MVC Blog -

26 Mar 2025

Overcoming Barriers to Healthcare Access: A Success Story at Marshfield Medical Center-Dickinson

March 26, 2025 | 0 Comments | health equity, Michigan Value Collaborative, MVC

In recent years, the pursuit of high-quality healthcare has pushed an increasing number of organizations to consider how tailored approaches can reduce gaps in outcomes, increase the value of care, and enhance patient experiences with the healthcare system. Reflecting this growing recognition, the Michigan Value Collaborative (MVC) surveyed its members in 2024 to better understand how members were approaching variation in health outcomes across populations. This survey resulted in MVC’s 2024 statewide health equity report [PDF]. With questions focused on data collection, strategic planning, and programming, MVC gleaned a wealth of impactful and innovative solutions already under way in hospitals across the state. To champion and share those stories across the collaborative, MVC will publish quarterly member spotlight blogs that reflect examples of ongoing programs that improve patients’ outcomes and access to care.

For the majority of the surveyed hospitals, the most common focus areas for programming were enhancing access to providers (i.e., telehealth, mobile units, and nontraditional clinic hours), improving access to reliable transportation, offering financial support, and providing translated materials. Although it is common for hospitals to have strategies in place in these areas, the specific approaches are often as varied as the communities they serve.

At Marshfield Medical Center-Dickinson, for example, one way they approach challenges to healthcare access in the community is through dental care programming for low-income patients. Recent studies have established a clear link between oral health and overall health, underscoring the importance of proper dental hygiene as a preventive measure against serious health complications. According to the Mayo Clinic, poor oral health can lead to significant conditions such as endocarditis, cardiovascular disease, pregnancy complications, and pneumonia. Consequently, effective dental hygiene education and preventive care can provide substantial health benefits that extend well beyond oral health alone.

Recognizing the multifaceted benefits of accessible oral healthcare, Marshfield has partnered with Smiles on Wheels to offer monthly dental services—including cleanings, sealants, and fluoride treatments—at their primary care clinic, regardless of the patient's ability to pay. This initiative has been especially beneficial for young children and parents who face financial challenges related to transportation. It also helps families avoid future costs associated with more complex treatments that may result from a lack of preventive care. The program has received positive feedback from the patient population, with many community members expressing their gratitude for the support it provides.

Figure 1. Smiles on Wheels provides dental care services to Marshfield Medical Center-Dickinson patients during wellness care visits.

Photo courtesy of Marshfield Medical Center-Dickinson

Dr. Alexis Cirilli Whaley, MMC-D Pediatrician said, “We are fortunate to have Smiles on Wheels offering dental care to our local children, particularly for those families needing additional support due to economic stressors. The initiative allows for increased access to dental treatment, conveniently scheduled during wellness care visits."

By partnering with Smiles on Wheels, Marshfield Medical Center-Dickinson is leveraging existing resources to create a meaningful impact. This collaboration optimizes the use of available assets and showcases an effective strategy that harnesses the strengths of community partners. Stories like that of Marshfield Medical Center-Dickinson highlight the power of community partnerships in bridging known gaps in care and making a significant difference.

Throughout the coming year, MVC looks forward to showcasing other examples of patient-focused programming that improves the value of care across Michigan’s populations. If your hospital or organization has an initiative they would like to share, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu – we would love to hear from you.

19 Mar 2025

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MVC Refreshes Registry Reports with New Data & Methods

March 19, 2025 | 0 Comments | Cardiac Rehab, cardiac rehabilitation, MVC registry, preoperative testing

At the end of February, MVC updated its registry with new payer data. MVC adds new data to the registry monthly upon receipt of new claims from included payers. This most recent update included the addition of two new months of Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) claims, one new quarter of Medicaid claims, and one new quarter of Medicare claims. Following these updates, the MVC registry now has the following data ranges for its data:

BCBSM PPO (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
BCN (Commercial and Medicare Advantage): 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
Medicaid: 01/01/2015 – 12/31/2024 (index events through 09/30/2024)
Medicare FFS: 01/01/2015 – 06/30/2024 (index events through 03/31/2024)

Anytime MVC publishes new data on its registry, the newest claims for each payer are incorporated throughout the various reports and dashboards where that payer’s data is present, including the interactive multi-payer reports for cardiac rehabilitation utilization and preoperative testing.

Refreshed Multi-Payer Cardiac Rehabilitation Reports

The multi-payer cardiac rehabilitation utilization reports were added to the registry in the first half of 2024 and have replaced the static PDF hospital-level push reports MVC previously distributed biannually. The regular release of new data on the registry, therefore, gives members opportunities throughout the year to check progress on cardiac rehabilitation metrics more regularly and find opportunities for improvement. For example, current data on cardiac rehabilitation enrollment for CABG patients with episode start dates between Jan. 1, 2024, and Sept. 30, 2024, indicates wide variability among hospitals, with many sites observing rates below the recommended 70%. Across the collaborative, enrollment in cardiac rehab after CABG procedures was as low as 28% at one MVC member hospital and as high as 83% at another with a statewide average of 61% (Figure 1). Similarly, cardiac rehab utilization is much lower on average among PCI patients over the same time period (32%), and there is wide inter-hospital variation with rates ranging between 6% and 86% (Figure 2).

Figure 1. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from CABG, 1/1/2024-9/30/2024

This latest registry update also included a methodological change impacting cardiac rehabilitation reporting for attendance. These methodological improvements were meant to increase the accuracy of MVC’s reported mean number of visits attended within a selected time period. MVC noted that this change resulted in increases in the average number of completed cardiac rehabilitation visits overall, and especially among BCN and Medicaid beneficiaries. This increase in the average number of visits reflects the fact that MVC improved the capture of multiple cardiac rehabilitation visits over a longer time period billed on a single claim.

Refreshed Multi-Payer Preoperative Testing Reports

The multi-payer preoperative testing utilization reports were added to the registry at the end of 2024 and have also replaced static hospital-level push reports that were previously distributed as biannual PDF reports to members. Looking at all available 2024 claims across payers, there is evidence of a small decrease in the MVC All rate of preoperative testing prior to low-risk surgery beginning in late 2022 and continuing throughout 2023 and into 2024 (Figure 3). Those members who are working to reduce unnecessary preoperative testing are encouraged to check their updated data. MVC is also able to supplement registry data with custom analytics by an MVC analyst to meet the needs of members. One such site recently utilized MVC’s custom analytics to identify differences in preoperative testing rates by physician NPI to support conversations about intra-hospital variation by provider and service line.

Figure 3. Statewide Rate of Preoperative Testing and Relative Difference in Preoperative Testing by Quarter, 2020-2024

12 Mar 2025

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MVC Welcomes Its Newest Senior Analyst, Steven Ellinger

March 12, 2025 | 0 Comments | Michigan Value Collaborative, MVC, MVC Coordinating Center

I’m ecstatic to join the MVC team as a senior analyst and bring my passion for healthcare analytics to the table! I am joining the team with over a decade of experience in healthcare analytics, pricing adjudication, reimbursement analysis, and provider network management. I’ve spearheaded projects to optimize network-level claims reporting and streamline data processes in every role. My background in economics and finance from Western Michigan University has helped me develop a strong analytical mindset, which I’ve applied in roles at Michigan Medicine-Sparrow, IBM Watson Health, McLaren Health Plan, and beyond. Healthcare large data manipulation is a passion of mine and you’ll see me smile each time a question is asked, as I am eager to find the answer.

Prior to joining the MVC team, I enjoyed five years as a pricing analyst at University of Michigan Health Plan (formerly Physicians Health Plan). I was responsible for establishing and maintaining provider fee schedules, ensuring competitive and compliant compensation across a vast provider and facility network. My expertise in SQL, Microsoft Excel, claims processing, and financial reporting have been instrumental in automating adjudication processes and enhancing financial forecasting. I also worked closely with provider relations, contract negotiations, and system configuration, making data-driven decisions to enhance efficiency.

Outside of work, my two kids under five keep me very busy with not a lot of free time. When I do find that time, I love staying active—backpacking, running marathons, and formerly teaching swing dancing. You will find me every year at the Indycar Detroit Grand Prix, at the paddock, pit line, or at the box suites, wishing the race was back at Belle Isle. I am thrilled to be on board and look forward to working with MVC’s members to make an impact on healthcare.

05 Mar 2025

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February Workgroups Highlight Hybrid Cardiac Rehab Delivery and Patient Journey Mapping

March 5, 2025 | 0 Comments | Cardiac Rehab, CHF, MVC workgroup, patient-centered care

In February, MVC hosted two virtual workgroup presentations – the first focused on hybrid cardiac rehab program delivery and the second a health in action session focused on patient journey mapping. The MVC Coordinating Center hosts workgroup presentations twice per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and heath in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to support practice sharing across the state.

February Cardiac Rehab Workgroup: Henry Ford Health

MVC’s first cardiac rehab workgroup of 2025 featured a presentation by Dr. Steven Keteyian, PhD, Director of Cardiac Rehabilitation/Preventive Cardiology at Henry Ford Health System. The presentation focused on the development and implementation of a non-traditional hybrid model of care delivery.

During the COVID-19 pandemic many healthcare facilities had to transition to virtual platforms to continue providing essential medical care to patients. Henry Ford Health’s cardiac rehabilitation programs, like many other services, pivoted to meet the needs of patients by establishing an evidence-based hybrid delivery model.

Dr. Keteyian emphasized that cardiac rehabilitation is more than just physical exercise. It is a comprehensive health improvement plan containing several core components (Figure 1) such as nutritional counseling, psychosocial management, weight management and body composition, tobacco cessation counseling, and more. All of these components are combined to establish an individualized treatment plan for the patient.

Dr. Keteyian explained that their patients begin their program in-person to establish baseline assessments and a treatment plan. Once established, cardiac rehab patients have the option to participate virtually for remaining sessions or return on-site depending on their preferences and the need to assess them in-person. Dr. Keteyian noted several factors that drive the use of hybrid cardiac rehab such as patient needs (returning to work, family care responsibilities, travel distance/transportation limitations), limited resources within the health system for a fully on-site program, and limited patient availability during the on-site hours of operation.

To be eligible for participation in cardiac rehabilitation, patients need to have a qualifying event such as acute coronary syndrome (ACS), heart valve repair/replacement (TAVR), cardiac transplant, or stable heart failure (with less than 35% ejection fraction). Henry Ford uses MVC data to track the percent of eligible patients enrolled in cardiac rehab within 90 days, and compares rates across different qualifying events (e.g., AMI, CHF, TAVR, etc.) to see where cardiac rehab is being underutilized compared to averages for the state and Centers for Medicare & Medicaid Services (CMS). The Henry Ford team began incorporating virtual cardiac rehab delivery as a strategy to increase enrollment and attendance among eligible patients.

Dr. Keteyian also discussed some common questions and concerns he hears when discussing hybrid program delivery, such as needed equipment, patient safety, and program efficacy. He shared information from the iAttend randomized control trial that Henry Ford Health participated in from 2019 – 2024, which tracked cardiac patient demographic data, eligibility, participation, and outcomes for hybrid and facility-based cardiac rehab programming (Keteyian, 2024). Data showed that none of the hybrid participants were required to go on-site due to clinical concerns, no virtual visits required physician intervention, and there were no mechanical falls requiring medical attention indicated in either group. A second randomized trial, HF-ACTION, tracked 2,331 heart failure (HFrEF) patients and found that hospitalizations during or within 3 hours after exercise occurred for 2% of the hybrid participants versus 3% for on-site patients. The mortality rate for patients in both study groups was very low (approximately 0.4%) indicating safety was not an issue. Though the data did show hybrid patients not progressing as quickly through the program as on-site patients, this lag became a teaching moment for cardiac rehab staff and an opportunity for improvement.

Attendance for both programs was comparable, and patient outcomes were statistically similar with patients showing improvement in desired performance measures such as peak oxygen uptake, exercise duration, and walking distance (Keteyian, 2024). Staff burden as a result of running a hybrid program was a key concern. To mitigate the potential for burnout, Henry Ford Health aligned services and materials with how the on-site cardiac rehab program is managed.

Dr. Keteyian closed by pointing out that the number of patients who qualify for cardiac rehabilitation each year outnumbers the available spaces in on-site programs throughout the United States. Even if these programs were running at full capacity, only ~ 50% of the eligible patients could be seen. He argued, therefore, that there is a significant need to increase the number of best-practice cardiac rehabilitation programs and the methods available to patients to access them (Balady, 2011).

February Health in Action Workgroup: MVC Coordinating Center

MVC’s health in action workgroup this month included a presentation and workshop on patient journey mapping with MVC’s Associate Program Manager Jana Stewart, MS, MPH. This workshop was a continuation from the October 2024 collaborative-wide meeting’s post-discharge follow-up breakout session. Following the fall workshop, MVC collated member feedback on common barriers to follow-up for heart failure patients, which Stewart summarized as part of the February workgroup presentation. Participants of the workgroup also engaged in polls and two guided breakout discussions aimed at improving outcomes for patients with congestive heart failure.

Using Patient Journey Mapping to Improve Patient Outcomes

Stewart explained that the purpose of patient journey mapping is to understand the patient’s experience and pain points as they manage their health. This practice looks at service delivery by providers as well as the patients’ steps beyond healthcare appointments, providing useful data for root cause analyses and developing effective interventions. Stewart shared examples of patient journey maps that described what a patient might do, think, and feel as they seek healthcare services as well as maps illustrating a hospital’s workflow for enrolling eligible cardiac rehab patients. By generating maps from both the patient and provider perspective, one can identify opportunities for efficiencies and necessary interventions points.

In the first of two breakout sessions, attendees provided feedback and edits on a patient journey map for cardiac rehab enrollment following heart surgery. Attendees reimagined how the patient experience and hospital steps might change for a heart failure patient. Some interventions that were discussed included staff reviewing discharge lists frequently to keep track of patients, having a nurse navigator to help patients prepare for cardiac rehab, and keeping a consistent treatment plan between inpatient and outpatient providers.

Patient Experience – Key Barriers That Impact Patients

Stewart also outlined some key considerations regarding a patient’s experience and some of the barriers that may impact their ability to manage their health. One key barrier discussed was the limitations of our brain's processing capacity and the ways in which mental fatigue make it harder to remember and cope with information. Famed environmental psychologist George Miller once posited that a typical person is able to process and store to memory 5 – 9 pieces of information at a time. When a person is mentally fatigued (e.g., sleep deprived, burned out, cognitively burdened), their ability to understand and store information decreases.

Stewart cited a research study on patient recall after specialty care visits (Laws et al, 2018), which found only half of patients remembered the recommendations they received from a provider, and only about half of what they remembered was recalled correctly. This can have a significant impact on how well a patient follows their treatment plan after they are discharged or sent home. These recall difficulties are further exacerbated in patients with more extensive mental fatigue, such as those experiencing minority stress, unmet social needs, older age, lower health literacy, and other factors. Stewart argued that a patient’s current mental capacity and literacy are key considerations when journey mapping, as they are often the culprit for not following treatment plans.

One strategy Stewart shared that can reduce cognitive burden is the use of storytelling. Used as a framework for delivering information, stories allow patients to better understand and remember details. This can be done through patient story videos as well as case studies that demonstrate the progression of an illness or treatment plan. During one of the breakout discussions, participants brainstormed how they might use storytelling to communicate information to CHF patients. Ideas included establishing private community groups on social media for patients to share their stories, patient story pamphlets, and videos to play on hospital televisions or linked in patient discharge materials.

The feedback and ideas generated by participants during February's health in action workgroup will be used to draft resources for MVC member sites. MVC plans to bring those draft materials to future meetings or workgroups to gather feedback prior to dissemination. Participants also received a copy of the patient journey mapping template so they can utilize this approach at their site(s).

26 Feb 2025

MVC P4P

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

February 26, 2025 | 0 Comments | MVC P4P

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.

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.

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

February 18, 2025 | 0 Comments | BCBSM P4P, MVC P4P, P4P

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.

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.

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.

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.

04 Feb 2025

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January Workgroups Highlight System-Level Sepsis Efforts and Community Paramedicine

February 4, 2025 | 0 Comments | health equity, MVC workgroup, sepsis

In January, MVC hosted two virtual workgroup presentations – the first a sepsis workgroup focused on the development of a system-level sepsis improvement plan, and a health in action workgroup focused on the implementation of a community paramedicine program. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and heath in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to support resources and best practice sharing across the state.

January Sepsis Workgroup: Munson Medical Center

On Jan. 14, MVC hosted its first sepsis workgroup of 2025 with a presentation on Munson Healthcare’s system-level sepsis improvement plan. Munson representatives who contributed to the presentation included Alex Callaway, MBA, CPHQ, CPPS, Director of Quality & Patient Safety; Diane Barton, MHA/MSN, CPHQ, CPPS, Director of Organizational & Clinical Quality; Jennifer Bentley, RN, BSN, Nursing Quality Coordinator; and Stephanie Bowen, RN, BSN, Nursing Quality Coordinator.

Barton commented that sepsis care became one of Munson Healthcare’s system-level driving strategies several years ago. This focus was partially driven by the system not performing well in comparison to state and national benchmarks but also because sepsis was found to be the number one cause of death for patients across Munson Healthcare.

With a goal to improve both internally as well as in comparison to state and national peers, Barton noted that early on Munson Healthcare identified the CMS SEP-1 bundle as a metric to guide their progress with quality improvement efforts. The CMS SEP-1 bundle is a protocol for treating patients with severe sepsis or septic shock focusing on early intervention and timely recognition of sepsis. It has been directly correlated to reduced mortality and improved patient outcomes.

Barton explained that since Munson is a relatively young system, they utilized an A3 problem solving system to examine the current state of sepsis management across all eight Munson Healthcare sites. With a system-level focus in mind, they created both site and system-level sepsis teams that engaged a variety of team members including representation from direct care providers and support services. The presenters then explained that to ensure provider buy-in, they first needed to develop a standard for monitoring sepsis compliance outcomes and the accompanying feedback pathways to provide up-to-date information to clinicians and quality staff.

At the start, Barton notes they were meeting compliance rates of only 60% but have recently seen less variation in their CMS SEP-1 bundle compliance and are encouraged by this trend. Callaway explained that over time they have modified their approach in response to provider feedback; for example, they eliminated the automated Cerner Sepsis Advisor alert in preference of a Sepsis Power Plan order set. Overall, the presenters noted that the improvement plan implemented by Munson Healthcare has had an overall positive impact on the system.

Following the presentation by Munson Healthcare, MVC Site Engagement Coordinator Emily Bair, MS, MPH, RDN, provided a brief review of the Program Year 2026-2027 sepsis value metric changes for the MVC Component of the BCBSM P4P Program. To better align with HMS sepsis measures, the MVC sepsis value metric transitioned from a readmission measure in PYs 2024-2025 to a follow-up measure in PYs 2026-2027. Bair noted that, following these changes, MVC observed a nearly fourfold increase in the number of participating P4P hospitals that selected the “14-day follow-up after sepsis” value metric.

Blinded MVC data for 14-day outpatient follow-up rates among patients hospitalized for sepsis was then shared with the workgroup attendees (Figure 1). The data showed an MVC All follow-up rate of 57.9% based on claims data for 30- and 90-day inpatient or surgical episodes of care for adults with index admission between 1/1/2022 and 12/31/2023. The hospital-level distribution of 14-day follow-up rates among patients hospitalized for sepsis ranged from 20% to 68% across MVC’s membership.

Bair closed out the sepsis workgroup by facilitating discussion about 2025 organizational goals related to sepsis and the specific strategies care teams plan to implement in service of those goals. The interventions shared throughout Munson’s presentation and MVC’s blinded data inspired robust discussion about goals and strategies across the collaborative. Common discussion themes for sepsis efforts in 2025 included:

Building upon 2024 successes
Inclusion of clinical champions to sepsis teams
Addition of inpatient sepsis cases into fallout tracking
Implementation of data tracking and feedback communication strategies
Standardization of documentation and order sets across hospital systems

January Health in Action Workgroup: Tri-Hospital EMS

The second workgroup of 2025 focused on a bird’s eye view of community paramedicine programming. This workgroup featured a presentation by Amanda Biskner, RN, Paramedic, CP-C, the Community Paramedicine Coordinator for Tri-Hospital EMS in St. Clair County, Michigan. The presentation reviewed the benefits and parameters of community paramedicine as well as the steps taken to implement a program in St. Clair County.

The practice of community paramedicine (CP) includes providing “out of hospital” care for non-emergent patients in their own home while also tending to their social determinants of health to improve overall quality of life. The CP’s ability to interface with the 9-1-1 system, extensive education in various topics including acute and chronic care, and license to utilize EMS and CPP protocols prior to PCP contact are just a few items that separate these practitioners from mobile integrated healthcare (MIH) and home health care programs. Bickner summarized the various services that community paramedics may cover within a patient visit (Figure 2).

Biskner described the process by which the Tri-Hospital EMS community paramedicine program was initiated, starting with identifying a portion of the objectives for the 2023-2027 St. Clair County Community Health Improvement Plan (CHIP) that could be supported by the program. Next, a pilot program was launched, and between June and October 2024 a total of 12 patients were enrolled and 45 visits completed through the program.

While the established goals for the trial were met –such as increased communication, healthcare access, patient satisfaction, and experience in care transitions – Biskner explained that there remain challenges to program expansion. Even though nearly 100 EMS agencies in 33 states across the U.S. have launched some version of a community paramedicine program, Biskner noted that funding and reimbursement issues are likely to continue since community paramedicine is not yet standardized in its training, licensure, or practice protocols. Increased community education, exposure, and relationships with local healthcare authorities are the primary methods Biskner recommended for expanding community paramedicine opportunities to other communities.

In February, MVC will host two more virtual workgroups. The first workgroup on Tues., Feb. 11 will focus on cardiac rehabilitation, and the next on Thurs., Feb. 27 will feature a health in action workgroup focused on patient journey mapping. To register for these or other future workgroups, please view the 2025 calendar on MVC’s events page [LINK]. If you are interested in leveraging MVC’s robust claims data and data specialists to inform a local or system-level quality improvement effort, reach out to the MVC Coordinating Center [EMAIL].

22 Jan 2025

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MVC Introduces Multi-Payer Preop Testing Registry Reports

January 22, 2025 | 0 Comments | MVC Coordinating Center, MVC registry, preoperative testing

MVC recently added three new multi-payer reports to its online registry focused on preoperative testing use prior to low-risk surgery. MVC has been tracking measures of this low-value practice since 2021, and previously shared biannual static push reports with its members on their testing rates. Now, MVC registry users can access these metrics under the multi-payer reports tab on MVC’s online data registry [LINK].

Similar to previous reporting, these new multi-payer reports provide interactive figures to assess a site’s opportunities to reduce unnecessary testing prior to three low-risk procedures: outpatient cholecystectomy, inguinal hernia repair, and lumpectomy. MVC hopes to add additional low-risk procedures in the future. For each of these procedures, preoperative testing is assessed in the 30 days prior to the surgery according to CPT codes identified in claims data. Each report reflects the most up-to-date available claims data from Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service (FSS), and Medicaid insurance plans.

Multi-Payer Report Filters

Users can dynamically select the procedure(s), payer(s), and date range (i.e., the span of the episode start dates) to meet their data needs. Users may also filter by patient characteristics such as age and the presence of certain comorbidities that may place a patient in a higher risk category. Additional patient-level characteristics related to the episode of care that can be filtered include gender, race/ethnicity, and a diagnosis of chronic kidney disease (CKD) or venous thromboembolism during the index event or within 90 days. Up to five comparison groups can also be applied to each figure: the average across all MVC member hospitals, a cohort of hospitals located within the user’s MVC region, hospitals of the same type as the user (i.e., general acute care hospital or Critical Access Hospital), hospitals of the same trauma center level, and, if applicable, other rural hospitals in MVC's membership. A full listing of MVC member hospitals and their GACH, CAH, and rural hospital status can be referenced on the MVC website [LINK].

Preoperative Testing Table

The first of the three new report pages includes a table summarizing the testing rates for each type of preoperative test, overall and by procedure. Rates are shown for a user’s selected hospital and the comparison group of their choosing. The filters as described above allow users to determine which episodes to include or exclude based on their needs.

Preoperative Testing Trends

The next report shows the preoperative testing rates for the user’s hospital(s) over time alongside a comparison group of their choosing, as well as a trend graph demonstrating the magnitude of a site’s rate changes over time (Figure 1). The trend figures provide data points for a time interval of the user’s choosing, either monthly, quarterly, or annually, along with any additional filters as described. If these trend graphs appear to have missing data points, there is likely suppression occurring due to insufficient eligible episodes for that time period. In those instances, MVC recommends modifying the time interval to include more episodes. For all multi-payer reports, MVC suppresses data points with denominators of less than 11, and also suppresses denominators of rates that can be used to back-calculate to a numerator of less than 11.

Preoperative Testing Utilization Rankings

Lastly, the third and final report provides a visual representation of hospital preoperative testing rates for the user’s site(s) alongside all other peer hospitals from a selected comparison group, such as MVC All, hospital type, or hospital region. This style of figure can be used to help benchmark a site’s performance by showcasing how their utilization compares within a larger group. Since both this report and the trend graphs are interactive, users can hover their cursor over a specific data point to view additional details such as the exact testing rate and the number of episodes included in that rate's denominator.

Accessing the Registry Reports

All report pages can be exported into a variety of file types, such as PDFs or JPGs, for ease of sharing or adding to other materials. All MVC registry users will have access to these reports to view the data for their site(s). If you do not have registry access and are interested in using the registry to view these reports, you may complete MVC’s user access request form [LINK].

MVC hosted its first webinar to demonstrate the functionality and features of these new multi-payer preoperative testing reports on Jan. 21 and will host a second webinar on Tues., Jan. 28 from 12-1 p.m. Please RSVP if you are interested in attending this second webinar [LINK].

If you have any additional questions or feedback about the new registry reports, please contact the Coordinating Center by email [LINK].

15 Jan 2025

MVC Coordinating Center

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MVC Welcomes New Senior Analyst, Tanima Basu, MA, MS

January 15, 2025 | 0 Comments | MVC Coordinating Center

I am thrilled to introduce myself to the MVC team. As a senior analyst at MVC, I will contribute analytic skills and past claims related working experience to improve the overall health of MVC member hospitals and their patients.

I am a senior statistician who has worked at Michigan Medicine for the past decade. My journey in the world of biostatistics began at the University of Michigan School of Public Health, where I earned a Master of Science in biostatistics in 2014. I also have an M.A. in applied statistics from Eastern Michigan University and a B.S. in physics (honors) from India.

Following my graduation from SPH, I began my professional career as a guest researcher at the Centers for Disease Control and Prevention (CDC) in Atlanta. At the CDC, I had the opportunity to work closely with epidemiologists on public health projects.

In 2014, I joined Michigan Medicine, initially contributing analytic expertise to the School of Nursing. After a few years, my career path led me to the Institute for Healthcare Policy and Innovation (IHPI) at Michigan Medicine, where I was first exposed to data analysis using claims data.

Currently, I have a partial appointment as a senior statistician in the department of cardiology for WIRED-L Center (Wearables in Reducing Risk and Enhancing Daily Lifestyle Center), which designs and tests mHealth apps. In this role I analyze clinical trial data to evaluate whether a mobile phone app and smartwatch notifications can help patients lower their blood pressure or improve their heart health.

In my free time I enjoy sketching, painting, and photography (nature). I also practice yoga and love to explore naturals trails. I look forward to working with the diverse group of analysts and team members at MVC.

07 Jan 2025

Emergency Department Utilization MVC workgroup post-discharge follow-up rural health

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December Workgroups Highlight MI-POST End-of-Life Medical Order and ED Throughput Project

January 7, 2025 | 0 Comments | Emergency Department Utilization, MVC workgroup, post-discharge follow-up, rural health

In December, MVC hosted two virtual workgroup presentations – the first a post-discharge follow-up workgroup focused on end-of-life care, and a rural health workgroup focused on emergency department (ED) throughput quality improvement processes. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to support resource and best practice sharing across the state.

December Post-Discharge Follow-Up Workgroup: Corewell Health, Michigan Department of Health & Human Services

The first workgroup of December focused on post-discharge follow-up and end-of-life care choices supported by Michigan Physician Orders for Scope of Treatment (MI-POST) legal documentation. This workgroup featured a presentation by Crystal Young, a Quality, Safety, & Experience Program Manager at Corewell Health, and Natalie Holland, Senior Advisor with the Michigan Department of Health & Human Services (MDHHS) Strategic Alignment and Engagement Team. The presentation reviewed Michigan’s MI-POST legal and healthcare guidelines, detailing options patients have when they are eligible for end-of-life services and care options.

MI-POST is an option for patients in their advance care planning (ACP) process. The ACP process includes discussing patient wishes for care, deciding how they want their needs met if they are unable to communicate, and documenting these decisions so that they are accessible for healthcare professionals when the patient is unable to speak for themselves. The presenters identified several ACP documents available in Michigan such as Durable Power of Attorney for Healthcare, Living Will, and Medical Orders such as the MI-POST and Out-of-Hospital Do-Not-Resuscitate Order (OOH-DNR).

The presenters described the history behind MI-POST as a portable medical order, starting as a pilot program in several Michigan counties in 2011 and then established through legislation and utilized across the state. This standardized form allows adult patients who require end-of-life services to establish specific guidelines for care in their last year of life. The presenters detailed the sections and fields included within the form, which can be found on the Michigan Department of Health and Human Services website. The presenters explained that the MI-POST form must be updated each year and has some similarities and differences to other ACP documents. Below is a table provided by the presenters comparing the MI-POST document to the other forms of ACP (Table 1).

December Rural Health Workgroup: McLaren Northern Michigan Hospital

On Dec. 12, MVC hosted its final rural health workgroup of 2024. Toni Moriarty-Smith, RN, MSN, Director of Quality and Clinical Risk at McLaren Northern Michigan Hospital, presented on their emergency department (ED) throughput quality improvement process.

Moriarty-Smith commented that many of the challenges faced by rural hospitals after the COVID-19 pandemic are still being dealt with today. McLaren Northern Michigan found that after the pandemic lifted, their ED experienced a significant uptick in patient volume and patient acuity, with increased wait times in the ED and patients leaving without being seen by a physician.

Moriarty-Smith said several factors played a part in the increased wait times and ED overcrowding at McLaren Northern Michigan. In addition to regular inpatient boarders, there were lengthy bed holds for skilled nursing patients because facilities were limiting admissions with selective criteria, behavioral health patients (especially pediatric) were being held longer in ED beds, and beds were being held for outside facility direct admits.

In addition to the influx of patients, she said, the hospital experienced an unprecedented reduction in staff (approximately 50%) either from retirements or resignations post-pandemic. This directly impacted the efficiency of moving patients through the ED in a timely manner. McLaren Northern Michigan completed root cause analyses to begin pinpointing areas of opportunity for improvement. After completing a review of current literature, Moriarty-Smith said hospital leadership identified multiple strategies to address their challenges.

One of the first adjustments made was implementation of a fast-track triage process with ED physicians and advanced practice providers working in the triage area. The fast-track triage process was triggered when all registered nurses (RNs) were in full assignment, a triage RN or other support staff were able to start protocol orders, and an ED provider was available to work in triage. The figure below shows the Median ED throughput for patients from arriving to the ED to discharge before and after the fast-track process was implemented.

Prior to the implementation of this new triage process, McLaren Northern Michigan struggled to complete timely blood draws. Due to diminished staffing the hospital was pulling nurses from the ED or from the floor to help do lab draws in the ED. This slowed the triage process and affected other areas within the hospital. In response, they developed a strategy to reduce the load on nurses by cross training patient care techs (PCTs) to do lab draws, offering a more senior position with increased pay to improve efficiency and processing.

McLaren Northern Michigan also worked in collaboration with their family advisory committee to establish a volunteer presence in the ED. These volunteers helped educate and inform patients about what to expect coming into the ED, provided warm blankets and words of encouragement, and generally supported those waiting to be seen. The extra care and attention helped patients feel seen and listened to and improved their experience (Figure 2). The addition of volunteers also helped reduce the number of patients who left without being seen (Figure 3).

Moriarty-Smith said they also sought to address issues related to staff recruitment. McLaren Northern Michigan raised the base pay of all RNs, transitioned contracted RNs to temporary status (approximately 70%), implemented a recruiting initiative to re-hire past employees, and expanded traveling provider contracts to open more beds for ED boarding patients.

The improvement measures McLaren Northern Michigan implemented have had an overall positive impact on the hospital. Over the course of her presentation, the challenges shared by Moriarty-Smith resonated with other attendees and inspired robust discussion about strategies being implemented across the state to address barriers to QI.

February Cardiac Rehab Workgroup: Henry Ford Health

Figure 1. AACVPR/AHA Cardiac Rehab Performance Measures

Feb. 11, 2025: MVC Cardiac Rehab Workgroup

February Health in Action Workgroup: MVC Coordinating Center

Figure 2. Sample Patient Journey Map for Enrollment in Cardiac Rehab Following a Heart Procedure

Feb. 27, 2025: Health in Action Workgroup

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January Sepsis Workgroup: Munson Medical Center

Figure 1. 14-Day Outpatient Follow-Up Rates Among Patients Hospitalized for Sepsis

Jan. 14, 2025: MVC Sepsis Workgroup

January Health in Action Workgroup: Tri-Hospital EMS

Figure 2. Community Paramedicine Services

Jan. 30, 2025: MVC Health in Action Workgroup

Figure 1.

December Post-Discharge Follow-Up Workgroup: Corewell Health, Michigan Department of Health & Human Services

Table 1. Comparing Advance Directive, OOH-DNR, & MI-POST

Dec. 3, 2024: Post-Discharge Follow-Up Workgroup

December Rural Health Workgroup: McLaren Northern Michigan Hospital

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Dec. 12, 2024: Rural Health Workgroup

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