20 Nov 2024
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Diabetes Awareness Month: MVC Highlights MCT2D Collaborations to Improve Diabetes Care

Diabetes Awareness Month: MVC Highlights MCT2D Collaborations to Improve Diabetes Care

November 20, 2024 | 0 Comments | , , ,

November is Diabetes Awareness Month, a time to bring attention to the growing prevalence and impact of diabetes as well as the importance of early diagnosis, effective management, and prevention. According to the CDC, diabetes is a leading cause of morbidity and mortality in the United States, affecting vital organs such as the nervous system, kidneys, heart, and eyes. In 2021, it was estimated that 38.4 million people of all ages had diabetes—more than 1 in 9 adults in Michigan alone—a number that continues to rise globally. Additionally, recent studies show that 98 million American adults have prediabetes, putting them at high risk for developing Type 2 diabetes (T2D). The need for increased awareness and proactive care has never been more urgent.

Despite being one of the most prevalent chronic conditions worldwide, T2D is largely preventable. Given its chronic nature, it is essential to advocate for widespread access to patient resources, leverage data analytics to pinpoint areas for improvement, and ensure that all individuals across Michigan have the opportunity to access care that can prevent the disease from progressing.

MVC Offerings for T2D Care

MVC is committed to using claims-based data to improve the health of Michigan through sustainable, high-value healthcare. Recently, MVC expanded its focus to address T2D and its complications. In March 2024, MVC incorporated two high-volume emergency department (ED) conditions into its new ED-based episodes: diabetes with long-term complications (e.g., renal, eye, neurological, and circulatory issues) and short-term complications (e.g., ketoacidosis, hyperosmolarity, or coma). These ED-based episodes were developed in partnership with MEDIC and can be used to generate custom analytics for any MVC hospital or physician organization member.

MVC also has ongoing collaborations with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to identify opportunities to improve care for T2D patients and evaluate the impact of CQI initiatives. Currently, both teams are partnering on a value exercise to assess whether practices participating in MCT2D reduced the use of certain diabetes medications compared to non-participating sites. This work will provide valuable insights into medication utilization.

More recently, MVC’s collaboration with MCT2D led to the creation of a new report on T2D in Michigan. It provided demographics and analyses for patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. The report also integrated pharmacy prescription claims. The report showcased several key trends, including:

  • A notable decrease in ED utilization and hospitalizations for T2D care from 2017-2023 (Figure 1).
  • An increase in visits with primary care providers (PCPs) and specialists, such as endocrinologists and nephrologists (Figure 2).
  • A shift in prescription utilization, with increased use of newer medications like GLP-1 receptor agonists and SGLT2 inhibitors, while the use of older therapies such as insulin and sulfonylureas declined (Figure 3).

Figure 1. Yearly Rates of ED Utilization Among T2D Beneficiaries, 2017-2023

Figure 2. Yearly Rates of Provider Visit Utilization Among T2D Beneficiaries by Provider Type

Figure 3. T2D Medication Utilization Among Beneficiaries with T2D, 2017-2023

The report also highlighted important demographic trends, including that T2D patients in Michigan are, on average, older, more likely to be male, and more likely to be Black, with a higher prevalence of non-commercial insurance coverage. These insights are helping MVC and MCT2D to focus their future efforts.

Looking Towards the Future

Although the prevalence of diabetes is a significant challenge, the innovative efforts of groups such as MCT2D and the American Diabetes Association provide hope for the future. MVC is excited to complete and share its value exercise with MCT2D in 2025, as well as continue to build on its offerings to MVC member hospitals and physician organizations for diabetes-related improvement projects.

Diabetes Awareness Month offers an opportunity to reflect on the challenges faced by millions living with diabetes, while also recognizing the significant progress being made in the fight against the disease. With the continued support of healthcare professionals, organizations, and communities, MVC is committed to improving care, prevention, and education. Together, we can raise awareness, improve outcomes, and provide support for those affected by diabetes.

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.

06 Nov 2024
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October MVC Workgroups Highlight Hospital Care at Home and Sepsis Compliance Work

October MVC Workgroups Highlight Hospital Care at Home and Sepsis Compliance Work

November 6, 2024 | 0 Comments | , ,

Last month, MVC hosted virtual presentations for a health in action workgroup as well as a sepsis workgroup. 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 these presentations to support resource sharing and collaboration across the state.

October Health in Action Workgroup: University of Michigan Health

In early October, MVC’s health in action workgroup focused on Hospital Care at Home (HCAH) and featured a presentation by Jessie DeVito, Administrative Director of HCAH at University of Michigan Health. DeVito’s presentation reviewed University of Michigan Health’s HCAH program from inception in 2019 through relaunch in February 2024, including valuable insights into their program development and implementation.

University of Michigan Health piloted their HCAH program in coordination with Blue Cross Blue Shield Commercial, and then expanded payer coverage to Medicare once the Centers for Medicare & Medicaid (CMS) established the Acute Hospital Care at Home Waiver during the COVID-19 pandemic. The intent for the HCAH program was to alleviate significant capacity issues within the brick-and-mortar hospital. By reviewing inpatient cases that met specific HCAH criteria, patients were able to continue necessary inpatient care at home while hospital beds were made available for more acute care needs.

Due to logistical and management barriers, the HCAH program decided to partner with an external vendor, Medically Home, in late 2023 to meet the needs of their patients and provide more in-home inpatient care and services. This vendor manages a 24/7 care team model, including a virtual hospitalist team, while providing services such as mobile diagnostics (e.g., X-ray, ultrasound), paramedicine, STAT labs and IV, and offering pathways to in-hospital services such as MRI or CT scans (Figure 1).

Figure 1.

The HCAH program has seen a maximum daily census of 10 patients and has an average length of stay of approximately 4 days. Patients who participated in the program had a lower 30-day readmission rate (17%) compared to patients who stayed in the hospital (20-24%). This correlates with a recent report from CMS on HCAH service data showing reduced 30-day readmission rates in most of the associated diagnosis related groups (DRGs) (Centers for Medicare & Medicaid Services, 2024) and is a promising trend for future program development.

One of the challenges the HCAH program faced was engaging providers in utilizing the at-home inpatient service. One proposed solution is to offer education and useful tools within the EPIC medical record, allowing providers to track which patients meet eligibility criteria and make appropriate referrals to the program. Additionally, once providers are educated on the HCAH program, they can share and educate their patients about this care option. By continuing to engage and educate providers and patients, the HCAH program anticipates continued expansion, with a goal to cover a broader patient population with increased payer coordination.

Oct. 8 Heath in Action Workgroup

October Sepsis Workgroup: Garden City Hospital

The second October workgroup focused on sepsis, one of MVC’s value metrics within the MVC Component of the BCBSM P4P Program. This workgroup featured a presentation by Akhil Vijay, Director of Quality Assurance and Performance Improvement at Garden City Hospital. Vijay’s presentation reviewed Garden City Hospital’s sepsis care program, sharing their development process and progress since the program’s implementation.

Following CMS and the Joint Commission's Sepsis Core Measure launch in 2015, Garden City Hospital has worked to build an effective sepsis care program reflective of all core elements (Figure 2). Starting in February 2024, their sepsis compliance rate was approximately 46%. After meeting with leadership, a root cause analysis was completed to determine why the compliance rate was low compared to the national average.  Building a partnership between leadership and providers proved to be a key strategy for successfully establishing weekly quality meetings to review sepsis cases and identify patterns of fallouts.

Figure 2.

Common case fallouts that were identified included delay in fluid/medication administration, missed labs or delays in results, incorrect antibiotic prescription, and no follow-up blood pressure reading after the patient received a required bolus. Using this information, the quality team was able to structure a successful follow-up plan to address sepsis case compliance issues (Figure 3).

Figure 3.

The quality team developed several methods for engaging leadership and providers in the program, such as:

  • developing an interdisciplinary sepsis committee to review cases,
  • following a standardized approach for case review with action plan development,
  • presenting sepsis cases at weekly didactic resident physician meetings,
  • and attending rounds with an infection prevention specialist to educate providers.

In addition to making this case education more visible in providers’ daily work, the program shared sepsis case scorecards with providers highlighting successes and areas for improvement. This in turn motivated the healthcare team to engage in friendly competition to achieve the best results.

Since January 2024, Garden City Hospital has improved its sepsis compliance, going from approximately 45% in January to a monthly average of approximately 63% by September 2024.

If you are interested in pursuing a sepsis care improvement program, MVC has a robust registry of medical insurance claims data that can be utilized as well as data specialists to help navigate and create custom analytic reports. Please reach out to the Coordinating Center [email] if you would like to learn more about MVC data or engagement offerings.

Oct. 17 Sepsis Workgroup

To learn more about the efforts showcased by University of Michigan Health, Garden City Hospital, or other past workgroup presentations, visit MVC’s YouTube channel here.

November’s workgroups include a preoperative testing presentation that occurred Nov. 5 with a presentation by Pam Racchi, BSN, RN, Clinical Site Coordinator with the Michigan Surgical Quality Collaborative. MVC will also host a cardiac rehabilitation workgroup on Nov. 21. You can view the complete 2024 and 2025 event calendars here.

30 Oct 2024
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MVC Fall 2024 Meeting Summary: Data-Driven Strategies for Success in Quality Improvement

MVC Fall 2024 Meeting Summary: Data-Driven Strategies for Success in Quality Improvement

October 30, 2024 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) held its fall 2024 collaborative-wide meeting on Fri., Oct. 25, in Livonia. A total of 99 attendees representing 54 hospitals, 6 physician organizations, 2 Collaborative Quality Initiatives (CQIs), and 8 healthcare systems from across the state of Michigan came together to discuss innovative approaches to data-driven quality improvement. The theme of this meeting was to provide MVC members with new data use strategies to support their QI initiatives.

MVC program manager Erin Conklin, MPA, kicked off Friday’s meeting with an update from the MVC Coordinating Center [SEE SLIDES]. She welcomed MVC’s newest team member, site engagement coordinator Rachel Folk, MHA. Conklin also announced phase 2 of recruitment for the RITE-Size preoperative testing initiative, and provided details for the Michigan Cardiac Rehab Network (MiCR) meeting planned for Fri., Nov. 8 in Midland [register here by 10/31]. She concluded by highlighting recent MVC reporting, including refreshed versions of MVC’s common conditions and procedures push reports, a new statewide diabetes report, PY 2024 P4P mid-year scorecards, and MVC’s 3rd annual QECP public report.

Senior Advisor Jim Dupree, MD, MPH, presented on the MVC Component of the BCBSM P4P Program [SEE SLIDES]. He reviewed MVC’s guiding principles, timeline, and historical program structure, announcing four key changes to the PY 2026-2027 cycle (Figure 1). The addition of a health equity measure is one of four key areas that MVC modified for the upcoming cycle.

Figure 1.

The first change that Dr. Dupree discussed in detail is the change to MVC’s payer mix for PYs 2026/2027. Since April 2023, MVC members were given access to rates and spending for their Medicaid patients. Adding this patient population to the MVC P4P payer mix allows the collaborative to score a more comprehensive and diverse patient population. Medicaid data will be reflected in baseline measures provided in MVC participants’ PYs 2026/2027 selection reports.

Dr. Dupree also announced changes to the P4P episode payment condition menu for PYs 2026/2027. MVC will retire colectomy, pneumonia, and joint replacement, and will add percutaneous coronary intervention (PCI). Dr. Dupree summarized MVC’s decision-making and rationale behind each retirement or addition. As a result of these changes, the episode spending metric options for the upcoming cycle include CABG, CHF, COPD, and PCI.

A third change announced on Friday was a revision to the definition of MVC’s sepsis value metric. Dr. Dupree explained that this adjustment was being made to align with the Michigan Hospital Medicine Safety Consortium (HMS) initiative to increase post-discharge care coordination after sepsis. In PYs 2026-2027, MVC’s sepsis value metric will change from 30-day risk-adjusted readmissions after sepsis to 14-day follow-up after sepsis.

To close out the P4P presentation, Dr. Dupree announced the inclusion of a new health equity measure and the methodology behind it. This measure was developed with the goal of addressing common barriers that MVC member hospitals reported in the MVC health equity survey, such as insufficient data, no clear business case, and insufficient financial investments. With the introduction of MVC’s P4P health equity measure (Figure 2), MVC wants to quantify and drive improvement in all-cause readmission rates between payer groups at each hospital using an index of disparity (IOD). Dr. Dupree explained that similar index or composite measures have been utilized by health organizations already, and that this risk-adjusted measure can help identify hospital-level preventable differences in readmissions. Hospitals will earn the health equity point by improving relative to their own baseline IOD or by performing well relative to their peers (i.e., having an IOD at or below the median IOD across the collaborative).

Figure 2.

Before closing the P4P session, Dr. Dupree reviewed the upcoming P4P timeline for various cycles. MVC selection reports for PYs 2026/2027 will be shared with members in early November. Following dissemination of these selection reports, MVC will accept selections until Dec. 13, 2024. Members may attend one of two webinars on Nov. 19 at 1 p.m. [REGISTER for 11/19] or Nov. 21 at 10 a.m. [REGISTER for 11/21] to support their selection process, as well as schedule one-on-one meetings with MVC staff as needed.

After the P4P session, MVC members and stakeholders presented posters highlighting their QI work on a wide variety of conditions and initiatives (Figure 3). The MVC Coordinating Center would like to thank all poster presenters for sharing their work. Electronic copies of the posters are available on the MVC website [LINK].

Figure 3.

The poster session was followed by a presentation from the vice president of care coordination for Corewell Health System, Tricia Baird, MD, FAAFP, MBA. Dr. Baird leads inpatient, transitional, and ambulatory care coordination teams comprised of registered nurses, social workers, and community health workers. The presentation, “Readmission Reduction: Intelligent Targeting to Timely Intervention,” provided an in-depth look at how Dr. Baird’s team identified a subset of their Medicare patients with readmissions that were preventable [SEE SLIDES]. After identifying their complex patients, the Corewell team then designed interventions to target those discharge journeys, essentially providing an example of how to lower a payer-specific readmission rate.

After a networking lunch, attendees spent the afternoon participating in breakout sessions on two topics of their choice. A cardiac rehabilitation breakout session was led by Jodi Perdue, RN-C, BSN, who presented on Munson Medical Center’s multi-phase cardiac rehabilitation program [SEE SLIDES]. Her session was followed by an MVC unblinded data presentation by MVC site engagement coordinator Emily Bair, MS, MPH, RDN.

In the post-discharge follow-up breakout session, MVC project manager Jana Stewart, MS, MPH, guided attendees through a patient journey mapping workshop [SEE SLIDES]. Attendees learned the basics of patient journey mapping approaches and collaborated to draft patient journey maps for key patient populations in Michigan.

In the preoperative testing breakout session, Dana Green, Jr., MPH, a project manager and de-implementation specialist for the Michigan Program on Value Enhancement (MPrOVE), educated attendees on available resources, lessons learned, and upcoming opportunities related to the RITE-Size initiative [SEE SLIDES]. MVC engagement manager Jessica Souva, MSN, RN, C-ONQS, then showed participants their own sites’ performance on MVC’s preoperative testing metric using unblinded data.

The fourth breakout session on sepsis was led by Pat Posa, RN, BSN, MSA, CCRN, FAAN, a quality and patient safety program manager with the Michigan Hospital Medicine Safety Consortium (HMS). She outlined the complex impact of sepsis on patients and the motivations behind launching the HMS Sepsis Initiative, as well as details about HMS sepsis bundles and performance data [SEE SLIDES]. The session was closed out by MVC senior analyst Kim Fox, MPH, with an unblinded data presentation on 14-day follow-up after sepsis, MVC’s newest value metric.

The meeting closed with reminders about upcoming meetings, key dates for the PY 2026-2027 P4P metric selection process, and post-event survey information presented by Jessica Souva (Figure 4).

Figure 4.

If you have questions about any of the topics discussed at MVC’s fall collaborative-wide meeting or are interested in following up for more details, contact the MVC Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Fri., May 9, 2025, in Midland.

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.

02 Oct 2024
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September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

October 2, 2024 | 0 Comments | , , , ,

Since its founding, a core component of MVC’s strategy has been organizing opportunities to collaborate with and learn from peers, leading to the ongoing facilitation of MVC workgroups. MVC has hosted workgroup presentations twice per month in recent years, and this year’s workgroups are focused on six topic areas: post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. Going forward, MVC will publish a monthly blog to highlight key takeaways and shared resources from the prior month’s presentations. In doing so, all MVC members and partners may utilize and benefit from the content regardless of their live participation.

September Post-Discharge Follow-Up Workgroup

MVC hosted a post-discharge follow-up workgroup on Sept. 10 featuring a presentation by Brian Leideker, RRT, COPD Navigator for Trinity Health Oakland Hospital. Leideker’s presentation summarized Trinity Heath Oakland Hospital’s progress since initiating an A3 COPD readmission committee in June 2021, including the key interventions their team has implemented to date.

One initial intervention was the hiring of a COPD navigator. Leideker described how his unique role as a respiratory therapist involved in case management has allowed him to be “a middleman between respiratory physicians and other entities trying to deliver and support services” for COPD patients.

Following several root cause analyses, the COPD committee identified that nearly 90% of patients readmitted for COPD at Trinity Health Oakland Hospital had an interruption in intended continuation of pharmacotherapy and/or non-pharmacotherapy treatments. This finding encouraged Leideker’s team to work to improve the education of patients, providers, and the greater healthcare community on ambulatory treatment for COPD as well as reviewing the testing and documentation needed to ensure coverage of durable medical equipment (DME) post-discharge.

With the help of an MVC custom analytic report, Leideker was able to trend DME utilization rates for patients hospitalized with COPD since the initiation of these interventions, as seen in Figure 1.

Figure 1. Annual Select* DME Utilization Rates During the Index and 30-Day Post-Discharge Period Among Patients Hospitalized for COPD at Trinity Health Oakland (2020-2023)**

Generally, the utilization rate of post-discharge non-bi-level home ventilators (E0466) was found to increase over time, while bi-level home ventilator (E0470) utilization has decreased. Leideker noted that this was somewhat expected since patients routinely report difficulty with the utilization of bi-level home ventilators (BiPAP) and often move on to non-bi-level home ventilators (CPAP). Additionally, based on Trinity Health Oakland’s internal analyses as of May 2024, their COPD three-day readmission rates have been reduced to <18% for all payers.

Sept. 10 Post-Discharge Follow-Up Workgroup

September Rural Health Workgroup

MVC hosted a rural health workgroup on Sept. 26 featuring a presentation by Brent Mikkola, MBA, PMP, Manager of Community Health at MyMichigan Health. Mikkola’s presentation summarized MyMichigan Health’s approach to developing a strategic plan for health equity and an overview of some specific community programs currently in place. MyMichigan Health’s phased approach to integrating health equity is currently focused on evaluating social determinant of health (SDoH) opportunities in an “assess, analyze, and address” model.

Some unique community partnerships that resulted from this process include:

  • Gratiot County Public Transit voucher program
  • Rx 4 Health – partnership with Michigan State Extension and specific grocery suppliers including SpartanNash, SaveALot, and Meijer
  • Food Pharmacies & Weekend Kits - partnership with the Greater Lansing Food Bank and the Food Bank of Eastern Michigan
  • Bridge to Belonging - virtual series on loneliness and social connection
  • Continuing Care Clinic Pilot with Community Health Workers (CHWs)
  • Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) Suspension Diversion Program

In addition to developing a strategic framework for reporting and developing objectives around health equity, Mikkola described how MyMichigan Health delved into the data collection, analysis, and quality improvement work surrounding health equity. For example, after initially integrating CHWs into community practices and inpatient services, MyMichigan Health further integrated CHWs following the WHO’s CHW Lifecycle Approach, as seen in Figure 2.

Figure 2.

CHWs have become instrumental to MyMichigan’s assessment of SDoH as required by CMS and JCAHO mandates by filling gaps in system workflows and in the expansion of the Continuing Care Clinic Pilot. To date, nearly 500 well visit appointments have been completed by CHWs at MyMichigan. Of those patients, 34% were identified as having SDoH needs and 50% of those needs have now reportedly been met through connections to community support services.

To learn more about the efforts showcased by Trinity Health Oakland and MyMichigan Health, or to view past workgroup presentations, visit MVC’s YouTube channel here.

October’s workgroups will include a health in action presentation on Oct. 8 about the University of Michigan’s Hospital Care at Home program, as well as a sepsis presentation on Oct. 17 by Garden City Hospital. You can view the complete 2024 calendar of events and register for workgroups here. To learn more about MVC workgroups or other presentation opportunities, contact the MVC Coordinating Center by emailing us here.

24 Sep 2024
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MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

September 24, 2024 | 0 Comments | , , , , ,

Chronic disease management was a key driver of healthcare utilization over the last decade and has been cited as the most expensive chronic disease in the U.S. In response, MVC recently partnered with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to develop a statewide report on Type 2 Diabetes (T2D), a chronic illness that impacts over 1 million adults in Michigan. This new report was recently shared by both MVC and MCT2D at the Michigan Obesity Summit and will be distributed to MVC member hospitals later this week.

The report summarized demographics, healthcare utilization, and prescription patterns among those patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. To create this report, MVC first used its claims data to identify beneficiaries aged 18 and older with a qualifying T2D diagnosis in the past year. After identifying annual cohorts of beneficiaries with T2D for each year, 2017-2023, MVC assessed annual utilization of T2D prescription medications, emergency department (ED) visits, inpatient hospitalizations, and provider visits.

MVC assessed filled prescriptions among T2D beneficiaries with corresponding prescription coverage using its pharmacy claims. This was the first time MVC included prescription claims data in a member push report and the first time that prescription claims from all MVC payer sources were utilized in a single MVC analysis. Medicare beneficiaries were excluded from 2022 and 2023 prescription utilization rates because Medicare pharmacy claims were only available through 12/31/2021. Diabetes-related drug classes were identified in pharmacy claims based on National Drug Code (NDC) as well as standardized prescription names and classes.

Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are frequently prescribed to improve glucose control, reduce mortality, slow kidney disease progression, and aid in weight loss. The American Diabetes Association now recommends the use of these medications for patients with cardiovascular disease, kidney disease, and obesity. In keeping with these guidelines, MVC’s analyses indicated a large increase in utilization of GLP-1 receptor agonists (3.1% to 18.6%) and SGLT2 inhibitors (2.3% to 14.2%) between 2017 and 2023 (Figure 1). In the same period, prescriptions decreased from 2017 to 2023 for insulins (20.9% to 16.5%) and sulfonylureas (17% to 10.9%).

Figure 1.

Demographic characteristics including age, sex, race (Figure 2), and insurance provider (payer) were described within the report for all beneficiaries with T2D across all payers 2017-2023 and compared to the characteristics of all beneficiaries reflected in MVC data during those years. Compared to all beneficiaries, those with T2D were older, with an average age of 66 years versus the average of 43 years among all beneficiaries. T2D beneficiaries were also more likely to be male (50% vs 43%), Black (20% vs 15%), and more often covered by non-commercial insurance plans (45% vs 28%).

Figure 2.

From 2017 to 2023, rates of diabetes-related ED visits and hospital admissions remained relatively infrequent among T2D beneficiaries. Around two percent of T2D beneficiaries visited an ED for a reason related to diabetes each year, and one percent were hospitalized in relation to diabetes. ED utilization unrelated to diabetes decreased from 37.4% in 2017 to 33.1% in 2023 among T2D beneficiaries (Figure 3). Hospital admissions unrelated to diabetes decreased from 21.3% to 16.4% (Figure 4).

Figure 3.

Figure 4.

In contrast, T2D beneficiaries saw primary care physicians, nephrologists, and endocrinologists more frequently between 2017 and 2023, with observed increases for all three provider types (Figure 5). Most notably, visit utilization with primary care providers increased from 18.3% to 32.9%. Nephrologist visit utilization increased from 1.2% to 2.2%, and endocrinologist visit utilization increased from 1.9% to 3.6%.

Figure 5.

This new report created in partnership with MCT2D provided a high-level overview of healthcare utilization among T2D beneficiaries within Michigan. Since the analyses utilized data derived from medical insurance claims, one key limitation was the exclusion of uninsured individuals as well as key indicators of T2D outcomes that are not accurately captured in claims data, such as HbA1C levels, blood pressure, continuous glucose monitor utilization, and retinopathy screening. Despite these gaps, the data revealed promising trends in diabetes care, including increased primary care visits, greater use of guideline-directed medications proven to show significant benefit, and reduced emergency department visits. MVC’s analyses also underscored areas for improvement, such as the need to address health equity gaps and continued promotion of guideline-directed medical therapy.

MVC will share copies of the completed report directly with members later this week, and a copy is also available on the MVC website [PDF]. If you are interested in pursuing a custom analysis for any of these measures or a different tailored custom analysis, please reach out to MVC.

17 Sep 2024
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MVC Welcomes Rachel Folk, MHA, New Site Engagement Coordinator

MVC Welcomes Rachel Folk, MHA, New Site Engagement Coordinator

September 17, 2024 | 0 Comments

I am excited to be joining the MVC team as a site engagement coordinator. I look forward to working with my fellow engagement team members, data analysts, and leadership to build healthcare improvement partnerships throughout Michigan.

I have worked in various healthcare related roles over the past seven years including skilled nursing facilities, senior communities, the Michigan Medicine Cardiovascular Center outpatient clinic and most recently in Michigan Medicine’s care management department as an administrative specialist. As I moved through these various professional experiences I also continued to build on my education; in 2023 I graduated from Central Michigan University with a Master of Health Administration.

In my last role, I had the opportunity to help develop an internal physician advisor program at the hospital. I found that I enjoyed process/workflow development, ascertaining valuable information from collected data, and participating in creative teamwork with a variety of healthcare professionals. I look forward to pursuing these interests with MVC and continuing to develop my skills and knowledge.

While professional development is important to me, I also have other interests that I enjoy in my free time. I find great joy in working in my garden, learning new plants, and integrating native plants into my landscaping to help support local flora and fauna. I also have an art background and enjoy drawing/sketching and painting, and love adventuring to new places with my family.

I look forward to working with MVC members and partners in the coming months. Please reach out if you have any questions.

11 Sep 2024
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MVC Publishes its 2024 QECP Annual Report as a Qualified Entity

MVC Publishes its 2024 QECP Annual Report as a Qualified Entity

September 11, 2024 | 0 Comments | , , , ,

Recently, the MVC Coordinating Center published its annual Qualified Entity Certification Program (QECP) public report for 2024. This report [PDF] was published in a new QECP section on the MVC website’s Data/Registry page and is an annual requirement for MVC as a qualified entity with the Centers for Medicare & Medicaid Services (CMS). This was MVC’s third public QECP report and continued to provide unidentified aggregated data about Michigan hospital performance on two measures: rates of 30-day rehospitalizations following start of home health care, and rates of outpatient follow-up received after hospitalization for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

All measures in the report were created using data from MVC claims-based episodes of care initialized by inpatient hospitalizations or surgeries between Jan. 1, 2018 and Dec. 31, 2022. Claims were incorporated from all MVC payer sources, including Medicare Fee-for-Service, Blue Cross Blue Shield of Michigan, Blue Care Network, and Michigan Medicaid.

The reported overall rate of 30-day unplanned rehospitalizations after the start of post-acute home health care among episodes beginning at MVC hospitals in Michigan was 11.6% for 2018-2022. Risk-adjusted rates by index hospital ranged from 2.5% to 17.2%. By home health provider, risk-adjusted rates ranged from 0.0% to 23.5% (Figure 1). Patients whose episode of care began with an index event for endocarditis, COPD, CHF, or percutaneous coronary intervention (PCI) were more likely than patients with other index conditions to experience an unplanned rehospitalization in the 30 days after they started home health care. Patients with a joint replacement episode of care were least likely to have an unplanned rehospitalization following the start of home health care.

Figure 1. Risk-Adjusted Rates of 30-Day Unplanned Rehospitalization from Home Health, by Home Health Provider

Results for the outpatient follow-up metrics remained similar to findings from previous annual reports. Across episodes of care for index events in 2018-2022 at the 106 MVC hospitals in Michigan, the unadjusted rate of patients receiving outpatient follow-up within 7 days after hospitalization for CHF was 44% (Figure 2). Following index hospitalizations for COPD, 36% of patients received outpatient follow-up within 7 days (Figure 3). For both conditions, there was wide variation across hospitals in Michigan in their 7-day follow-up rates after hospitalization, with rates ranging between less than 10% to over 60%. Rates of follow-up were fairly steady over time.

Figure 2. 7-Day Follow-Up After CHF Hospitalization by MVC Hospital

Figure 3. 7-Day Follow-Up After COPD Hospitalization by MVC Hospital

For more information and the entire set of findings we invite you to read the full 2024 report, available here.

QE certification status allows MVC to provide hospital members with additional data from Medicare Fee-for-Service (FFS) claims at a level of granularity which would not otherwise be available under standard CMS data use agreements. Reports located under the “QE Medicare” icon on the MVC registry allow hospital registry users to see unsuppressed Medicare data including case counts <11 as well as utilization rates and average payments based on case counts <11. In addition, on any QE Medicare registry report, members can click on specific data points to load a list of all episodes underlying that data point. From that episode list it is possible to view drilldown information on individual episodes to learn more about the claims and price-standardized payments comprising that episode.

Members may contact the MVC Coordinating Center by emailing Michigan-Value-Collaborative@med.umich.edu to learn more about data available through MVC’s QECP reports and to receive the forms necessary to gain access on the registry.