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.

The Collaborative Care Model

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.

09 Feb 2023
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MVC to Honor Medical Pioneers for February’s Black History Month

MVC to Honor Medical Pioneers for February’s Black History Month

February 9, 2023 | 0 Comments | ,

Black History Month is an opportunity to celebrate the triumphs and reflect on the struggles of African American or Black persons throughout the history of the United States. In honor of this celebration, the MVC team is highlighting some of the Black pioneers who opened doors to medical fields and advanced the field of health through research.

It seems logical to begin by highlighting the work of James McCune Smith (Figure 1), notably America’s first Black physician. He received a medical degree from the University of Glasgow in 1837, when African Americans were denied admission to medical schools in the U.S. He also later became the first Black man to operate a pharmacy as well as the first Black author to be published in a medical journal. He applied his scientific mind and expertise to debunking poor science, outdated assumptions, and racist theories related to African Americans. As an abolitionist and close friend of Frederick Douglass, he wrote the introduction to Douglass' book, My Bondage and My Freedom.

Figure 1.

He was followed by many inspiring African American and Black healthcare providers who made history in their respective fields. There were leaders such as Daniel Hale Williams (1856-1931), who founded the Provident Hospital and Training School for Nurses in Chicago, America’s first Black-owned and interracial hospital. He is also known for having performed the world’s first successful heart operation, which saved the life of a man who had been stabbed in the chest.

Then there was Robert F. Boyd (1858-1912) who in 1895 co-founded the National Medical Association, the nation’s oldest and largest organization representing Black physicians and health care professionals. He served as its first president.

Alexa Canady (Figure 2), born in 1950, is also a Black physician of great strength and impact. She fought her way into one of the most competitive and exclusive fields of medicine when she became the first Black female neurosurgeon in the U.S. in 1981. She is an alumnus of the University of Michigan Medical School who specialized in pediatric surgery. She became chief of neurosurgery at the Children’s Hospital of Michigan from 1987 until her retirement in June 2001.

Figure 2.

As representation and institutional support grew, so too did the voice of African Americans in published medical research. Prominent physician and researcher Charles Richard Drew (1904-1950) studied blood transfusions and helped develop large-scale blood banks deployed during World War II. Patricia Bath (1942-2019), an ophthalmologist dedicated to blindness prevention in marginalized communities, was the first Black female physician to be awarded a medical patent for her invention of a laser cataract treatment.

A wealth of researchers working today dedicate their expertise to studying disparities, race, and ethnicity in healthcare. The Agency for Healthcare Research and Quality (AHRQ) honored Black History Month recently by highlighting the work of its grantees. Dr. Fabian Johnston, for instance, studies early utilization of palliative care for African Americans using culturally informed patient navigation, and Dr. Mya Lee Roberson evaluates geographic variation in breast cancer surgical outcomes among Black women in the South. AHRQ’s spotlight for Black History Month also includes an expansive list of recent research findings and publications related to race and health equity.

These professionals and countless others had a profound impact on medicine, research, and society. However, Black History Month is also a time to acknowledge the struggles and ongoing challenges experienced by the African American and Black communities. While much of the 20th and 21st centuries allowed for a series of “firsts,” they also bore witness to abhorrent racism that resulted in gruesome experiments, forced sterilizations, harmful research studies, and undertreatment for pain. As a result, there is rampant mistrust of the healthcare system within the Black community, even among some medical professionals. This was evident throughout the COVID-19 pandemic; hospitalized patients who did not trust healthcare providers were less likely to believe they were at increased risk of severe illness and were less likely to become vaccinated.

The MVC Coordinating Center is committed to emphasizing equitable care in Michigan by providing members with equity metrics and collaboration opportunities. The MVC team set several concrete goals to share research findings and resources throughout 2023 in service of members’ equity-related initiatives. Some of these resources may be used to build communication and trust with patients and solicit their input on healthcare practices.

In addition, those who follow MVC on Twitter or LinkedIn will see additional stories about African American medical pioneers throughout the remainder of February. If you have a colleague or individual you would like to nominate to be featured this month, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

24 Nov 2022
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Happy Thanksgiving from the MVC Coordinating Center

Happy Thanksgiving from the MVC Coordinating Center

November 24, 2022 | 0 Comments

The Michigan Value Collaborative wishes you a happy Thanksgiving holiday. Thank you to all Michigan hospitals and physician organizations for working tirelessly every day to improve healthcare quality across Michigan. We are grateful for your partnership and your efforts on behalf of Michigan patients.