michigan. Serving as Co-Directors of MiCR are Mike Thompson, Co-Director of MVC, and Dr. Devraj Sukul, Associate Director of BMC2 PCI. MiCR will distribute regular CR utilization summaries to relevant providers, convene regular meetings with its stakeholder and advisory groups, create resources that help hospitals and CR facilities optimize CR utilization, and continue to leverage the expertise of both CQIs.

In one of its first coordinated efforts, MiCR worked with CR providers and content experts to create a Cardiac Rehab Best Practices Toolkit, which was launched in April. It outlines initiation, maintenance, and innovation strategies for increasing the utilization of CR (see Figure 2 for a sample page). MVC encourages members to turn to this tool as they work to encourage the enrollment of more patients.

Figure 2. Sample Page from MiCR Best Practices Toolkit

The partner CQIs behind MiCR also released new statewide goals for improved CR utilization. Currently, 30% of patients utilize CR following transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), and acute myocardial infarction (AMI). The first goal is to reach 40% CR utilization for TAVR, SAVR, CABG, PCI, and AMI patients. In addition, only about 3% of congestive heart failure (CHF) patients currently utilize CR. The second statewide goal is a collaborative-wide utilization rate of 10% for CHF patients. Progress on these goals will be shared by MVC in its CR reports sent every six months.

The two CQIs will also continue with their respective activities in the CR space. MVC supports CR participation in two primary ways. One is providing opportunities for MVC members to collaborate, and the second is the preparation of reports using its unique multi-payer data sources. The MVC team supports collaboration through stakeholder meetings and workgroups, which allow sites and clinicians to share solutions for common challenges. The reports MVC prepares analyze member claims data with time-specific hospital-level information on CR enrollment and completed visits within one year of discharge. This allows hospitals to benchmark their performance against peers and identify areas for improvement. MVC will also share unblinded data on CR rates with members at its May semi-annual meeting in one week, which is meant to drive conversation and encourage best practice sharing across the collaborative. The MVC team hopes that its outreach and resources help members to save lives by providing strong endorsements for CR and addressing barriers that may limit patient participation.

For more information on MVC’s CR efforts, visit MVC’s Value Coalition Campaign webpage. For more information about CR, view this MVC video or visit the Million Hearts website. If you have questions about any of the above activities or resources, reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

28 Apr 2022
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Sepsis Push Reports Include Demographics, COVID Patients

Sepsis Push Reports Include Demographics, COVID Patients

April 28, 2022 | 0 Comments |

For the last two years, the Michigan Value Collaborative (MVC) Coordinating Center has offered a sepsis service line developed in partnership with the Michigan Hospital Medicine Safety Consortium (HMS). In conjunction with this work, reports customized to each member hospital are distributed each year. The most recent iteration shared with members this week features several updates from the 2021 versions.

A new patient population snapshot table is one new feature that the MVC Coordinating Center added in order to integrate its demographic data. These tables (see Figure 1 for a sample table of a blinded acute-care hospital) provide each hospital with demographics for their sepsis patient population, including race, mean age, top patient zip codes, the most frequent and average number of comorbidities, the proportion of dual-eligible patients, and the proportion of patients with a confirmed diagnosis of COVID-19. Furthermore, this data is stratified by payer, providing additional insights into specific groups of patients.

Figure 1.

The inclusion of COVID-positive patient percentages is an important statistic since this iteration of the sepsis push report includes COVID patients, whereas the Coordinating Center removed these patients in previous versions. This final row of the patient population snapshot table will help hospitals understand the extent to which their data is driven (or not) by patients with a confirmed COVID diagnosis code. Across the collaborative, 90-day total episode payments increased in 2020, which can likely be attributed to episodes with a COVID diagnosis; however, the 2020 average is not much higher than the average from 2018 through early 2019 (see Figure 2). Since the COVID-19 pandemic hit regions of Michigan at different times, regional comparisons for select measures will be particularly useful in understanding one’s data. Different versions of the report were created for acute-care and critical access hospitals, which allowed for tailored comparison groups.

Figure 2.

The complete report compares MVC hospitals on 90-day risk-adjusted total episode payments, inpatient length of stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality and discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, and Medicaid.

In addition to continuing to offer its sepsis push reports, the MVC Coordinating Center also offers a bimonthly sepsis workgroup. The next workgroup will take place on Thursday, May 26 from 2-3 p.m., and will feature a presentation about successes in sepsis-bundle compliance. Register today to join the MVC Coordinating Center for this presentation and discussion.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. We are also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at michiganvaluecollaborative@gmail.com.