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Semi-Annual Summary: Turning Data & Collaboration into Action

Semi-Annual Summary: Turning Data & Collaboration into Action

The Michigan Value Collaborative (MVC) held its first semi-annual meeting of 2022 last Friday. A total of 158 leaders joined the MVC Coordinating Center’s virtual meeting, representing 68 different hospitals and 15 physician organizations (POs) from across the state of Michigan. “Turning Data and Collaboration into Action” was the theme of this year’s first semi-annual, putting the spotlight on quality initiatives that successfully leveraged data or collaboration to bring about improvements in healthcare.

MVC’s Director, Dr. Hari Nathan, kicked off Friday’s meeting with an update from the MVC Coordinating Center. He welcomed two new collaborative members, McLaren Caro Region and UP Health System - Bell, as well as MVC’s newest team member, Engagement Associate Chelsea Andrews. Dr. Nathan also highlighted the successes delivered by the Coordinating Center during the first six months of 2022. This included the incorporation of Medicaid data into MVC’s suite of push reports to provide a more complete view of the collaborative’s patient population, the launch of three new push reports (colectomy, pneumonia, and P4P), and the incorporation of additional demographic data into MVC's reporting.

MVC’s recent Qualified Entity accreditation was also highlighted, representing a breakthrough for the collaborative that will allow the relaxation of certain data use agreement regulations and improve the granularity of data available to members. As part of extending this improved access, the Coordinating Center will reach out to site coordinators to have authorized representatives at each institution complete a new data use form. To align with the security requirements of the Qualified Entity program, the MVC registry will also begin requiring multi-factor authentication for users upon login. More information on each of these elements will be shared with the collaborative in the coming weeks. Chelsea Abshire Pizzo, MVC’s Manager of Analytics, rounded off the meeting welcome by sharing some highlights from Program Year 2021 of the MVC Component of the Blue Cross Blue Shield of Michigan Pay-for-Performance (P4P) Program.

Showcasing opportunities where MVC data can drive change was a focal point for the meeting. Utilizing unblinded data from the collaborative, MVC Analyst Jessica Yaser led attendees through a data session focused on MVC’s two Value Coalition Campaigns (VCCs): Preoperative Testing and Cardiac Rehab. This allowed attendees to see their preoperative testing and cardiac rehab utilization rates compared to their peers. Hospitals performing well were invited to offer insights as to how this was achieved and what mechanisms other hospitals could adopt to improve performance levels. Jessica also announced new collaborative-wide goals around cardiac rehab utilization rates (see Figure 1), which will continue to be promoted and highlighted in the months ahead.

Figure 1.

With the scene set, MVC welcomed guest speakers Mary Pool and Holly Gould from McLaren Port Huron hospital. Mary and Holly provided attendees with an overview of how they have used MVC data to help tackle high readmission rates for the congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) patient populations at McLaren Port Huron. Specifically, data provided by the Coordinating Center helped confirm the suspicion that although follow-up rates were high across the institution, this wasn’t being translated into a reduction in readmissions. Stratifying these data further helped McLaren Port Huron introduce tailored initiatives in the form of their COPD and Heart Failure Navigator Programs, aimed at driving the effectiveness of follow-up visits (see Figure 2).

Figure 2.

After hearing from McLaren Port Huron, Michelle Marchese from BCBSM provided an overview of how their Physician Group Incentive Program (PGIP) platform supports value-based care. As part of this, Michelle provided a walk-through of the current state of BCBSM data and report sharing, outlining how these all fit together to provide valuable healthcare insights for physician organizations (POs) (see Figure 3). MVC’s ongoing partnership with BCBSM to identify PO-level opportunities for improvement was also highlighted – a collaboration that will continue moving forward to enhance the level of support available to POs across the state. Michelle then passed the baton to Dr. Shannon Martin from MyMichigan Health who shared how MyMichigan has used its internal data to develop, implement, and assess its “Health Aging Program.” This initiative is aimed at decreasing the use of high-risk medications in the elderly population, saving many seniors from the harm of adverse drug effects.

Figure 3.

The meeting concluded with a summary of the day and key upcoming activities, led by MVC Engagement Associate Chelsea Andrews. The recording from Friday’s meeting is available here. If you have questions about any of the topics discussed at the semi-annual or are interested in finding out more about MVC, please reach out to the Coordinating Center. MVC’s next semi-annual meeting will be in person on Friday, October 28 at the Radisson in Lansing – we look forward to seeing you all then!

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HBOM Resources Help CQIs, Providers Reduce Smoking

HBOM Resources Help CQIs, Providers Reduce Smoking

Today, the leading preventable cause of death, disease, and disability in the United States is tobacco use. National studies show that 70% of smokers want to quit, but in Michigan only about 15% receive treatment. This critical gap is the current focus of one of the newest population health Collaborative Quality Initiatives (CQIs) in the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio. The Healthy Behavior Optimization for Michigan (HBOM) CQI aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful.

HBOM’s mission is to make “the healthy choice the easy choice,” which is accomplished in this case by providing tobacco cessation support throughout the state of Michigan through value-based reimbursement (VBR). In 2022, nine CQIs committed to working with HBOM to provide targeted, just-in-time tobacco cessation support to seize on their “teachable moment.” This approach draws on evidence-based behavior change strategies that leverage unique shifts in patient motivation around major health events, when they may find new motivation to commit to positive health behaviors like smoking cessation.

HBOM works with hospitals, clinics, and care teams across the state of Michigan through its partner CQIs to promote healthy behaviors among patients. They also provide partner CQIs and their respective members with the infrastructure and metrics to measure the impact of these changes. Although HBOM is primarily concerned with three health behaviors (smoking cessation, healthy eating, and physical activity), smoking cessation is their current focal point.

HBOM’s smoking cessation tools and resources are available in both paper and electronic formats to ensure equitable access, and are being shared widely at the patient, physician, and organization levels. Clinicians can share these materials with patients to increase access, awareness, and utilization of smoking cessation opportunities. One example includes a “Tap for Support” near-field communication (NFC) badge (see Figure 1) that clinicians and healthcare staff can wear for patients to scan with their phone, providing them with instantaneous online smoking cessation tools and resources.

Figure 1.

Another example is the Tobacco Cessation Box that HBOM tailored to meet the needs of those wishing to quit smoking. In addition to the badges, it includes HBOM’s Quit Smoking Resource Guide Tear Off Pad (see Figure 2), which providers can use as a discussion tool for Nicotine Replacement Therapy options. The box also includes a reference guide containing a high-level overview of tobacco cessation prescription medication options and HBOM’s VBR toolkit.

Figure 2.

When CQIs and their members wish to learn more or provide support beyond the resources mentioned above, they can connect with HBOM to discuss state-wide smoking cessation metrics, best practices, challenges, and collaboration opportunities. The HBOM collaborative meets regularly with participants and partnering CQIs to address challenges and improve population health. The team is also closely connected with the Michigan Tobacco Quitline and resource recommendations delivered by text message for anyone who wishes to quit smoking.

The MVC and HBOM teams have discussed plans to include HBOM resources in future relevant MVC report communications, such as those chronic conditions that are related to tobacco use. In the meantime, hospitals and physicians can request their own tobacco cessation boxes (see Figure 3).

Figure 3.

For more information on HBOM, visit their website.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is cognizant that many other CQIs also partner with hospitals and providers throughout Michigan. Throughout 2022, MVC will post a series of blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with any suggestions or questions.

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MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

MVC, BMC2 Launch Michigan Cardiac Rehab Network & Toolkit

This year in the United States, cardiovascular disease will be responsible for one in every four deaths. Despite its prevalence, few cardiac patients eligible for cardiac rehabilitation utilize this life-changing program. In response, the Michigan Value Collaborative (MVC) and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) recently established the new Michigan Cardiac Rehab Network (MiCR) to collaborate on efforts that heighten awareness of these programs and support meaningful improvement in Michigan.

Cardiac rehabilitation (CR) is a comprehensive program encompassing supervised exercise, nutrition education, smoking cessation, mental health resources, skills training for heart-healthy lifestyles, and peer support from others who are experiencing a similar life event. It has a Class IA indication for recent cardiac-related events or procedures, meaning there is high-quality evidence that it is beneficial to patients. In fact, individuals who complete the full program of 36 sessions have a 47% lower risk of death and a 31% lower risk of heart attack than those who attend only one session. The evidence is clear that CR extends life and improves quality of life for patients with a recent cardiac-related event or procedure. Unfortunately, only one in three eligible Michiganders participates—a rate well below the Million Hearts nationwide goal of 70% participation.

Using claims data, MVC can assess both initiation and adherence – whether and when someone starts CR, and how long they keep going. There is wide variability in CR rates between MVC’s member hospitals (see Figure 1 for a sample plot from a recent blinded report). The site with the highest rate of cardiac rehab after coronary artery bypass graft surgery (CABG), for example, succeeds at sending 75% of their CABG patients to CR, while another only sends 28% of their CABG patients. This variation shows that it is possible to reach high CR rates, and hospitals can learn from each other to make improvements that save lives and reduce costs.

Figure 1. Collaborative-Wide CR Use Following CABG Discharge

MiCR was developed for this reason and will work to equitably increase CR participation for all eligible individuals in Michigan. Serving as Co-Directors of MiCR are Mike Thompson, Co-Director of MVC, and Dr. Devraj Sukul, Associate Director of BMC2 PCI. MiCR will distribute regular CR utilization summaries to relevant providers, convene regular meetings with its stakeholder and advisory groups, create resources that help hospitals and CR facilities optimize CR utilization, and continue to leverage the expertise of both CQIs.

In one of its first coordinated efforts, MiCR worked with CR providers and content experts to create a Cardiac Rehab Best Practices Toolkit, which was launched in April. It outlines initiation, maintenance, and innovation strategies for increasing the utilization of CR (see Figure 2 for a sample page). MVC encourages members to turn to this tool as they work to encourage the enrollment of more patients.

Figure 2. Sample Page from MiCR Best Practices Toolkit

The partner CQIs behind MiCR also released new statewide goals for improved CR utilization. Currently, 30% of patients utilize CR following transcatheter aortic valve replacement (TAVR), surgical aortic valve replacement (SAVR), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), and acute myocardial infarction (AMI). The first goal is to reach 40% CR utilization for TAVR, SAVR, CABG, PCI, and AMI patients. In addition, only about 3% of congestive heart failure (CHF) patients currently utilize CR. The second statewide goal is a collaborative-wide utilization rate of 10% for CHF patients. Progress on these goals will be shared by MVC in its CR reports sent every six months.

The two CQIs will also continue with their respective activities in the CR space. MVC supports CR participation in two primary ways. One is providing opportunities for MVC members to collaborate, and the second is the preparation of reports using its unique multi-payer data sources. The MVC team supports collaboration through stakeholder meetings and workgroups, which allow sites and clinicians to share solutions for common challenges. The reports MVC prepares analyze member claims data with time-specific hospital-level information on CR enrollment and completed visits within one year of discharge. This allows hospitals to benchmark their performance against peers and identify areas for improvement. MVC will also share unblinded data on CR rates with members at its May semi-annual meeting in one week, which is meant to drive conversation and encourage best practice sharing across the collaborative. The MVC team hopes that its outreach and resources help members to save lives by providing strong endorsements for CR and addressing barriers that may limit patient participation.

For more information on MVC’s CR efforts, visit MVC’s Value Coalition Campaign webpage. For more information about CR, view this MVC video or visit the Million Hearts website. If you have questions about any of the above activities or resources, reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.

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Sepsis Push Reports Include Demographics, COVID Patients

Sepsis Push Reports Include Demographics, COVID Patients

For the last two years, the Michigan Value Collaborative (MVC) Coordinating Center has offered a sepsis service line developed in partnership with the Michigan Hospital Medicine Safety Consortium (HMS). In conjunction with this work, reports customized to each member hospital are distributed each year. The most recent iteration shared with members this week features several updates from the 2021 versions.

A new patient population snapshot table is one new feature that the MVC Coordinating Center added in order to integrate its demographic data. These tables (see Figure 1 for a sample table of a blinded acute-care hospital) provide each hospital with demographics for their sepsis patient population, including race, mean age, top patient zip codes, the most frequent and average number of comorbidities, the proportion of dual-eligible patients, and the proportion of patients with a confirmed diagnosis of COVID-19. Furthermore, this data is stratified by payer, providing additional insights into specific groups of patients.

Figure 1.

The inclusion of COVID-positive patient percentages is an important statistic since this iteration of the sepsis push report includes COVID patients, whereas the Coordinating Center removed these patients in previous versions. This final row of the patient population snapshot table will help hospitals understand the extent to which their data is driven (or not) by patients with a confirmed COVID diagnosis code. Across the collaborative, 90-day total episode payments increased in 2020, which can likely be attributed to episodes with a COVID diagnosis; however, the 2020 average is not much higher than the average from 2018 through early 2019 (see Figure 2). Since the COVID-19 pandemic hit regions of Michigan at different times, regional comparisons for select measures will be particularly useful in understanding one’s data. Different versions of the report were created for acute-care and critical access hospitals, which allowed for tailored comparison groups.

Figure 2.

The complete report compares MVC hospitals on 90-day risk-adjusted total episode payments, inpatient length of stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality and discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. Each figure presented reflects index admissions from 1/1/18 – 12/31/20 for Medicare FFS, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage, BCN Medicare Advantage, and Medicaid.

In addition to continuing to offer its sepsis push reports, the MVC Coordinating Center also offers a bimonthly sepsis workgroup. The next workgroup will take place on Thursday, May 26 from 2-3 p.m., and will feature a presentation about successes in sepsis-bundle compliance. Register today to join the MVC Coordinating Center for this presentation and discussion.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. We are also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at michiganvaluecollaborative@gmail.com.

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MVC Integrates Surgeon-Level Data in Latest Preop Reports

MVC Integrates Surgeon-Level Data in Latest Preop Reports

In 2020, the Michigan Value Collaborative (MVC) introduced the Preoperative Testing Value Coalition Campaign (VCC) with the aim of reducing the use of unnecessary preoperative testing for surgical procedures. Preoperative testing, especially in low-risk surgical procedures, often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan. As part of MVC’s campaign to eliminate unnecessary and potentially harmful preoperative testing, the Coordinating Center developed a related push report, the latest version of which was shared earlier this week to help members benchmark data for common preoperative tests. MVC and the Michigan Surgical Quality Collaborative (MSQC) partnered to distribute these reports more widely and to encourage clinical and quality personnel to work together in identifying patterns and exploring new strategies.

This iteration of the report is the first to include blinded surgeon-level reporting, which will allow for a more nuanced understanding of variation within a given hospital. To include this, the Coordinating Center attributed one surgeon per episode based on condition-specific BETOS codes and NPI specialty information, with the understanding that the attributed surgeon may not be the individual ordering the preoperative test for that procedure. If their MVC data indicates wide variation between specific providers, hospitals may choose to drill down into their own data to investigate further. For hospitals that have several surgeons with enough cases for these procedures, there was significant variation in testing rates (see Figure 1).

Figure 1. Rate of Any Preoperative Test by Surgeon (Blinded Report)

Included in the report were patients undergoing elective and outpatient laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. It incorporated index admissions between 1/1/2018 – 12/31/2020 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, Blue Care Network (BCN) HMO Commercial, BCN Medicare Advantage, Medicare Fee-For-Service (FFS), and Michigan Medicaid. Hospitals only received a report if they had 11 or more cases in at least one of the three conditions and at least 11 cases per year in the three procedures combined. The analysis evaluated the use of the following tests using CPT codes: electrocardiogram, echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

In general, the report demonstrated significant variation in testing rates between members, with some testing rates ranging from 20% to over 90%. Due to the amount of variation, MVC suspects that preoperative testing is overused at the state level such that even hospitals that are average or below average may still have significant opportunities to safely reduce preoperative testing. The report included a table with each hospitals’ rates for each procedure and test, with accompanying comparisons to the rates of regional peers and the collaborative as a whole (see Figure 2).

Figure 2. Preoperative Testing Rates Table (Blinded Report)

The report also included figures for preoperative testing rates by specific tests, by payer, and by procedure. The variety of figures is meant to help hospitals better understand its variability in utilization, since specific procedures or tests may be driving their overall testing rate. One figure, for example, presents a hospital's three procedure-specific testing rates alongside their overall or “combined procedures” rate. To more easily identify areas of opportunity to reduce their overall testing rate, a hospital can compare their procedure-specific rates to determine which is driving their average, as well as compare their average to those of their regional peers and the collaborative as a whole (see Figure 3).

Figure 3. Rate of Any Preoperative Test by Procedure (Blinded)

In the case of the blinded example above, this hospital is more frequently ordering preoperative testing in cholecystectomy patients but is ordering fewer tests on average than their peers for all procedures combined. This finding is atypical since lumpectomy was found to have a higher testing rate in general; cholecystectomy testing rates were generally lower. In addition, MVC found that electrocardiography and blood tests (complete blood count, basic metabolic panel, coagulation studies) had the highest testing rates across all procedures.

Helping MVC members to make internal and external data comparisons is core to MVC reporting and is critical to its efforts to reduce unnecessary testing. As part of MVC's continued efforts in this area, the Coordinating Center will share hospital-level preoperative testing data at its upcoming semi-annual meeting in order to foster continued awareness of wide practice variation and encourage best practice sharing between members.

MVC is eager to drive improvement in this area. For more information on how MVC is working to reduce unnecessary preoperative testing, visit its Value Coalition Campaign webpage here. If you are interested in a more customized report or would like information about MVC’s preop testing stakeholder working group, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC Releases Agenda, Speakers for May Semi-Annual Meeting

MVC Releases Agenda, Speakers for May Semi-Annual Meeting

The MVC Coordinating Center recently released the full agenda for its forthcoming spring Semi-Annual Meeting on Friday, May 13, 2022, from 10-11:30 a.m. The MVC Coordinating Center holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This meeting’s theme of “turning data and collaboration into action” reflects how members often balance multiple internal and external data sets in addition to a broad portfolio of resources from MVC and other CQIs.

Speakers at semi-annual events are often members who share their successes, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers outlined on May’s meeting agenda will share examples of quality initiatives that successfully leveraged data or collaboration to bring about improvements in healthcare. The speakers also represent a variety of stakeholder groups, including hospitals, physician organizations (POs), payers, and of course MVC Coordinating Center leadership.

The first guest presentation will be from hospital leaders at McLaren Port Huron’s Quality Improvement and Organizational Excellence team. Regional Director Mary Pool and Manager Holly Gould will discuss partnering for clinical efficiency and effectiveness. This presentation will be followed by Michelle Marchese, Director of Care Delivery Analytics at Blue Cross Blue Shield of Michigan (BCBSM), who will present about how BCBSM’s Physician Group Incentive Program (PGIP) supports value-based care. The final guest presentation of the day will feature PO members and comes from leaders at the MyMichigan Collaborative Care Organization. Dr. Shannon Martin, Primary Care Council of MyMichigan Medical Group, will present on affecting medication overload in seniors.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about the MVC Component of the BCBSM Pay-for-Performance (P4P) Program, as well as insights on how performance in the areas of preoperative testing and cardiac rehabilitation utilization compares across the collaborative.

At the conclusion of the meeting, attendees will be able to identify the value of a variety of data sources and collaboration opportunities to assist with implementing and evaluating quality improvement projects. The full agenda can be accessed online here.

These presentations would be informative and applicable for any of the following stakeholders who are welcome to attend:

  • MVC Hospital Site Coordinators
  • MVC Physician Organization Site Coordinators
  • Quality Leadership
  • Clinicians
  • Healthcare abstractors, analysts, and statisticians
  • CQI staff

Those interested in attending this informative and collaborative meeting should register here. The MVC Coordinating Center looks forward to a fantastic meeting. See you there!

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MVC Distributes New Push Report Dedicated to P4P Conditions

MVC Distributes New Push Report Dedicated to P4P Conditions

MVC launched a new push report this week dedicated to the MVC P4P conditions. Its purpose is to support hospitals in identifying areas of opportunity within past and present conditions of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The conditions currently included in P4P and in this report are chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), colectomy (non-cancer), coronary artery bypass graft (CABG), joint replacement (hip and knee), pneumonia, and spine surgery. Acute myocardial infarction (AMI) is also included in this report as a historical P4P condition. Hospitals received a page for each condition if they met a case count threshold of 11 episodes in 2019 and 2020.

This report was limited to episodes included in the P4P program with index admissions in 2019 and 2020, and thus included the following payers: BCBSM Preferred Provider Organization (PPO), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), BCN Medicare Advantage, and Medicare Fee-For-Service (FFS). To align with the P4P program, MVC excluded patients with a discharge disposition of inpatient death or transfer to hospice, episodes that started with an inpatient transfer, and episodes with a COVID-19 diagnosis on a facility claim in the inpatient setting. To fully exclude COVID-19 patients, pneumonia episodes in March 2020 were also excluded.

The reports provided data on hospital trends in episode payments, readmission rates, post-acute care utilization, and emergency department utilization for P4P patients. Data from the push report can be used in conjunction with the registry reports to inform areas of opportunity in the P4P conditions. The push reports also provided a snapshot of each hospital’s P4P patient population (see Figure 1), including race, mean age, and the average number of comorbidities.

Figure 1. Patient Population Snapshot for Blinded Hospital

For Critical Access Hospitals (CAHs), the report also included index length of stay. For acute care hospitals, the report included a “reasons for readmissions” table that identified the top five reasons a P4P patient was readmitted. However, this table was removed from the report’s joint replacement page due to low readmission rates among joint replacement surgeries. In its place, acute care hospitals received their ratio of outpatient to inpatient surgeries.

As with other push reports, hospitals were compared to other members in the collaborative for select measures. For acute care hospitals, each hospital’s report includes a comparison point for all MVC episodes (“MVC All”) as well as for episodes at hospitals in the same geographic region (“Your Region”). These reference points do not include episodes that occurred at hospitals with a CAH designation. Similarly, the reports distributed to CAHs included comparison points for MVC episodes at all CAHs in the collaborative (“CAH Average”).

This report takes the place of the cardiac service line reports, which included data on CHF, AMI, and CABG. The new P4P conditions push report uses many of the same measures and figures from the cardiac service line reports, but for the complete list of P4P conditions.

For more information on the MVC Component of the P4P Program, see the MVC P4P Technical Document. Please share your feedback on the newest P4P conditions push report with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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New Collaborative MIBAC Seeks to Address Back Pain

New Collaborative MIBAC Seeks to Address Back Pain

Lower back pain is a common—and challenging—realm of healthcare that is the leading cause of disability globally. As many as 80-95% of patients presenting to primary care providers with this condition have no identifiable origin for their pain. The absence of a specific etiology is exacerbated by challenges related to treatment; although there are many treatment options, not all are evidence-based and there is rarely a simple, easy fix. In addition, most primary care physicians do not like managing back pain and feel they have not been adequately trained in musculoskeletal medicine.

With the above considerations in mind, researchers argue that greater attention is urgently needed in response to the rising burden and impact of this condition. Low back pain was, therefore, an ideal area of focus for the Blue Cross Blue Shield of Michigan’s Collaborative Quality Initiatives (CQI) portfolio. The Michigan Back Collaborative (MIBAC) was rolled out in 2021 and is based at Henry Ford Hospital. This new statewide quality improvement initiative focuses on better care for low back pain to address issues such as rising costs, rising disability, and patient and provider dissatisfaction (see Figure 1).

Figure 1

MVC Coordinating Center staff had the pleasure of meeting with the MIBAC team recently to learn more about the program, its focus, and goals. MIBAC has two components: training and quality analysis (see Figure 2). Training is the focus of the first year of commitment to the collaborative, with progression to quality analysis in years two or three. These components are all voluntary and participation in one is not contingent on completion of another.

Figure 2

MIBAC membership currently includes clinicians such as primary care physicians and chiropractors, as these are typically the “first-contact” clinicians for low back pain. As the program expands, there is a plan for additional provider types (including physical therapists and emergency room physicians) to become involved as members of the collaborative, and the MIBAC Coordinating Center is working to recruit more physician organizations as well as independent chiropractic practitioners from across the state of Michigan.

MIBAC’s evidenced-based training is available to all its providers and was delivered to more than 800 primary care and chiropractic practitioners in 2021. The curriculum was developed by Spine Care Partners and delivers information on a biopsychosocial model of spine care management. Education is provided on guidelines for referrals, imaging, and pain medication, with an emphasis on solutions and techniques that cultivate inter-professional and doctor-client partnerships. Training sessions are offered virtually and in-person and provide continuing educational credit.

MIBAC is also planning to provide data for clinicians to support more effective care patterns, better outcomes for patients, and greater satisfaction for clinicians and patients. The MIBAC database will integrate patient-reported outcomes (PROs) along with clinical and demographic data. The hope and goal of the MIBAC registry is to identify variations in practice and key quality metrics whilst building clinical and administrative “best-practices” in spine care. In order to establish a data cohort, MIBAC will focus on a six-month review and a six-month follow-up as their defining period. MIBAC plans to cultivate collaboration and networking between participating members at meetings, site visits, webinars, and other strategies.

To date, the MVC team has supported the MIBAC Coordinating Center to assess the utilization of appropriate imaging by providers to inform the development of the collaborative's VBR program. Moving forward, the MVC team will continue to work closely with MIBAC to explore other avenues to help achieve the collaborative's aim of achieving better care for low back pain for Michigan residents.

For more information on MIBAC, visit their website at https://mibac.org/.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is cognizant that many other CQIs also partner with hospitals and providers throughout Michigan. Throughout 2022, MVC will post a series of blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with any suggestions or questions.

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Unique Food Assistance Program Bridges Medical and Food Sectors

Unique Food Assistance Program Bridges Medical and Food Sectors

MVC hosted another successful session of its new health equity workgroup last week with a guest presentation by Ariane Donnelly, MPH, RD, Health Promotion Coordinator at the Washtenaw County Health Department. The new health equity workgroup was established in response to a greater strategic focus on health equity within the MVC Coordinating Center as well as widespread interest in this topic within the healthcare field.

The March 16 workgroup focused on the Prescription for Health program, which takes a unique approach to chronic disease management by connecting the medical system with the food sector. It operates by having participating healthcare providers assign “prescriptions” to their patients to eat more fruits and vegetables. These prescriptions can then be “filled” at local participating farmers markets, where patients receive $100 in tokens to spend on fresh fruits and vegetables as well as nutrition education and support. Participants also work with Community Health Workers to set health goals. The program leverages the fact that Michigan is the second most agriculturally diverse state in the country, and its abundant farmers markets can be an asset in supporting healthy lifestyles for patients.

Evaluation of the program’s effectiveness has been fruitful. For every year of the program, the health department found a statistically significant increase in self-reported fruit and vegetable intake, often by one cup or serving per day (see Figure 1).

Figure 1.

The program was first created in 2008 in response to high levels of food insecurity within communities in Washtenaw County combined with generally low consumption of fruits and vegetables, both of which are associated with an increased risk of chronic disease. Ms. Donnelly pointed out that while many clinics provide nutrition advice, patients face multiple barriers to equitably accessing healthy foods and need additional support. Since its first pilot, the program has continued to grow in total enrollees and economic impact, and it maintained its participation levels throughout the pandemic with a modified version of the program.

Similar programs are in operation in other parts of the state and country as well, such as Food Rx in Chicago and Fresh Prescription in Detroit. Washtenaw County’s Prescription for Health program launched an implementation toolkit in 2016 to help others with starting a similar program in their area.

To learn more about the Prescription for Health program’s operations, impact, and lessons learned, watch the full recording of the workgroup here: https://bit.ly/3IyIsnS. You can also visit the program website for more information: www.washtenaw.org/prescriptionforhealth.

MVC will continue to invite guest speakers with valuable insights on a more equitable health system. The next MVC health equity workgroup will take place on Tuesday, May 10, from 1-2 p.m. If you would like to suggest a topic or speaker for a future workgroup, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

Prescription for Health is funded by Saint Joseph Mercy Health System with additional financial support from multiple partners.

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MVC Component of the BCBSM P4P Program: PY21 in Review

MVC Component of the BCBSM P4P Program: PY21 in Review

Last month the Michigan Value Collaborative (MVC) Coordinating Center distributed the final scorecards for the 2021 program year of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The 2021 program year was the second year of a two-year cycle for which hospitals were evaluated using MVC data. Hospitals were scored on two conditions that they selected from seven options: chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure one shows the frequency of hospital condition selections for the two-year program cycle.

Figure 1. Distribution of Hospital Condition Selections for PY21

The MVC Component of the BCBSM P4P Program evaluates each participating hospital’s risk-adjusted, price-standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points is by reducing their payments from the baseline period (which included index admissions in 2018) to the performance period (which included index admissions in 2020). These are termed “improvement points.” Alternatively, hospitals can earn points by being less expensive than the other hospitals in their cohort. These are referred to as “achievement points.” The MVC cohorts are groups of hospitals determined to be peers using bed size, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each condition. Hospitals are also eligible to earn a bonus point for each condition provided all hospitals in their respective cohort who selected the same condition reduced spending by five percent. For the 2021 program year, the Coordinating Center added two additional bonus points that could have been earned by attending both semiannual meetings (one point) and by completing a site visit with MVC in 2021 (one point). A maximum of 10 points were awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for the 2021 program year.

Figure 2. Distribution of Total P4P Scores for PY21

On average, hospitals earned 6.8 points total, an increase of 1.3 points from the 2020 program year average of 5.5 points. A majority (88%) of hospitals earned at least one of the two possible participation bonus points. In addition, 31 cohort bonus points were distributed within COPD, CHF, and joint replacement. Consistent with previous years, the condition with the highest average point total was joint replacement at 4.5 points with CABG coming in second at 2.9 points (Figure 3).

Figure 3. Average Points by Service Line

When looking at the episode payments behind the point totals, MVC found that hospitals that selected CABG, CHF, and joint replacement saw a decrease in payments from 2018 to 2020 (see Figure 4). Taking into account case counts for all conditions in the baseline year, MVC also found that payments decreased overall for the selected P4P conditions by $7.7 million dollars in program year 2021.

Figure 4. Payment Change by P4P Condition

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021. If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com. The Coordinating Center will be evaluating and releasing a report on the 2020 and 2021 program year cycle later in 2022.