12 Jan 2023
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Latest PO Joint Replacement Report Adds Outpatient Rehab Rates, Demographics, and More

Latest PO Joint Replacement Report Adds Outpatient Rehab Rates, Demographics, and More

January 12, 2023 | 0 Comments | , , , ,

MVC proudly partners with 40 physician organizations (PO) spanning the state of Michigan and continues to refine and add to the resources tailored to these members. As part of this work, MVC recently refreshed and shared PO joint replacement reports in December. These PO-level reports were first shared in October 2021 with a focus on the shift away from inpatient surgeries as well as post-acute care utilization for combined joint procedures.

The recently refreshed reports carried forward many of the joint episode metrics included previously, but with additional stratification and detail. For instance, whereas the 2021 version presented figures for all joint surgeries combined, many of the figures in the December 2022 version provided data stratified by hip procedure, knee procedure, and all joint procedures. Similarly, some figures are stratified by the location of the procedure (inpatient vs. outpatient). This new differentiation was intended to help POs more easily understand the underlying drivers of their metrics. For example, the blinded hospital below (Figure 1) could observe that its average 30-day price-standardized total episode payment is driven more by hip surgeries ($17,399) than knee surgeries ($16,643). This site could also observe that its overall total episode payment is below both the collaborative-wide PO average and the average in their region, and at the average for other POs of a similar size.

Figure 1.

Additional detail was also added to the patient attribution table, which now identifies the top 10 index facilities (rather than five) where a PO’s attributed patients underwent joint replacement surgery. This table now also includes each index facility’s percent of joint episodes performed in an outpatient setting as well as their average 30-day price-standardized total episode payment for attributed patients. This change was intended to inform quality improvement discussions between POs and partner hospitals or Ambulatory Surgical Centers (ASCs).

Also new to this report were 30-day outpatient rehabilitation rates and a patient population snapshot table to help POs better understand the demographics of patients included in the report. The table included mean age, top two patient Zip codes, the percent of patients living in an “at-risk” or “distressed” Zip code according to the Distressed Communities Index, the proportion of patients belonging to different racial categories, their average length of stay, and their 30-day post-surgery complication rate. Each of these categories was summarized separately by insurance plan.

This report utilized administrative claims from attributed members spanning 1/1/19 – 6/30/21 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, and Medicare Fee-for-Service. Reports were prepared for all POs that participate in MVC and had at least 20 joint replacement episodes in 2019 and 2020, and at least 11 episodes in the first half of 2021.

In general, report findings indicated that utilization of outpatient surgery settings continued to increase in 2021 on average (Figure 2). However, there was still significant variation between MVC’s 40 PO members in their average rate of joint replacement surgeries taking place in outpatient settings (Figure 3). For joint episodes in 2019 through the first half of 2021, outpatient surgery rates ranged from just over 20% to nearly 80%.

Figure 2.

Figure 3.

On average across the collaborative, POs still had low rates of skilled nursing facility (SNF) utilization (6.7%) and higher rates of home health (HH) utilization (55.3%). However, variation in PO member HH utilization rates ranged from approximately 10% to 90%.

If you have feedback on your new PO joint replacement report or would like to request an additional custom analysis to better fit your needs, contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

13 Oct 2022
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MVC Shares New COPD Report with Physician Organizations

MVC Shares New COPD Report with Physician Organizations

October 13, 2022 | 0 Comments | , , , ,

This week the Michigan Value Collaborative (MVC) introduced a new push report for its physician organization (PO) members focused on chronic obstructive pulmonary disease (COPD), providing a tailored version for each of MVC’s 40 PO members. This new push report was created in response to member interest in improving the quality of care for chronic diseases. It utilized 30-day claims-based COPD episodes from Medicare Fee-For-Service, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, and BCBSM Medicare Advantage with index admissions from 1/1/19 to 6/30/21.

One feature the MVC Coordinating Center is excited to highlight is the inclusion of 30-day readmission rates by major comorbidity categories for COPD. Rates were assessed for a PO’s attributed COPD patients overall as well as for attributed patients with congestive heart failure, diabetes, and vascular disease (see Figure 1). These comorbidities are assessed using diagnosis codes on claims in the six months prior to the patient’s index hospitalization.

Figure 1.

Also featured in this report were 90-day rates of pulmonary rehabilitation utilization following COPD index hospitalizations. This is the first time MVC has included a measure of pulmonary rehabilitation utilization in a collaborative-wide report, and the Coordinating Center hopes that this metric will encourage increased use of this important program across Michigan. Across all COPD episodes in the report, the collaborative-wide rate of pulmonary rehabilitation for PO-attributed patients was 2.7% (see Figure 2).

Figure 2.

Due to the low collaborative-wide rate, the Coordinating Center assessed 90-day utilization of pulmonary rehabilitation rather than 30-day utilization. However, the American Thoracic Society recommends the initialization of pulmonary rehabilitation within three weeks following hospitalization. Click here to learn more about American Thoracic Society recommendations for pulmonary rehabilitation and other care following COPD hospitalization.

Each PO’s complete report also includes figures illustrating average price-standardized risk-adjusted 30-day total episode payments, average index hospitalization length of stay, trends in readmission rates, rates and payments of post-acute care utilization, rates of outpatient follow-up, and patient population demographics. A patient population snapshot table details several demographic variables, including a variable based on data from the Economic Innovation Group’s Distressed Communities Index (DCI). It identifies the proportion of patients living in an “at-risk” or “distressed” zip code across all payers (see Figure 3). The DCI is derived from the U.S. Census Bureau’s Business Patterns and American Community Survey.

Figure 3.

A second table provides information on index hospital locations of care for the PO’s attributed patients, comparing the percent of patients treated at each site as well as each index hospital’s average 30-day total episode payment.

The COPD PO report is also being shared with members of the newly established lung care Collaborative Quality Initiative, commonly referred to as INHALE (Inspiring Health Advances in Lung Care). INHALE focuses on patients with asthma and COPD. They disseminate strategies to improve outcomes in these patient populations and reduce the costs associated with asthma/COPD care.

MVC also partnered with a fellow Collaborative Quality Initiative to provide POs with a provider resource that may be relevant to their work with COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) team provided its Quit Smoking Resource Guide to send alongside MVC’s report. HBOM aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful. Read more about HBOM’s materials and efforts on the HBOM website or in MVC’s May spotlight blog.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. MVC is also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at Michigan-Value-Collaborative@med.umich.edu.

25 Aug 2022
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BCBSM Initiative Incentivizes Data Collection on Social Factors

BCBSM Initiative Incentivizes Data Collection on Social Factors

August 25, 2022 | 0 Comments | , , ,

Health equity is a top priority for providers across the country, who are keenly aware of the prevalence and exacerbation of existing health inequities. The state of Michigan in particular ranks poorly in measures of population health and social determinants of health (SDOH), which represent a huge opportunity to improve equity and health outcomes for patients. Health equity is currently a key strategic focus of the Michigan Value Collaborative (MVC) Coordinating Center in the years ahead, as well as for Blue Cross Blue Shield of Michigan (BCBSM). As work in this area grows, some suggest that better data collection is the next critical step to improving health equity.

Data collection is the focus of BCBSM’s latest initiative - the SDOH Standardized Data Collection and Aggregation Initiative - which offers incentives to physician organizations (POs) for collecting and submitting SDOH screening data. Its goal is to increase SDOH screening by primary care physicians during annual wellness visits as well as enhance SDOH data submitted to the Michigan Health Information Network (MiHIN), Michigan's nonprofit statewide health information network.

This data will be used in the short term to improve data conformance and SDOH definitions within the Michigan provider community. Ideally, this initiative will help BCBSM to improve care coordination between providers, identify gaps in resources and community-level social need trends, and provide analytics and reporting to the provider community. The long-term goal is to reduce disparities and improve health outcomes.

There are multiple pathways for POs to participate, primarily by either submitting screening data through MiHIN’s SDOH use case, or by developing infrastructure to enable participation in MiHIN’s SDOH use case. BCBSM sees this incentive program as an important step toward ensuring all patients receive the care they need.

“The SDOH initiative is valuable for both patients and providers because it encourages providers to screen for SDOH needs in patients and also encourages that the data from these screenings is exchanged in an interoperable way,” said Karolina Skrzypek, MD, Medical Director of Clinical Partnerships at BCBSM. “It is very important that providers across the state of Michigan have the ability to access SDOH screening data regardless of where the screening took place. Screening for SDOH needs by providers is the first step in helping to address these needs in our patients.”

These points were echoed by Martha M. Walsh, MD, MHSA, FACOG, Medical Director of Clinical Partnerships and Engagement at BCBSM, who said, “We know that when patients have SDOH needs, that it is more difficult for them to have their healthcare needs met and for patients to care for their chronic conditions. Our initial goal in having providers screen for SDOH needs is for patients to have their needs addressed at the point of care.”

Some POs are already actively submitting this data to MiHIN and can receive incentive payments for continuing to do so. The other pathways are focused on those who have capacity to store and extract SDOH data but are not submitting it to MiHIN, or those POs who don’t yet have the digital infrastructure in place. Helping all POs to achieve a similar capacity and submit their data to the same vendor will allow for a broader understanding of the gaps and communities in need of further funding.

“By aggregating this data, we hope to learn more about specific domains of need and geographic areas with the most needs so that we can start to address these more broadly,” said Dr. Walsh. “We hope that by screening for and addressing SDOH needs, we will start to be able to decrease disparities in care for our most vulnerable patients.”

Incentives for the MiHIN SDOH use case pathways are paid out of the BCBSM Physician Group Incentive Program (PGIP) reward pool. Therefore, any deadlines related to participation are based on PGIP payment cycles. Those POs wishing to participate in the October 2022 cycle should submit their opt-in form and any other required materials by the end of August.

A separate value-based reimbursement (VBR) reward was created specifically for patient-centered medical home (PCMH) designated primary care physicians for completing SDOH screenings using Z codes. This VBR payment was available when the SDOH initiative launched in January. Provider offices had six months to work towards meeting the criteria to receive VBR effective 9/1/2022. Criteria for the 2023 cycle was previously announced and updates to the criteria will be provided during the upcoming BCBSM September PGIP quarterly meeting.

Any POs or providers interested in learning more about this initiative and the pathways for participating can read the full brochure here and submit questions directly to BCBSM at POPrograms@bcbsm.com. In addition, if your PO or hospital has success stories or insights that have resulted from collecting SDOH screening data, please consider sharing your story and insights with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

Support for MVC is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships program. Although BCBSM and MVC work collaboratively, the opinions, beliefs, and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. To learn more about the Value Partnerships program, visit www.valuepartnerships.com.

26 May 2022
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MVC Launches Hysterectomy Report Tailored to PO Members

MVC Launches Hysterectomy Report Tailored to PO Members

May 26, 2022 | 0 Comments | , , ,

Earlier this week, the MVC Coordinating Center shared a new hysterectomy report with physician organizations (POs). This is the third report MVC has created specifically for its PO membership; MVC launched a joint replacement report in 2021 and a colectomy report earlier this year.

Hysterectomies were identified as a focus area in partnership with POs, who expressed an interest in more reports on surgical conditions. In addition to being surgical, hysterectomy aligns with PO activity for a Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) women’s health initiative. To align with the metrics used by this BCBSM PGIP initiative, this report was limited to women aged 18 to 64. The report incorporated claims from 1/1/19 – 6/30/21 for BCBSM PPO Commercial and BCBSM Medicare Advantage. Information on common comorbidities was included, as well as a patient population snapshot table showcasing race-based demographics in the hysterectomy patient population.

Several comparison groups were used to stratify data throughout the report. Those comparison groups included:

  • All MVC POs
  • INDEPENDENT PO: As defined in the BCBSM PGIP 2021 physician list, POs with less than 50% are considered independent.
  • PO SIZE: These groups were based on the number of attributed members at each PO. Member reports include a PO size comparison group in which they belong so they can compare their performance to POs of a similar size.

Hysterectomy can be performed laparoscopically, abdominally, or vaginally. Since these modes of hysterectomy can impact clinical outcomes, many of the metrics in the latest MVC report were stratified this way. Across all MVC POs, hysterectomies were most commonly performed laparoscopically and least commonly performed abdominally.

This report included measures on total 30-day episode payments, length of stay, and medical and surgical complication rates. The average price-standardized risk-adjusted total episode payment was $8,562, and the average index length of stay was 2.1 days (see sample figures from a blinded report in Figure 1).

Figure 1.

Medical complications included venous thromboembolism, coronary vascular events, cardiac events (angina, myocardial infarction, cardiac arrest, and heart failure), gastrointestinal events (obstruction and abdominal pain), kidney failure, pulmonary events (pneumonia and respiratory failure), and transfusion reaction. Surgical complications included intraoperative injuries, hemorrhage, shock, surgical site infection (including sepsis), and complications related to wound healing (fistula, hernia, foreign body left during procedure). Medical and surgical complications were identified with ICD-10 diagnosis codes. The overall complication rate across all MVC POs was 28.5%. Surgical complications occurred more frequently than medical complications with rates of 23% and 9%, respectively (see Figure 2).

Figure 2.

Preoperative testing rates were also incorporated since some of these types of tests are commonly ordered prior to hysterectomies but may not be clinically indicated. Claims for the index event as well as 30 days prior to the procedure were evaluated for electrocardiograms, x-rays, urinalysis, blood tests, and basic metabolic panels. These tests were identified using CPT codes, which do not distinguish between testing for preoperative purposes and testing for other reasons. Tests that were performed in the emergency department or inpatient setting were not included. Across all MVC POs, the most common types of preoperative tests performed were blood testing (which includes complete blood count, basic metabolic panel, and coagulation tests) and basic metabolic panels. The least common types of preoperative tests that were utilized were X-rays and urinalysis testing (Figure 3).

Figure 3.

To ensure the continued provision of the highest quality information, MVC engages regularly with PO members to drive the formation and improvement of PO-specific reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

03 Feb 2022
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New Report on Colectomy Distributed to Member POs

February 3, 2022 | 0 Comments | , , ,

The Michigan Value Collaborative introduced its first colectomy physician organization (PO) report this week. A colectomy is the surgical removal of a section of the large intestine (colon) or bowel and is performed to treat diseases of the bowel (i.e., Crohn’s disease, ulcerative colitis, and colon cancer).

The report incorporated administrative claims of attributed members from 1/1/19 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage, and 1/1/19 – 9/30/20 for Medicare Fee-for-Service. Reports were created for all POs that currently participate in MVC and had at least 11 colectomies per year in both 2019 and 2020.

There were significant differences in the anticipated clinical course and the likelihood of complications between elective (planned) and emergent colectomy. Therefore, MVC provided a stratified summary of planned versus emergent colectomies (Figure 1), and some metrics in the report were stratified by planned and emergent status to highlight when there was an emergency department revenue code on the episode. For example, there were notable differences in post-acute care utilization between planned and emergent colectomies (Figures 2 & 3).

Figure 1. PO A Colectomy Report Table

Figure 2. PO A Risk-Adjusted Payments: Planned Colectomies

Figure 3. PO A Risk-Adjusted Payments: Emergent Colectomies

In an effort to provide valuable data to MVC POs, the Coordinating Center continually meets with key stakeholders, BCBSM, and PO members to drive MVC PO report development. The contents of this report were developed based on that feedback. For example, this report allowed POs to individually compare their organization to new comparison groups.

The comparison groups in the new colectomy report include:

  • All MVC POs
  • EMPLOYED VS. INDEPENDENT POs: As defined in the BCBSM Physician Group Incentive Program (PGIP) 2021 physician list, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with less than 50% are considered independent.
  • PO SIZE: These groups were based on the number of attributed members at each PO (Figure 4). Member POs would see the PO size comparison group in which they belong so they can compare their performance to other POs of a similar size.

Figure 4. PO Size Grouping

Other components included in the report were a list of the top 10 facilities where a PO’s attributed patients had a colectomy performed, the five most common comorbidities among attributed colectomy patients, median length of stay, 30-day risk-adjusted total episode payment, 30-day readmission rate, and the utilization rate for post-acute care services (emergency department, skilled nursing facility, and home health). General findings included that diabetes was the most common comorbidity across all colectomies (planned and emergent) performed at POs and was frequently one of the top two comorbidities for individual POs. In addition, home health services had the greatest variation in post-acute care utilization (see Figure 5).

Figure 5. PO A Home Health Utilization Rate

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

14 Oct 2021
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MVC Releases New Physician Organization Joint Report

MVC Releases New Physician Organization Joint Report

October 14, 2021 | 0 Comments |

Taking care of patients is the most important responsibility of the healthcare industry. To achieve optimal care, providers require robust and valuable resources that support their efforts. At MVC’s inception in 2013, the primary focus was the development of hospital-based metrics to improve patient outcomes, reduce healthcare costs, and encourage hospitals to collaborate in best practice sharing. MVC has since expanded its focus outside the hospital walls, recruiting all 40 physician organizations (POs) to participate as MVC members and collaborate to improve the health of Michigan through sustainable, high-value healthcare.

In April of 2021, MVC released its first PO population-level report containing data on health care utilization, allowing POs to benchmark themselves against all MVC PO members. To ensure the continued provision of the highest quality information, MVC engages regularly with PO members to solicit feedback on MVC outputs and to understand their priorities. For example, feedback from MVC’s first PO-specific report resulted in the MVC Coordinating Center updating its patient attribution process to align with that of its Blue Cross Blue Shield of Michigan (BCBSM) partners and their Physician Group Incentive Program (PGIP). As a result, MVC members are attributed to their respective POs with Blue Cross attribution methodology. The MVC Coordinating Center continues to leverage input from these stakeholders to drive the formation of PO-specific reports (see Figure 1).

Figure 1.

A new PO report released this week focuses on episode-based metrics related to joint replacement surgery. This report utilizes updated methodologies and is comprised of administrative claims from attributed members spanning 1/1/19 – 12/31/20 for BCBSM PPO Commercial and BCBSM Medicare Advantage. Reports were prepared for all POs that participate in MVC and had at least 11 joint replacement surgeries per year in 2019 and 2020, respectively. The selection of metrics contained in this report is a result of feedback from PO members and BCBSM.

The new PO Joint Replacement Report includes:

  • Top five facilities where attributed patients had a joint replacement surgery
  • Percent of joint replacement surgeries performed in an inpatient setting by six-month interval
  • Percent of joint replacement surgeries performed in the inpatient setting
  • Utilization rate after a joint replacement surgery in the inpatient/outpatient setting for the following:
    • Home health care
    • Skilled nursing facility (SNF)
    • Emergency department (ED)

The MVC Coordinating Center is stratifying metrics by employed vs. independent PO using BCBSM’s Summer 2021 PGIP physician list. Therefore, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with fewer than 50% are considered independent.

The report indicates a downward trend over time in the percent of surgeries performed in the inpatient setting (see Figure 2). This is a positive finding given the push for joint replacements to occur in the outpatient setting; however, it is unclear whether COVID-19 was a factor in this decrease given that the reporting period includes 2020.

Figure 2.

In addition, POs generally have low rates of skilled nursing facility (SNF) utilization (see Figure 3) and relatively higher rates of home health (see Figure 4) utilization. This finding is also encouraging since SNFs are expensive.

Figure 3.

Figure 4.

The metrics with the greatest variation among the different POs are home health rates as well as the overall percentage of joint replacement surgeries performed in the inpatient setting (see Figure 5).

Figure 5.

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve its future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about the Michigan Value Collaborative, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.