15 Oct 2025
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MVC 2025 Fall Collaborative-Wide Meeting Summary – Adapting Together in 2025 and Beyond: High-value Care for All in a Changing Landscape

MVC 2025 Fall Collaborative-Wide Meeting Summary – Adapting Together in 2025 and Beyond: High-value Care for All in a Changing Landscape

October 15, 2025 | 0 Comments | , , , , ,

The Michigan Value Collaborative (MVC) held its fall 2025 collaborative-wide meeting on Friday, Oct. 10, in Livonia. A total of 91 attendees representing 64 hospitals, three physician organizations, and 13 healthcare systems from across the state of Michigan came together to share strategies for mitigating the impact of non-medical drivers on health outcomes.

MVC Director Mark Bradshaw, MSc, kicked off Friday’s meeting with updates on the MVC Coordinating Center [See slides]. He introduced MVC’s newest team members, Manager of Data Analytics Ian Raxter, MPH, and Project Manager Emily Woltmann, PhD, MSW, as well as announced the promotion of Julia Mantey, MPH, MUP, to Lead Analyst. Bradshaw encouraged sites to register for the 2025 Michigan Cardiac Rehab network (MiCR) fall meeting at Corewell Health Troy Hospital by the Oct. 31 deadline. He also provided an update on Phase II of the RITE-Size preoperative testing trial and recent MVC reporting since MVC’s spring meeting, including refreshed common conditions push reports, the new health outcome variation push report, and the P4P Program Year 2025 mid-year scorecards. Bradshaw provided insights on the content included in the health outcome variation push report and the P4P Program Year 2025 mid-year scorecards before reviewing Program Year (PY) 2026-2027 cycle changes and member selections (Figure 1 and Figure 2).

Figure 1.

Figure 2.

Following Bradshaw’s announcement that MVC’s 2026 engagement point menu is now posted on MVC’s P4P webpage, MVC Engagement Manager Jessica Souva, MSN, RN, C-ONQS, highlighted the differences from previous versions of MVC’s engagement point menu. Souva noted that most of the changes to the engagement point menu were adjustments to the point values; however, Souva introduced the addition of a site coordinator education modules offering (Figure 3). Details on these modules will be shared with MVC site coordinators in the coming months via email.

Figure 3.

The meeting then featured a presentation from the MSHIELD CQI, including Program Manager Julia Weinert, MPH, and Bradley Iott, PhD, MPH, on implications of non-medical drivers of health for quality improvement. Weinert and Iott presented research evidence on the importance of addressing upstream drivers of health outcomes, MSHIELD implementation toolkits, and resources available on the MSHIELD website.

MVC’s keynote presentation was delivered by Gloria Rey, PA-C, MPH, Director of Post-Acute Care for Henry Ford Health/Populance. Her presentation detailed Henry Ford Health’s approach to developing and maintaining strong relationships with post-acute care providers [See slides]. Rey went on to demonstrate how these relationships have improved patient outcomes and cost savings (Figure 4).

Figure 4.

After a networking lunch, MVC Medical Director Hari Nathan, MD, PhD, and MVC Analyst Kushbu Narender Singh, MDS, MPH, delivered an MVC data presentation focused on MVC’s new health outcome variation measure [See slides]. During the presentation, Narender Singh supplemented Dr. Nathan’s explanation of the measure definition (Figure 5), benefits, and rollout timeline with MVC member unblinded data and case scenarios. An introductory video for the health outcome variation measure is available on MVC’s P4P webpage.

Figure 5.

Attendees spent time in the afternoon in various breakout sessions (Figure 6) learning about strategies from other MVC members to address non-medical drivers of health outcomes [See slides].

Figure 6.

The meeting closed with a reflection of the day spent together and reminders about upcoming meetings and events [See slides].

What are the attendees saying about the meeting?

“I gained a lot of insight and ideas to take back to my organization to review with others.”

“I learned that patients can be in home care and cardiac rehab at the same time which is a game changer for us.”

“Enjoyable to see the multi-faceted approaches that are being used throughout the state's regions for decreasing readmissions.”

“I really enjoyed the breakout sessions and discussions!”

“Loved the ability to talk with other groups and learn from each other. Like the unblinded data, it was more meaningful to what was being discussed.”

If you have questions about any of the topics discussed at MVC’s fall collaborative-wide meeting or are interested in following up for more details, email the MVC Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Fri., May 8, 2026, in Traverse City.

03 Sep 2025
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August Workgroups Highlight Preop Testing and Three-Pronged Behavioral Health Initiative

August Workgroups Highlight Preop Testing and Three-Pronged Behavioral Health Initiative

September 3, 2025 | 0 Comments | , , , ,

In August, MVC hosted two virtual workgroup presentations – a preoperative testing workgroup focused on planning and evaluation of an initiative to reduce unnecessary preoperative testing, and a health in action workgroup on the Michigan Department of Health and Human Services (MDHHS) behavioral health initiative. The MVC Coordinating Center hosts workgroup presentations twice per month on a variety of topics including post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. 

Preoperative Testing Workgroup - Holland Hospital

On Aug. 12, MVC hosted a preoperative testing workgroup with a presentation by Amy Poindexter, BSN, RN, from Holland Hospital. Poindexter is the Performance Improvement Analyst in Holland Hospital’s quality department and played an integral role in their quality initiatives over the past 16 years. Her work includes data abstraction for Core Measures, Michigan Hospital Medicine Safety Consortium (HMS), Michigan Surgical Quality Collaborative (MSQC), and the Multicenter Perioperative Outcomes Group (MPOG) Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) registry. 

Holland Hospital’s quality initiative focused on reducing unnecessary, routine preoperative testing within 30 days of low-risk elective surgeries. Conditions included in the project were elective hernia, lap cholecystectomy, and breast lumpectomy. The types of testing that were considered included electrocardiograms (ECG), transesophageal echocardiogram (TEE), cardiac stress test, chest x-ray, urinalysis, labs (CBC, BMP, coagulation tests), and pulmonary function tests (PFT). Baseline data used for this initiative was based on Blue Cross Blue Shield of Michigan (BCBSM), Medicare, and Medicaid patient episodes from January 2023 – March 2023. The initiative goal was to reduce unnecessary preoperative testing by 20% through December 2023. 

The parameters for selecting the preoperative tests were based on recommendations from several well-known medical societies. The American Society of Anesthesiologists recommends not obtaining baseline laboratory studies in patients without significant systemic disease (ASA I or II). The American College of Cardiology recommends avoiding performing ECG screening as part of the preoperative cardiovascular risk assessment in asymptomatic patients scheduled for low-risk non-cardiac procedures. Guidelines to not perform chest x-rays on patients with unremarkable history and physical exams, which are provided by the American College of Radiology and American College of Surgeons, were also used to establish preoperative testing parameters. Holland Hospital used the RITE-size decision aid (Figure 1) to guide testing logic:

Figure 1. RITE-Size Preoperative Testing Decision Aid for Low-Risk Surgeries

Graphic of RITE-size Preop Testing Decision Aid for Low-Risk Surgeries

Prior to implementing the quality initiative to improve preoperative testing rates, Holland Hospital worked with MVC claims data and MSQC abstracted clinical data from Q1 2023 to develop a baseline data visualization tool. The hospital found that their preoperative testing rates for low-risk surgeries were approximately 10% higher than the MVC All average. According to the sampled cases from MSQC, their average baseline rate was approximately 33%. Holland Hospital set a goal of reducing preoperative testing by 20% (the average rate would need to be less than or equal to 26%) by the end of December 2023. 

Planning Phase 

During the pre-implementation phase of planning, the hospital formed a multi-disciplinary team including pre-admission testing (PAT) staff, surgery providers, hospital leadership, anesthesiologists, and quality improvement staff. The team focused on their pre-admission testing lab draw (basic chemistry panel) policy, which was focused on general and major anesthesia of male and female patients ages 65 – 74 and patients aged 75 and older for specific types of labs such as epidural, spinal, regional, and brachial plexus. Initially, labs were drawn within one month of the procedure, but with the revised policy, patients undergoing low-risk general procedures such as elective hernia or lap cholecystectomy only required labs within 60 days of their procedure. In addition, the process shifted to establish the pre-admission assessment as the trigger for the preoperative testing decision chart. 

Evaluation 

After analyzing the percentage of preoperative screening tests ordered for the associated low-risk procedures, Holland Hospital found that in 2022 they were ordering preoperative tests at a rate of approximately 52% (MVC All rate equaled approximately 45%). With further investigation of preoperative test ordering practices, the site found that of the physicians ordering the tests, 71% were surgeons and 29% were primary care providers (PCPs). Interestingly, the PCP orders would often fall within the 30-day window as the turnaround time from PCP appointment to surgery appointment was happening within a month. It was discovered that physicians had been following old guidelines that were given to them when they were initially onboarded at the hospital in prior years. This finding initiated the implementation of provider education and a slight change in ordering practices.  

To improve ordering accuracy, the PAT team was assigned the responsibility of checking and ordering any preoperative tests needed instead of the surgeons ordering them. As shown in Figure 2, the preoperative testing rates remained above average through September 2023 until provider education and process changes were fully implemented at the end of Q3. After implementing provider education, testing rates showed a significant reduction through the end of 2023.

Figure 2. Holland Hospital Preoperative Testing Rates in 30 Days Prior to Admission for Low-Risk Surgery – Pre-Implementation through Post-Implementation of QI

Vertical bar graph of Holland Hospital Preoperative Testing Rates in 30 Days Prior to Admission for Low-Risk Surgery – Pre-Implementation through Post-Implementation of QI

Workgroup participants asked Poindexter whether other staff had the ability to order preoperative lab tests (such as anesthesia staff) and whether surgical or anesthesia staff were internal or external contracts (Holland Hospital has a mix). Participants were also curious to know how internal or external contracts impacted consistent education. Poindexter noted the education piece was an easier lift at their smaller site, since they only have a few surgical physicians. Participants discussed best practices such as having an updated preoperative testing education program in place for physicians and surgical teams, utilizing RITE-size resources, and including an editable letter and related resources for PCPs about preop testing guidelines and procedures.

Health in Action Workgroup - MDHHS 

On Aug. 28, MVC hosted a health in action workgroup with a MDHHS presentation by Lindsey Naeyaert, MPH, Director of Behavioral Health Transformation in Health Services, and Leah Julian, Innovation in Behavioral Health Specialist in Health Services. Naeyeart leads and directs policy development and changes, program operations, analysis, research, and reporting of integrated health models at MDHHS. Julian is responsible for planning, implementation, and oversight of the Innovation in Behavioral Health (IBH) Model in partnership with the Centers for Medicare & Medicaid Services (CMS). Naeyaert and Julian presented the three programs currently offered through MDHHS: Behavior Health Home, Certified Community Behavioral Health Clinics, and the Innovation in Behavioral Health Model. 

Behavior Health Home (BHH) 

The BHH is one of the longest running Medicaid optional state plan benefits, authorized under the 1945 US Social Security Act. This plan allows for more flexible funding towards care for serious and complex chronic conditions of Medicaid beneficiaries. The purpose of the BHH plan is to serve the “whole person” by including physical, behavioral, and social services through an interdisciplinary care team. The goal of this program is to integrate care, create cost-efficiencies, and increase participant health status. This plan is available for people with Medicaid who have two or more chronic conditions, or one chronic condition and are at risk for a second condition. 

In 2014, MDHHS launched a county model of BHH and revamped the design in 2020. The updated program targeted beneficiaries with a diagnosis of Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED). The service area includes 79 counties and 40 home health providers including community mental health services programs, federally qualified health centers, hospital-based clinical practices, rural health clinics, and tribal health centers. In fiscal year (FY) 2024, there were 4,399 people enrolled with ages ranging from 4-86.  

Under this plan, interdisciplinary team members can now be reimbursed for services provided under Health Home Core Services (HHCS) that in the past could not be billed. For example, if the team meets to discuss a patient’s treatment plan it can be billed under care coordination through HHCS (Figure 3). Other covered services include comprehensive care management, health promotion, comprehensive transitional care, individual and family support, referral to community, and social services.

Figure 3. Health Home Core Services

graphic of six Health Home Core Services

Since the implementation of the program, there have been several positive outcomes observed such as increased post-discharge follow-up for mental illness or intentional self-harm episodes, increased care coordination between physical and mental health providers, increased control of high blood pressure, and increased access to preventive/ambulatory health services. 

Certified Community Behavioral Health Clinics (CCBHCs) Demonstration 

CCBHCs are non-profit or local government agencies that must meet robust state certification criteria (200 standards). These sites must serve all people, regardless of insurance status or ability to pay, and are required to work with local hospitals as part of their certification criteria. These sites use a state-developed and clinic-based prospective payment system model for reimbursement. There are currently 35 demonstration sites across the state of Michigan. The primary objectives of CCBHCs are to increase access to high-quality services that use evidence-based practices; coordinate behavioral health, physical health, and social needs; promote the use of evidence-based practices; and establish statewide standardization and consistency using the same criteria across all certified clinics. 

In year three (FY 2023) through four (FY 2024), MDHHS added 17 CCBHC sites in Michigan and expects to add 10 more sites by FY 2025. Data collected through FY 2024 shows positive impacts on participating patient populations and CCBHCs. Overall, CCBHCs have seen a 77% increase in individuals served since development year two, with 81% of participating patients enrolled in Medicaid. Some patients with commercial health plans have been able to see providers at CCBHCs as well. Data also shows that 23% of CCBHC patients were children 18 years old and younger. This suggests that parents are bringing their children to see the same providers they do, making it easier for them to access care for all family members in one location. Additional findings show that even though they may have other clinics closer to home, 11% of patients were served outside their county of residence, meaning they are specifically seeking CCBHCs for treatment.  

Naeyeart shared that CCBHCs exceeded statewide averages for Medicaid beneficiaries in the following areas: 

  1. Follow-up after emergency department visit for mental illness 
  2. Follow-up after emergency department visit for alcohol and other drug dependence 
  3. Follow-up after hospitalization for mental illness 
  4. Diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications 
  5. Adherence to antipsychotic medications for individuals with schizophrenia 
  6. Plan all-cause readmission rate 
  7. Initiation and engagement of alcohol and other drug dependence treatment 

Innovation in Behavioral Health (IBH) Model 

The newest program launched is the IBH model. Julian shared that Michigan had been selected to participate in the IBH model in 2024 and began participation on Jan. 1, 2025. This is a cooperative agreement with CMS focused on improving the quality of care and behavioral and physical health outcomes for adults enrolled in Medicaid and Medicare with moderate to severe mental health conditions and substance use disorder. The goal is to assist in minimizing barriers to high quality integrated care. 

The core elements of the IBH framework include: 

  1. Care Integration – Behavioral health practice participants will screen, assess, refer, and treat patients as needed for the services they require. 
  2. Care Management – An interprofessional care team led by the behavioral health practice participant will identify and address multifaceted needs of patients for ongoing care. 
  3. Health Information Technology – Expansion of health information technology capacity through targeted investments in interoperability and tools (e.g. electronic health records) will allow participants to improve quality reporting and data sharing. 

The primary objectives of this program are to improve quality and delivery of whole person care, align care delivery and payment systems between Medicare and Medicaid, explore Medicaid payment strategy, develop value-based payment methodologies, and improve health information systems to improve quality and data sharing.  

This program aims to work with providers who are integrated and engaged with CCBHC or BHHs, sites that are Medicaid entities, providers that serve at the outpatient level with at least 25 people enrolled in Medicaid per month, and sites that provide mental health and or substance use disorder services at the outpatient level of care. The model has an eight-year performance period, including three years of planning (2025-2027) and five years for implementation (2028-2032). In the current planning phase, the focus is on building the structure for the model’s framework identifying stakeholders (e.g., state personnel, practice participants, community organizations, etc.), developing a recruiting strategy, designing a care delivery framework, establishing a Medicaid payment approach, and designing an effective health information technology plan. 

Workgroup participants inquired about any intention of collaborating with other CQIs like the Michigan  Mental Health Innovation Network for Clinical Design  (MI Mind) or community-based organizations like Salvation Army or the Young Women’s Christian Association (YWCA) system. Workgroup participants expressed significant interest in being involved with this model as participant partners.

MVC Health in Action Workgroup: Aug. 28, 2025

MVC welcomes workgroup presenters from across Michigan to share their expertise, success stories, initiatives, and solution-focused ideas with MVC members. Please reach out to MVC by email if you are interested in being a workgroup presenter or submit a presentation proposal here. 

23 Feb 2024
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BMC2 Recognized as a 2023 Eisenberg Patient Safety & Quality Award Recipient by NQF, Joint Commission

BMC2 Recognized as a 2023 Eisenberg Patient Safety & Quality Award Recipient by NQF, Joint Commission

February 23, 2024 | 0 Comments | ,

BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) has been recognized with the prestigious John M. Eisenberg Patient Safety and Quality Award in the Local Level Innovation in Patient Safety and Quality category.

BMC2 has been honored for its remarkable improvements in the documentation of radiation use, a decrease in high-dose radiation exposure, and reduction in opioid pill prescribing rates. BMC2 is a statewide quality improvement collaborative that develops and administers a portfolio of quality improvement interventions for patients who undergo heart stenting, vascular surgical procedures, and transcatheter valve procedures in Michigan. The consortium is one of 22 Collaborative Quality Initiatives sponsored by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.

The Eisenberg Awards honor the late John M. Eisenberg, MD, MBA, and bring together the quality community to recognize groundbreaking initiatives in healthcare that are consistent with the aims of the National Quality Strategy: better care, healthy people and communities, and smarter spending. Dr. Eisenberg was the former administrator of the Agency for Healthcare Research and Quality (AHRQ) and an impassioned advocate for healthcare quality improvement. The award, presented annually by The Joint Commission and the National Quality Forum (NQF), recognizes major individual, local, and national achievements in healthcare that improve patient safety and healthcare quality.

“BMC2’s work impacts 30,000 patients treated by hundreds of physicians from more than 100 hospital teams each year,” shares Dr. Hitinder Gurm, Director of BMC2. “We are fortunate to have this unique partnership between providers, hospitals, and payers, that is focused solely on improving safety, quality, and appropriateness of care. The collaborative creates data-driven quality improvement goals and initiatives, shares best practices, and distributes reports benchmarked to statewide performance, all focused on improving cardiovascular care throughout Michigan.”

In Michigan, documentation of radiation use improved from 73.1% in 2019 to 85.5% in 2021, and BMC2 sites are outperforming national rates, which were 57.5% in 2019 and 74.3% in 2021. BMC2 sites achieved an overall 43% decrease in cases with high-dose radiation exposure (2.8% in 2018 to 1.2% in 2021), affecting hundreds of patients and care teams. BMC2 also reduced opioid pill prescribing; data showed improvement in the rate of patients with a prescription of less than 10 opioid pills by approximately 30% between 2018 (62%) and 2021 (91%). In addition, BMC2 has been exploring strategies to address healthcare disparities and partners with a patient advisory council to create resources for patients and providers.

The Eisenberg Award panel was impressed by BMC2’s dissemination of its work. BMC2 data has supported more than 100 publications in peer-reviewed medical journals and more than 100 presentations at national and international conferences. The panel noted that this kind of collaborative, best-practice approach improved outcomes, reduced costs, and could be replicated by other states. The panel was inspired by BMC2’s inclusive scope across so many clinicians, physicians, teams, and sites, acknowledging the collaborative is “working to improve care, at every institution, and for every patient. It's remarkable.”

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BMC2 is a collaborative consortium of health care providers in the State of Michigan comprised of three statewide quality improvement projects addressing percutaneous coronary interventions (BMC2 PCI), vascular and carotid interventions (BMC2 Vascular Surgery), and transcatheter aortic and mitral valve procedures (MISHC) in collaboration with the Michigan Society of Thoracic and Cardiovascular Surgeons. Learn more about BMC2’s activities and achievements in their 2023 Annual Report.

Like MVC, support for BMC2  is provided by Blue Cross Blue Shield of Michigan and Blue Care Network as part of the BCBSM Value Partnerships program.

16 Feb 2024
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MVC Celebrates Heart Month, Annual Cardiac Rehab Week

MVC Celebrates Heart Month, Annual Cardiac Rehab Week

February 16, 2024 | 0 Comments | , ,

Throughout February’s American Heart Month, the Michigan Value Collaborative (MVC) has and will continue to provide cardiac rehab resources and information on behalf of the Michigan Cardiac Rehab Network (MiCR). This week, MVC also shared content as part of National Cardiac Rehabilitation Week, joining other organizations across the country to promote the benefits of the program and share information on statewide initiatives. As cardiac rehab week comes to a close, MVC is proud to highlight recent activity.

The MiCR partnership was established by MVC and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), who have partnered in recent years to support quality improvement and innovation around cardiac rehabilitation participation. Although the strategies and initiatives have changed and expanded over time, the key goal remains: to equitably increase cardiac rehabilitation utilization among eligible patients across the state of Michigan. This week, MiCR sought to educate providers within the BMC2 and MVC collaborative about the benefits of the program, current statewide participation rates, and novel initiatives in place to support improvement.

One product highlighted this week was the MiCR cardiac rehab hospital-level push reports, which benchmark cardiac rehabilitation participation across the collaborative. The 2023 report highlighted significant variation in performance and also demonstrated that several hospitals in Michigan are already successfully reaching or exceeding goals for utilization (Figure 1).

Figure 1.

Current MiCR resources, including both hospital-level cardiac rehab benchmarking reports and the MiCR Best Practices Toolkit, were designed to serve members in tracking hospital cardiac rehabilitation utilization and provide guidance to improve enrollment and adherence to the program; however, neither resource specifically investigated patient barriers to participation. To bolster successful referrals to cardiac rehabilitation in Michigan, MiCR recently partnered with Healthy Behavior Optimization for Michigan (HBOM) to launch a new program titled NewBeat. Designed to deliver heartfelt, pragmatic support to new cardiac rehabilitation patients, NewBeat is a multi-component intervention designed to address three common barriers to patient enrollment and participation: lack of education, unclear physician endorsements, and transportation access.

To address the first barrier, MiCR recently launched its website, which houses patient and provider-facing resources, MiCR event dates, and publications in one convenient location. The website already includes features such as a cardiac rehabilitation location finder and unified cardiac rehabilitation resources, but over the coming months will continue to expand.

There is research evidence that strong, personal physician referrals increase the likelihood of cardiac rehabilitation participation. For many patients, in fact, a personal referral is the only reason they sign up. Following the data, NewBeat’s second intervention component is its Cardiac Care Cards, which leverage the influence of cardiovascular providers in encouraging cardiac rehabilitation enrollment in a memorable and personal way. The cards, which can be saved and displayed on kitchen tables and refrigerators, serve as a reminder to patients that the care team understands their recovery process and supports them as they enter cardiac rehabilitation as the next step in their recovery (Figure 2). Hospitals and rehab program staff can request on the MiCR website.

Figure 2.

As the initiative continues to develop, NewBeat will grow to include patient success stories, provider-facing videos, and an informational handout on transportation resources.

One of MiCR’s key strategies in promoting the benefits of cardiac rehabilitation is fostering collaboration between providers and program staff. One of these opportunities is through an MVC workgroup series focused on cardiac rehabilitation, with the next session taking place at noon on Thurs., Feb. 22 (Figure 3). The workgroup will include a guest presentation by Devraj Sukul, MD, MSc, Co-Director of MiCR and Associate Director of BMC2 PCI. The presentation will feature recent findings about cardiac rehabilitation liaisons and their impact on patient enrollment. Register here to participate. MiCR also recently sent a save the date for its next stakeholder meeting, which will take place virtually on Fri., April 5, 10-11 a.m.

Figure 3.

MVC would like to thank everyone who contributed to Cardiac Rehabilitation Week this year. Advocating for cardiac rehabilitation continues to be a high priority for the MVC team, and the Coordinating Center is inspired by the recent growth and interest in this endeavor. Collectively, by promoting cardiac rehabilitation we can save lives and help patients in Michigan get back on their feet faster. Please contact the MVC team with any questions about attending future cardiac rehabilitation events or receiving related materials.

02 Feb 2024
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CQI Leader Selected as 2024 Presidential Leadership Scholar

CQI Leader Selected as 2024 Presidential Leadership Scholar

February 2, 2024 | 0 Comments

The Collaborative Quality Initiatives (CQIs) will be represented in this year’s Presidential Leadership Scholars (PLS) program, which invites 60 scholars to participate in a six-month, one-of-a-kind, bipartisan initiative focused on learning from the presidencies of George W. Bush, William J. Clinton, George H.W. Bush, Lyndon B. Johnson, and their administrations.

Scholars are chosen from a highly competitive field and must undergo a rigorous application and review process. They are selected based on leadership growth potential and the strength of their personal leadership projects addressing local, national, or international challenges.

For Amanda Stricklen, RN, MSN, it’s an opportunity to continue her lifelong professional journey of improving healthcare, and she brings robust experience in healthcare quality improvement and patient safety to the PLS program. She earned bachelor’s and master’s degrees from the University of Michigan School of Nursing before gaining years of experience in bedside nursing. Currently, Stricklen serves as the program manager for the Michigan Bariatric Surgical Collaborative (MBSC) and the Michigan Surgical Quality Collaborative (MSQC) focusing on improving clinical outcomes, enhancing patient experiences, and building a statewide community of providers who work together to elevate the care of surgical patients. Like the Michigan Value Collaborative, the coordinating centers for MSQC and MBSC are housed at Michigan Medicine.

“I am honored to be one of 60 scholars for this year’s Presidential Leadership Scholars Program,” said Stricklen. “I look forward to learning new leadership skills and representing the Collaborative Quality Initiatives, Michigan Medicine, Blue Cross Blue Shield of Michigan, and the University of Michigan as a whole. My goal is to learn new leadership goals to empower and provide support to participating hospitals and healthcare providers to enhance care in Michigan and across the nation.”

“Amanda Stricklen is one of the longest serving program managers in Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiative program, the first of its kind, internationally recognized, award-winning model that focuses on a critical challenge – improving health care quality and value,” said Tom Leyden, director of the BCBSM Value Partnerships program, which provides funding for the CQIs. “Amanda is an accomplished leader who demonstrates a strong commitment to the CQIs’ shared principles of transparency, collaboration, trust, and measuring performance.”

Stricklen will join leaders from across the country representing the military, non-profit organizations, public and private sectors. Scholars will travel to each participating presidential center to learn from key former administration officials, business and civic leaders, and leading academics. They will study, put into practice varying approaches to leadership, and exchange ideas to help strengthen their impact in the communities they serve.

“Amanda, a beacon of excellence in Michigan's quality improvement landscape, has earned her place as a Presidential Leadership Scholar, illuminating the path of leadership with dedication and innovation,” said CQI Portfolio Director Michael Englesbe, MD. “We look forward to benefiting from the enhanced skills she will gain through this program.”

The 2024 program kicks off Jan. 24 in Washington, D.C.

About the Presidential Leadership Scholars

The Presidential Leadership Scholars program is a partnership among the presidential centers of George W. Bush, William J. Clinton, George H.W. Bush, and Lyndon B. Johnson. To learn more, visit presidentialleadershipscholars.org.

11 Jan 2024
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MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

January 11, 2024 | 0 Comments | ,

On Monday, organizations large and small will honor the work and legacy of Dr. Martin Luther King Jr. His work has continued to inspire the country on issues such as equality, discrimination, and systemic racism. As the MVC Coordinating Center approaches this national holiday, we reflect on the continued relevance of one of Dr. King’s famous quotations about healthcare injustices: "Of all the forms of inequality, injustice in health is the most shocking and inhuman.” Dr. King made this comment and others about healthcare discrimination in 1955, and yet almost 70 years later our healthcare system continues to grapple with issues of inequity, discrimination, and racism.

As a result, health equity is currently a priority across most major healthcare and government agencies. The MVC Coordinating Center has similarly identified health equity as a strategic priority in recent years and in its newest strategy refresh. This means that a variety of health equity conversations, reporting, and learning opportunities will be offered to MVC members throughout the year. In discussions with members to date, it has been evident that many are still in an information-gathering phase and desire advice around best practices. Therefore, MVC will seek to identify differing approaches to health equity across the collaborative through a health equity survey, which will be shared with members at the end of January. Members will have until mid-April to complete this survey, after which MVC will report aggregate results and facilitate connections between members.

MVC also plans to continue integrating health equity into its workgroup offerings, with each workgroup series (e.g., cardiac rehab, preoperative testing, post-discharge follow-up, rural health, sepsis, health in action) offering at least one session focused on equity. In addition, MVC is planning to offer a reimagined health equity report informed by the results of the survey that integrates supplemental data sets tied to social determinants of health.

MVC’s equity activities this year come on the heels of MVC’s fall collaborative-wide meeting, which focused on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare. The agenda incorporated the voices of key leaders and community-based organizations working to improve equity in care delivery, including 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. Key takeaways and links to slides from Dr. Canady and other guests are available in MVC’s meeting summary. The session also included roundtable speakers from community-based organizations, which helped to facilitate collaboration and networking to support direct patient support services. MVC will strive to offer similar networking and collaboration opportunities at future collaborative-wide meetings.

The MVC Coordinating Center wishes its members and partners well as they celebrate MLK Day in their way. We are grateful for your continued engagement and partnership on important issues as we collectively strive to provide high-quality care for all.

08 Dec 2023
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MVC Announces Key Event Dates in 2024 Engagement Calendar

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.

16 Nov 2023
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MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

November 16, 2023 | 0 Comments | , , ,

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).

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).

Figure 2.

MyMichigan Medical Center Sault identified several lessons learned from delivering its Rides-to-Recovery Program over the last 10 years and applied many of those lessons to the development of its more recent Rides-to-Wellness Program. Pins also shared several tips for starting similar hospital-based transportation support programs at other locations throughout the state (Figure 3).

Figure 3.

Those who missed the workgroup and would like to learn more about these two programs, how they are managed, and how they were developed can review the full recording here. MVC is excited to offer a new rural health workgroup series quarterly in 2024. Contact MVC if you are interested in receiving invitations to those workgroups.

06 Jul 2023
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Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

July 6, 2023 | 0 Comments | , , ,

The opioid epidemic continues to harm individuals and communities worldwide; over-prescribing, overuse, and related overdose deaths persist in the United States and abroad. Without proper intervention, the proliferation of opioid use disorder and its negative impact on population health will continue. Healthcare professionals and stakeholders eager to stem this crisis are investing in the development and iteration of interventions that improve control of opioid distribution. As part of this effort, one team of healthcare researchers recently published a paper in Urology investigating the impact of an insurance payer’s novel opioid reduction intervention on the adoption of opioid-sparing pathways.

The authors of this publication, including lead author Dr. Catherine S. Nam, M.D., and her colleagues from Michigan Medicine, sought to compare the percentage of patients who filled peri-procedural opioid prescriptions before and after Blue Cross Blue Shield of Michigan (BCBSM) launched a modifier 22 incentive for opioid-sparing vasectomies in Michigan. This program incentivized the utilization of an opioid-sparing post-operative pathway developed by the Michigan Opioid Prescribing Engagement Network (OPEN) by allowing the use of the modifier 22 reimbursement code for vasectomies performed with minimal or no post-operative opioids. Previous literature has demonstrated success in this approach for other medical procedures. The use of modifier 22 as an opioid reduction intervention was first launched by BCBSM in 2018 for select procedures and was expanded to include vasectomies in 2019. Typically, modifier 22 can be applied to select insurance claims with the primary procedure code when the work attributed to that procedure or medical intervention exceeds the typical amount of required labor. When approved, insurance companies may provide additional reimbursements of up to 35%.

The expanded eligibility for the modifier 22 into vasectomy presented substantial quality improvement potential given both how commonly this procedure is performed—approximately half a million times annually across the US—and the fact that a 2019 survey indicated more than half of urologists prescribed opioids for patients receiving a vasectomy, even though the procedure can be completed without them. For a vasectomy procedure to qualify for the modifier 22 program, a surgeon must intend to follow an opioid-free peri-procedural course as well as provide additional counseling to patients about post-procedural pain expectations, proper opioid disposal, and non-opioid pain management strategies.

Given the novel quality incentive for opioid-sparing pathway application to vasectomy with implications for payers, providers, patients, and policymakers, Dr. Nam and her colleagues were interested in evaluating the impact this policy change had within the state of Michigan.

To perform this analysis, Dr. Nam and colleagues leveraged Michigan Value Collaborative (MVC) administration claims data from beneficiaries in BCBSM’s preferred provider organization (PPO) plan. The data provided by MVC included men ages 20 to 64 who participated in urologic procedures between Feb. 1, 2018, and Nov. 16, 2020.

Between these dates, Dr. Nam and colleagues identified 4,559 men who underwent office-based vasectomies and 4,679 men in the control group, which consisted of men who underwent cystourethroscopies, prostate biopsies, circumcision, and transurethral destruction of prostate tissue. These procedures are all office-based and not eligible for opioid-sparing modifier 22, thus providing a point of comparison.

The results of the analysis demonstrated a strong association between the implementation of modifier 22 for vasectomies and filled opioid prescriptions. Before July 1, 2019—prior to the implementation of the expanded modifier 22 policy—32.5% of men filled an opioid prescription after receiving a vasectomy, whereas after implementation only 12.6% of men filled an opioid prescription post-procedure (see Figure 1). As highlighted in the figure below, Dr. Nam and colleagues found a 19.9% absolute reduction and 61% relative reduction in the percentage of vasectomy patients who filled peri-procedural opioid prescriptions.

Figure 1. Percent of Patients Filling Opioid Prescriptions Before and After Implementation of Modifier 22

Among the vasectomy patients in the analysis, for every three opioid prescriptions filled before the implementation of modifier 22, only one was filled after the initiative was implemented. They did not find a significant decrease in the percentage of patients who filled peri-procedural opioid prescriptions in the control group.

In addition to the decreased frequency of men filling peri-procedural opioid prescriptions for vasectomies, Dr. Nam and colleagues also found a significant decrease in the prescribed amount. After the implementation of modifier 22 for vasectomies, the oral morphine equivalents (OME) of peri-procedural opioid prescriptions fills dropped from 89.7 OME per prescription to 27.1 OME per prescription. Dr. Nam and colleagues estimated that this decrease in prescription size led to the distribution of approximately 8,473 fewer oxycodone 5mg pills in Michigan.

When asked about the significance of these findings, Dr. Nam explained, “This estimate helped us grasp the impact of the Modifier 22 policy change for patients as well as the community. If this was the impact in a bit over a year for a single procedure in one state, how large could this impact be annually? What could the impact be when quality incentive is expanded to additional procedures? What if the quality incentive could be expanded to other states?”

These findings suggest that the modifier 22 incentive does decrease the percentage of patients who fill peri-procedural prescriptions after a vasectomy and its implementation correlates with a reduction in the number of opioids circulating within the community. In addition to reducing the unnecessary presence of opioids in communities, this initiative also emphasizes a shift to refocus healthcare interactions on the patient. The required additional education about pain management and proper use of pain management medications implemented as part of the modifier 22 initiative provides patients with a better understanding of their care and encourages physicians to consistently deliver high-value care.

Despite the significant findings of this study, a question remained. If these practice changes were initiated by incentivized modifier 22 interventions, what would happen if BCBSM terminated the incentive? Since the publication of Dr. Nam and colleagues’ original study, BCBSM terminated the financial incentive using modifier 22 for opioid-sparing vasectomies on Dec. 31, 2021. This termination provided the group with an opportunity to observe the long-term impact modifier 22 had on physician prescribing patterns and patient opioid use after the incentive was no longer in place.

Dr. Nam and colleagues performed another interrupted time series analysis before and after the termination of modifier 22 using the same vasectomy and control groups. After analyzing the data provided by MVC, they observed no significant changes in the opioid fill rate compared to the rate observed when the modifier 22 program was in effect. This was true for both the vasectomy group and the control group (see Figure 2). The persistence of reduced opioid prescription sizes was also observed following termination of modifier 22. Prior to incentive termination, the mean opioid prescription amount was 59 OME, and after termination the mean further reduced to 36 OME.

Figure 2. Percent of Patients Filling Opioid Prescriptions Before and After Termination of Modifier 22

These critical findings demonstrate that physician opioid prescribing behavior remained constant after the removal of financial incentives. More research still needs to be done on the long-term impact of programs such as modifier 22; however, Dr. Nam and colleagues suggest that other payers could implement incentive programs like BCBSM’s modifier 22 initiative in order to spur similar changes in prescribing patterns and are hopeful that short-term financial incentives are part of the solution to creating lasting practice changes.

“This is the first example of a novel quality incentive targeting physicians to provide high-value care by incentivizing opioid-sparing pain pathway,” she said. “However, this incentive can be adapted to incentivize other high-value care – could we recognize physicians that are providing guideline-based care? How about ensuring that appropriate lab and imaging tests are ordered for patients as part of their care plan? And if so, could it be possible for there to be an investment made from the insurance companies to champion high-value care for a short period of time to have lasting effects?”

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. In partnering with clinical, administrative, and CQI experts to leverage MVC data for analyses, MVC aims to identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Catherine S. Nam, MD; Yen-Ling Lai, MSPH, MS; Hsou Mei Hu, PhD, MBA, MHS; Arvin K. George, MD; Susan Linsell, MHSA; Stephanie Ferrante; Chad M. Brummett, MD; Jennifer F. Waljee, MD; James M. Dupree, MD, MPH

Full Citation

Nam, C. S., Lai, Y.-L., Hu, H. M., George, A. K., Linsell, S., Ferrante, S., Brummett, C. M., Waljee, J. F., & Dupree, J. M. (2022). Less is more: Fulfillment of opioid prescriptions before and after implementation of a modifier 22 based quality incentive for opioid-free vasectomies. Urology, 171, 103–108. https://doi.org/10.1016/j.urology.2022.09.023.

11 May 2023
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MVC Honors Mental Health Awareness Month with Workgroup

MVC Honors Mental Health Awareness Month with Workgroup

May 11, 2023 | 0 Comments | , ,

Mental illness and related conditions such as depression are increasingly prevalent and costly. More than 50% of patients will be diagnosed with mental illness or disorder at some point in their lifetime, according to a World Health Organization research survey, and one in four adolescents will experience depression by the age of 18, contributing to an estimated $406 billion in medical treatment costs in a single year in the U.S. To bring attention and awareness to this issue, the month of May is celebrated nationally as Mental Health Awareness Month. It represents an important opportunity for healthcare providers and hospitals to evaluate the ways in which they currently support patients experiencing mental health/substance use disorder (MH/SUD) conditions.

To help facilitate this conversation, the Michigan Value Collaborative hosted a workgroup yesterday focused on increasing access to high-quality mental health for patients and increasing support for providers. MVC’s guest speakers hail from the Michigan Collaborative Care Implementation Support Team (MCCIST), including Gregory Dalack, MD, MCCIST Co-Lead and Daniel E. Offutt III Professor and Chair of the Michigan Medicine Department of Psychiatry, and Karla Metzger, LMSW, MCCIST Program Manager.

The presenters highlighted the psychiatric Collaborative Care Model (CoCM), an evidence-based integrated behavioral health model that is primary care based and highly cost-effective. Research evidence suggests that up to $6 are saved in long-term healthcare costs for every dollar spent on collaborative care. The presentation included research evidence of the benefits of CoCM, an introduction to its components, tips for implementation and common challenges, and several success stories from both patients and providers.

Those unable to attend Thursday's MVC workgroup can access the full recording on MVC’s YouTube channel. Additionally, the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM) jointly developed a report on the CoCM that reviews current evidence, essential elements of implementation, and recommendations for better meeting the health needs of people with mental health conditions, which is available here.

The American Hospital Association has also compiled a variety of resources on its Mental Health Awareness Month webpage related to mental health information, suicide prevention, opioid stewardship, downloadable posters to help employees adopt respectful language, case studies, and other tools and resources.

For those working in the behavioral and mental health space, there is also a recently formed Collaborative Quality Initiative (CQI) focused on mental health. Established in 2022, the Michigan Mental Innovation Network and Clinical Design (MI Mind) CQI is a statewide partnership with providers and provider organizations that works to prevent suicide and improve outcomes by reducing suicide attempts and deaths. MI Mind offers access to and engagement in evidence-based services for providers with a focus on suicide prevention, with plans to expand into other behavioral health domains, such as depression, anxiety, and substance use disorders. For a closer look at MI Mind, read MVC’s blog about their formation and check out the MI Mind website.