26 Feb 2025
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CHF and New 14-Day Follow-Up After Sepsis Top Selections for MVC P4P PYs 2026-2027

CHF and New 14-Day Follow-Up After Sepsis Top Selections for MVC P4P PYs 2026-2027

February 26, 2025 | 0 Comments |

In November 2024, the MVC team distributed selection reports to eligible hospitals for Program Years (PY) 2026-2027 for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These reports were provided in conjunction with details pertaining to the selection process as well as changes to the program structure, scoring methodology, and cohort assignments for the upcoming two-year cycle.

All eligible hospitals returned their selections by the December 2024 deadline, and are now treating the patients who will make up their performance year data for PY 2026 of the new cycle. The program cycle will award a maximum of 10 points, made up of a maximum of three points from their selected episode spending metric, a maximum of four points from their selected value metric, a maximum of two points for engagement activities completed in calendar year 2026, and a maximum of one point for the health equity measure (a new component). Please refer to the previous blog about program structure changes for PYs 2026-2027 for more detail.

Each participating hospital selected one of the four available conditions for 30-day episode spending: chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI). See Figure 1 for a description of the total selections for each episode spending condition. The episode spending metric that most hospitals selected was CHF (32), followed by COPD (16). The number of sites selecting CHF for episode spending in PYs 2026-2027 increased from 21 to 32 compared to PYs 2024-2025; selections for COPD doubled from 8 to 16 compared to PYs 2024-2025. Figure 2 shows that the distribution in episode spending selections varied when stratified by MVC regions of Michigan. However, CHF was the most selected condition within all regions.

Figure 1.

Figure 2.

Each participating hospital also selected one of the seven available value metrics for evaluation based on rates of utilization: cardiac rehabilitation after CABG, cardiac rehabilitation after PCI, 7-day follow-up after CHF, 14-day follow-up after COPD, 7-day follow-up after pneumonia, 14-day follow-up after sepsis, and preoperative testing. Figure 3 illustrates that the value metric selected by the most hospital members was the newly introduced 14-day follow-up after sepsis metric (19) and this was followed by cardiac rehabilitation after PCI (16). Both of these metrics align with the work and measures used at peer CQIs (HMS and BMC2, respectively). Compared to selections from the previous PY 2024-2025 cycle, the number of hospitals that selected preoperative testing doubled from 6 to 13, while selections for 7-day follow-up after CHF decreased from 24 to 15. None of the hospitals selected 7-day follow-up after pneumonia, and the number of hospitals that chose cardiac rehabilitation value metrics did not change much between program cycles.

As seen in Figure 4, there was variation in the distribution of value metric selections by MVC region. Regions 1 & 3 observed similar trends with 14-day follow-up after sepsis selected the most and cardiac rehabilitation after CABG selected by none of the sites. Cardiac rehabilitation after PCI was the most selected value metric in region 4, followed by preoperative testing. In region 2, both preoperative testing and 7-day follow-up after CHF were the most selected value metrics.

Figure 3.

Figure 4.

Brand new in PYs 2026-2027 will be the health equity measure, for which all participating hospitals will be evaluated using an index of disparity that indicates the magnitude of payer-specific differences in risk-adjusted all-cause readmission rates within a hospital. P4P cohorts were reassigned for PYs 2026-2027. Those cohort assignments and the new technical document have been published on the MVC website’s P4P page. The cohorts were not intended to group hospitals alike; rather, they create a reasonably comparable grouping from which MVC can complete statistical analysis.

MVC’s P4P measure began in 2018 when BCBSM allocated 10% of its P4P program to an episode of care spending metric based on MVC data. If you have questions about any aspect of the MVC Component of the BCBSM P4P Program, please contact the MVC Coordinating Center.

18 Feb 2025
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MVC Distributes PY 2024 Final Scorecards for MVC Component of the BCBSM P4P Program

MVC Distributes PY 2024 Final Scorecards for MVC Component of the BCBSM P4P Program

February 18, 2025 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) Coordinating Center distributed final scorecards for Program Year (PY) 2024 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This report provided hospitals with their final score for PY 2024 as well as detailed breakdowns by scoring component. This was the first year of a two-year cycle for which MVC claims data was used to score hospitals on their episode spending and value metric selections. PY 2024 used baseline year claims data from 2021 and performance year data from 2023.

The episode spending conditions for which MVC is scoring hospitals for PY 2024 include chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement (hip and knee), and pneumonia. These conditions differ slightly from the list of episode spending conditions available in the PY 2026-2027 cycle (view PY 2026-2027 FAQ). Figure 1 shows the frequency of hospital selections for the PY 2024-2025 program cycle for episode spending; the plurality of hospitals selected joint replacement, whereas pneumonia was selected the least.

Figure 1.

The value metrics for which MVC scored hospitals for PY 2024 included cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), follow-up after CHF, follow-up after COPD, follow-up after pneumonia, preoperative testing, and risk-adjusted readmissions after sepsis. Figure 2 shows that the plurality of hospitals selected 7-day follow up after CHF, and both 90-day cardiac rehab after CABG & 30-day inpatient readmissions after sepsis were selected the least.

Figure 2.

The MVC Component of the BCBSM P4P Program evaluated each participating hospital’s risk-adjusted, price-standardized, average 30-day episode payments for their selected condition as well as rates of utilization for their selected value metric through two methods. Hospitals earned points via "improvement" by reducing their payment or improving their utilization rate from the baseline period, or alternatively earned "achievement" points by being less expensive or having a better relative utilization rate than the peers in their designated cohort. The MVC cohorts are groups of hospitals determined to be peers using factors such as hospital bed size and case mix index.

While hospitals were scored on both improvement and achievement, members received the higher of those two scores for each of their selections. Hospitals were also eligible to receive engagement points by completing eligible MVC activities. A maximum of 10 points (4 points each for the selected episode spending condition and value metric, 2 points from engagement activities) were awarded to participating members. The distribution of total points earned by hospitals for the PY 2024 is illustrated in Figure 3.

Figure 3.

On average, hospitals earned 6.6 points in total, a decrease of 0.8 points from the PY 2023 average of 7.4 points. Figure 4 shows that the episode spending condition with the highest average awarded points was joint replacement (3.1 points) followed by CABG (2.3 points). Similarly, Figure 5 shows that the value metric with the highest average awarded points was preoperative testing (3.3 points) followed by 90-day cardiac rehabilitation after PCI (2.7 points). The breakdown of average points by each program component is illustrated in Figure 6. On average, hospitals earned 1.7 of the 2 available engagement points.

Figure 4.

Figure 5.

Figure 6.

If you have any questions regarding PY 2024 of the MVC Component of the BCBSM P4P Program, please refer to the MVC P4P PY 2024-2025 Technical Document. If you would like to set up a meeting to review your hospital’s program year selections or scores, please contact the Coordination Center [EMAIL]. MVC will evaluate and release mid-year scorecards for PY 2025 in the summer of 2025.

13 Nov 2024
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PY 2026-2027 Selection Reports Sent for MVC Component of BCBSM P4P Program

PY 2026-2027 Selection Reports Sent for MVC Component of BCBSM P4P Program

November 13, 2024 | 0 Comments |

Beginning in 2018, Blue Cross Blue Shield of Michigan (BCBSM) allocated 10% of its Pay-For-Performance (P4P) program to a metric based on Michigan Value Collaborative (MVC) claims data. In 2024, the BCBSM P4P Quarterly Workgroup approved changes to how hospitals will be evaluated in the upcoming two-year cycle for Program Years (PYs) 2026 and 2027. These program years will use claims data from 2025 and 2026, respectively, for the performance years (Figure 1). Hospitals recently received selection reports to aid in their decision-making on which metrics to choose within the new program structure.

Figure 1.

What is staying the same from PYs 2024-2025?

Similar to the PY 2024-2025 cycle, hospitals will continue to be scored out of 10 points maximum. They will also continue to be evaluated on their risk-adjusted, price-standardized total episode spending for a selected condition; their rate for a selected value metric; and their engagement in MVC activities. Hospitals can continue to select coronary artery bypass graft (CABG), congestive heart failure (CHF), or chronic obstructive pulmonary disorder (COPD) for episode spending scoring. Similarly, most of the value metric options remain the same with changes in definition for only the preoperative testing and sepsis value metrics.

Each hospital’s episode spending and value metric selections will continue to be scored on improvement compared to the hospital’s own past performance as well as on achievement relative to an MVC cohort. Each hospital will continue to be awarded the greater of the two scores, either improvement or achievement, which are calculated using Z-scores. Cohort designation is still based on bed size, critical access status, and case mix index.

What is changing for PYs 2026-2027?

While the overall program structure will be scored to a maximum of 10 points (Figure 2), the scoring within the components varies from PY 2024-2025. The PY 2026-2027 cycle is made up of a maximum of three points from an episode spending metric, a maximum of four points from a value metric, a maximum of two points from engagement activities, and a maximum of one point from a health equity measure (a new component). For this cycle, hospitals will need to select an episode spending condition and a value metric. The health equity and engagement activities do not require selection. Eligibility for selections are determined based on case counts. To be eligible to select a condition or value metric, a hospital must have at least 20 cases in the full baseline year of 2023.

Figure 2.

Although three episode spending conditions offered in PYs 2024-2025 will continue to be options in PYs 2026-2027 (i.e., CABG, CHF, COPD), MVC retired colectomy (non-cancer), joint replacement, and pneumonia from its episode spending menu. In addition, MVC is adding percutaneous coronary intervention (PCI) as an episode spending condition. The full menu of episode spending conditions for PYs 2026-2027 will be CABG, CHF, COPD, and PCI.

MVC is also modifying two of its value metrics. The sepsis value metric in PYs 2026-2027 will be 14-day follow-up after sepsis rather than 30-day risk-adjusted readmissions after sepsis. This change is more closely aligned with the HMS incentive for increasing post-discharge care coordination. The preoperative testing value metric definition will also be different in PYs 2026-2027. The first change is that all three included procedures (i.e., laparoscopic cholecystectomy, inguinal hernia repair, and lumpectomy) will be combined for scoring. Previously, each procedure was treated separately, and hospitals were scored on the best of the three. The second change is that lab testing will be included in the definition. Previously, preoperative lab tests such as complete blood count, metabolic panel, coagulation studies, and urinalysis were not included in calculating the testing rate prior to the three procedures. Going forward, MVC will identify preoperative testing that occurs in the 30 days prior to MVC-defined laparoscopic cholecystectomy, inguinal hernia repair, and lumpectomy for any of the following tests: complete blood count, basic metabolic panel, comprehensive metabolic panel, coagulation studies, electrocardiogram, echocardiogram, cardiac stress test, chest x-ray, pulmonary function test, and urinalysis.

Brand new in PY 2026-2027 will be the addition of a claims-based health equity measure, for which hospitals will be assessed using an index of disparity (Figure 3). The index of disparity (IOD) will measure the spread of 30-day risk-adjusted all cause readmission rates for medical conditions among different payer categories within their hospital. Scoring for this measure will begin in PY 2026, but hospitals will begin to see sample scoring for this measure on their PY 2025 scorecards. Hospitals can earn the health equity point through both improvement and achievement pathways, similar to their episode spending and value metric selections.

Figure 3.

The payer mix for PYs 2026-2027 will now include Michigan Medicaid episodes in addition to the previously included BCBSM Preferred Provider Organization (PPO) Commercial, BCBSM PPO Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO) Commercial, BCN HMO Medicare Advantage, and Medicare FFS coverage. The addition of Medicaid takes the MVC Component of the BCBSM P4P Program closer to a more diverse and representative population. Medicaid data are reflected in the baseline measures provided in the PY 2026-2027 selection reports.

Next Steps for PY 2026-2027 Selections

The P4P selection reports distributed earlier this week include tables for the various episode spending and value metric options, identifying case counts in the baseline year, the hospital’s average payment or rate of utilization, the cohort and MVC All average payments or rates, and the projected changes necessary for the hospital to earn maximum points. Accompanying the reports was a health equity measure document that details the methodology behind this newly introduced measure along with scoring examples.

For a detailed summary on the methodology, please refer to the PY 2026-2027 P4P Technical Document on the MVC P4P webpage. MVC has also developed an FAQ document to answer some of the mostly frequently asked questions regarding PY 2026-2027 changes, and is offering webinars on Nov. 19 at 1 p.m. [register here] and Nov. 21 at 10 a.m. [register here] to answer member questions. Member hospitals should submit their PY 2026-2027 selections by December 13, 2024, using this Qualtrics survey. Please contact the MVC Coordinating Center if you have any questions.

23 Oct 2024
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Hospitals Receive PY24 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY24 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

October 23, 2024 | 0 Comments |

Last week the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2024 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This report provided hospitals with their current standing for PY 2024.

Each hospital received a mid-year score out of a total of 10 points, including 0 to 4 points for their selected total episode payment metric, 0 to 4 points for their selected value metric, and 0 to 2 points for completed eligible engagement activities thus far in calendar year 2024. PY 2024 scores achievement and improvement points for each hospital’s selected episode spending conditions and value metrics using index admissions from 2023 as the performance year against admissions in 2021 as the baseline year. Hospitals are awarded the higher of their achievement and improvement point scores.

The performance data timeframes included in mid-year PY 2024 scoring were index events 1/1/2023-12/31/2023 for BCBSM PPO Commercial, BCBSM Medicare Advantage, BCN HMO Commercial, and BCN HMO MA, and index events 1/1/2023-9/30/2023 for Medicare FFS. The engagement points accrued represent all completed activities from 1/1/2024-9/30/2024. This is the first year of a two-year (PY24-25) P4P cycle. The full methodology for this program cycle can be found in the PY2024-2025 technical document.

Figure 1 illustrates the current distribution of total points out of 10 across the collaborative. The average points scored across the mid-year scorecards was 6.2/10. This average is 0.2 points lower than the average points scored at the conclusion of PY23.

Figure 1.

Figure 2 illustrates the breakdown of scoring on average by each program component (i.e., episode spending metric, value metric, engagement points). Hospitals could earn up to four points each for their episode spending and value metric selections, and up to two points for engagement activities. Across the collaborative, the average points scored was higher for value metrics (2.7) than for episode spending (2.5).

Figure 2.

Figure 3 illustrates the breakdown of average points by episode spending condition. Consistent with previous years, joint replacement was the highest scoring condition with an average of 3.1 points. Much of the recent success observed for the joint replacement condition could be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries; however, with most joint replacements now occurring in outpatient settings there is less savings to be achieved from such shifts going forward. Congestive heart failure and pneumonia were the lowest scoring conditions with hospitals earning less than two points on average for each.

Figure 3.

Figure 4 illustrates the breakdown of average points by value metric. The highest scoring value metric was preoperative testing with 3.4 points followed by 90-day cardiac rehab utilization after percutaneous coronary intervention (PCI) with 2.8 points. For both of these value metrics, hospitals have access to additional support and resources via MVC’s value-based improvement initiatives, including the RITE-Size (Right-Sizing Testing before Elective Surgery) initiative and the Michigan Cardiac Rehab Network (MiCR) offerings. The lowest scoring value metric was 7-day follow-up rates after pneumonia (2.1).

Figure 4.

These mid-year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2023 claims are incorporated. Hospitals can track their score through the P4P PY24-25 reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points in one place. These registry reports can be filtered by selected conditions/metrics to make the tracking of P4P points easier. Contact the MVC Coordinating Center [EMAIL] for a walkthrough of your hospital’s PY24 mid-year scorecard or P4P registry reports.

16 Oct 2024
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New Qualitative Analysis Offers Insights on How Hospitals Approach MVC P4P Program

New Qualitative Analysis Offers Insights on How Hospitals Approach MVC P4P Program

October 16, 2024 | 0 Comments | ,

Quality improvement is critical for ensuring that healthcare services are safe, efficient, patient-centered, and equitable. As such, payers have increased their reliance on financial incentives to encourage high performance, foster improvement, and promote accountable spending. Despite the saturation of studies assessing hospital approaches to federal incentive programs, there remains a lack of information surrounding hospitals’ strategies for episode-based reimbursement in commercial payment models.

Blue Cross Blue Shield of Michigan’s (BCBSM) Hospital Pay-for-Performance (P4P) Program rewards hospitals that excel at care quality, cost-efficiency, and population health management. In 2018, BCBSM partnered with the Michigan Value Collaborative (MVC) in allocating 10% of its P4P program budget to an episode of care spending metric based on MVC data.

To fill the knowledge gaps mentioned above, a qualitative analysis published earlier this year in the American Journal of Managed Care (AJMC) [LINK] took advantage of a unique opportunity to explore hospital activity and decision-making within MVC’s episode-based incentive program. The lead author of the resulting publication was MVC Senior Faculty Advisor Dr. Scott E. Regenbogen, MD, MPH, who previously served as a Co-Director of MVC. In engaging with MVC’s hospital members, the project team aimed to understand hospital approaches to commercial incentive programs, identify best practices for success, and collect information to promote the optimal design of future metrics.

In an effort to understand the variability between participating hospitals, qualitative interviews were completed with 21 leaders from 8 intentionally selected hospitals with ranging performance metrics. Between December 2020 and November 2021, administrative leaders and quality officers were interviewed using a video teleconference-based platform. Each interview followed a standardized protocol and addressed four domains: choice of clinical condition for evaluation, strategies for episode spending reduction, best practices for success in learning incentives, and barriers to achievement.

Clinical Condition Selection Approaches

When asked about approaches to selecting clinical conditions, besides programmatic constraints, the project team found that multiple factors impacted hospitals’ decisions. Throughout the selection process, many hospital leaders aimed to identify opportunities for improvement or areas of historic underperformance.

In analyzing this trend, Dr. Regenbogen commented, “We were somewhat surprised that there was less ‘playing to the test’ than expected. For the most part, hospitals were committed to success in this program and made good faith efforts to try and achieve savings through operational improvements, not just making the numbers look good.” In addition to seeking opportunities for the greatest improvement, participants selected conditions that often aligned with ongoing value-based improvement efforts, especially those related to federal value-based financial incentive programs. A final factor contributing to the selection approach for many sites was the commitment and motivation of physician leaders to contribute to quality improvement. Most site coordinators agreed that without individual and collective dedication to hospital-based initiatives, success was unlikely.

Strategies for Episode Payment Improvement 

As members of MVC, the participants in this analysis had access to comprehensive utilization data and risk-adjusted comparisons with other hospitals across the state of Michigan. When asked about methods to improve performance, site coordinators highlighted the immense benefits of MVC’s custom analytic and annual push reports, citing the utilization of administrative and clinical data to motivate and inspire improvement at their respective hospitals. In addition to using MVC data to identify areas of growth, respondents also recognized the importance of standardizing protocols and policies to promote the implementation of consistent best practices.

Best Practices for Success in the Incentive Program 

In discussing the strategic approaches of program participants, hospitals highlighted three main areas of importance regardless of their performance rank: consistent leadership focus on metrics, readmissions reduction, and controlling costs related to post-acute care.

Obstacles to Success

However, despite these similar strategic approaches, low-performing participants also noted obstacles and barriers to their success in the program. One institution noted a failure to remain focused on cost containment for a condition across the measurement period, while another expressed a disconnect between institutional achievement goals and non-employed physician incentives. In response to participants’ obstacles to engaging with physicians, co-author and MVC Senior Advisor Mike Thompson, PhD, MPH, who served as MVC’s most recent Co-Director until June 2024, noted, “Perhaps it isn’t surprising, but the challenge of engaging front-line clinicians in pay-for-performance programs is always difficult. Bridging the gap between broader administrative goals and daily clinical operations can sometimes feel like a canyon, but it is necessary for success.”

Implications for the Future

Altogether, the data collected during the qualitative arm of this analysis gleaned key quality improvement insights that MVC can utilize to inform the continued refinement and improvement of the MVC Component of the BCBSM P4P Program. The project team posits that, to be successful, these incentives must possess enough depth and relevance to capture the attention of hospital leadership or align closely with larger initiatives to facilitate collaboration; they must address and resolve any discrepancies between the goals of the hospital and the incentives driving credentialed physicians; and, most importantly, commercial episode-based incentives should offer the chance for success by delivering not only initial performance enhancements but also consistently maintaining excellence over time.

Moving forward, continued program evaluation will be crucial for understanding how to best design metrics in the pursuit of high-value, equitable healthcare. This area of investigation opens the door to future insights into the relationship between financial incentives and quality improvement in healthcare, holding vast potential to shape future incentive-based measures and reporting. As such, MVC is committed to understanding and improving the effectiveness of its own incentive-based measures in partnership with BCBSM.

To learn more about MVC offerings and the MVC Component of the BCBSM P4P Program, please visit our website or contact us at Michigan-Value-Collaborative@med.umich.edu.

07 Aug 2024
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MVC Shares P4P Engagement Point Updates with Members, Highlights Remaining Activities

MVC Shares P4P Engagement Point Updates with Members, Highlights Remaining Activities

August 7, 2024 | 0 Comments | ,

Peer collaboration, networking, and learning have always been foundational priorities for the Michigan Value Collaborative (MVC), with the Coordinating Center’s member engagement activities serving as a key platform in support of those priorities. These MVC engagement activities were further emphasized by their inclusion in the scoring for Program Years (PYs) 2024 and 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program (Figure 1) - a change meant to increase and enhance collaborative learning across the MVC network. At the end of July, MVC published engagement point snapshots via Dropbox to apprise members of their engagement point standing for PY 2024, with each participating P4P hospital receiving a summary of all engagement activities completed by their site between Jan. 1 and June 30.

Figure 1. PYs 24-25 Scoring Structure

To date, the MVC Coordinating Center has offered a wide range of engagement activities by which members may earn up to two engagement points and learn from the larger collaborative. These engagement activities have included: MVC’s spring collaborative-wide meeting and poster session, virtual workgroups and workgroup presentations, health equity and quality improvement surveys, and custom analytic reports, among others. Points earned through participation in these activities are tracked by the Coordinating Center with quarterly updates on point standing.

Following the dissemination of the Q2 reports, MVC identified sites at risk of finishing the year with low engagement points and will soon reach out to site coordinators to detail their available options for PY 2024 scoring. Sites that wish to take advantage of the remaining MVC engagement activities for 2024 can reference MVC’s complete list available on MVC’s P4P page. Several of these options include deadlines to request or complete a given activity by Sept. 30 to ensure its completion before the end of the year. Namely, members may submit a request no later than Sept. 30 for:

Members have until Sept. 30 to submit in Qualtrics their completed quality improvement survey (0.25).

In addition to these opportunities, MVC is hosting a virtual networking event next Tues., Aug. 13, from 12-1 p.m. This networking event titled Collaborate, Innovate, Integrate: Evaluating MVC’s PY 24-25 P4P Offerings will be an opportunity to reflect with peers on the most recent changes to point allocations for the MVC Component of the BCBSM P4P Program – including the introduction of value metrics and engagement activities. Sites who participate in this session and complete a post-networking event survey are eligible to receive 0.25 engagement points. Additional in-person networking events are currently being planned and more details with dates will be available in the coming weeks.

MVC’s in-person fall collaborative-wide meeting is scheduled for Fri., Oct. 25, at 10 a.m. at the Vistatech Center in Livonia. Members may now register through Oct.15. Hospitals can earn 0.25 engagement points for attendance by a site representative for the entire meeting. For sites that also attended MVC’s spring 2024 collaborative-wide meeting in May, a hospital can earn a total of 0.75 engagement points for attendance at both meetings, which is tracked by check-in and completion of MVC’s post-meeting survey. As part of the fall collaborative-wide meeting, MVC will again offer a poster session for members to showcase the quality improvement work happening at their hospitals and physician organizations. If you are interested in submitting a poster, please complete the poster proposal form (link) by Fri., Sept. 13. Hospitals who participate in this poster session are eligible to receive 0.5 engagement points.

MVC is currently in the process of developing its engagement point menu for PY 2025 and look forward to disseminating this to members in the coming months.

If you have any questions or would like to schedule an individual consultation to ensure your site is on track to earn the full two engagement points in PY 2024, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

Thank you for your ongoing partnership. We look forward to seeing you at future events!

04 Jun 2024
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MVC Finalizes Summary Evaluation of PY22-23 P4P Cycle

MVC Finalizes Summary Evaluation of PY22-23 P4P Cycle

June 4, 2024 | 0 Comments | , , ,

This year, the Michigan Value Collaborative (MVC) completed all scoring and evaluation for Program Year 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This concluded a two-year program cycle encompassing the program methodologies and conditions utilized in PYs 2022 and 2023. MVC is excited to share its member evaluation document for these two program years, which highlights hospital performance on average 30-day risk-adjusted, price-standardized total episode payments for the included conditions across both program years.

The PY 2022-2023 program cycle utilized episode claims from 2019 through 2022. PY 2022 scoring compared performance year data from 2021 against baseline year data from 2019. PY 2023 scoring compared performance year data from 2022 against baseline year data from 2020.

Hospitals chose two conditions from seven available options for the PY 2022-2023 program cycle, including chronic obstructive pulmonary disease (COPD), coronary artery bypass graft (CABG), congestive heart failure (CHF), colectomy (non-cancer), joint replacement (hip and knee), spine surgery, and pneumonia. Among these seven P4P conditions, joint replacement was the most selected condition (40), and colectomy was selected the least (4). Trends in average price-standardized episode payments showed a consistent decrease over the years for CABG and joint replacement, and a recent downward trend for pneumonia, spine, and colectomy payments as seen in Figure 1. MVC observed relatively consistent average payments over time for CHF and COPD episodes during PY 2022-2023.

Figure 1. Average Price-Standardized Episode Payment Trends for P4P Conditions

The most striking observation in PYs 2022 and 2023 is the increasing shift to the outpatient setting for both spine and joint replacement surgeries. For joint replacement surgeries, 23.2% of episodes took place outpatient in 2019, 49.4% were outpatient in 2020, 71.6% were outpatient in 2021, and 85.4% were outpatient in 2022. Similar shifts were observed for spine surgeries during the PY 2022-2023 cycle, with the percent of outpatient spine surgery procedures increasing from 30.4% in 2019 to 51.4% in 2022 as seen in Figure 2.

Figure 2. Utilization of Outpatient Setting for Spine Surgery by Year

This shift in outpatient utilization also impacted the decrease in average total episode payments since the associated costs for outpatient surgeries were significantly lower than inpatient surgeries. The decrease in total episode payments for spine and joint replacement surgeries was largely reflected in the index payments for PYs 2022 and 2023 respectively (Figures 3 and 4).

Figure 3. Change in Average Price-Standardized Episode Components, PY 2022

Figure 4. Change in Average Price-Standardized Episode Components, PY 2023

Overall, there was not much change between PY 2022 and PY 2023 in the overall points earned and average points based on hospital characteristics, though the scores on average were slightly higher in PY 2022 (Figures 5 and 6).  For detailed, condition-specific analyses on scoring, please refer to the full member evaluation document.

Figure 5. PY 2022 Total Point Distribution (Includes Bonus Points)

Figure 6. PY 2023 Total Point Distribution (Includes Bonus Points)

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2022 and 2023 and the MVC P4P FAQ PY 2022-2023. If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

 

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.

30 Nov 2023
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Michigan Cardiac Rehab Network Hosts In-Person Stakeholder Meeting at Trinity Health

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

November 30, 2023 | 0 Comments | ,

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

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

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

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

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

Figure 1.

As of the Nov. 17 meeting, the 2024 CMS reimbursement rules for cardiac rehab had not been announced. Once they are, MiCR will help share those updates and related resources with its contacts. Please reach out to info@michigancr.org with any questions.

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

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

August 24, 2023 | 0 Comments |

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

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

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

Figure 1.

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

Figure 2.

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