23 Apr 2025
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MVC Announces Agenda, Speakers for Spring Collaborative-Wide Meeting

MVC Announces Agenda, Speakers for Spring Collaborative-Wide Meeting

April 23, 2025 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce the agenda for its spring collaborative-wide meeting on Fri., May 9, 2025, from 10 a.m. – 3 p.m., at the H Hotel in Midland, MI. This meeting’s theme of “collaboration in action” reflects a focus on partnerships, collaborating to overcome barriers, and leveraging data to shape improvement projects. Those interested in attending MVC's spring collaborative-wide meeting can learn more and register here.

MVC Director Hari Nathan, MD, PhD, and Managing Director Mark Bradshaw, MSc, will kick off the day with Coordinating Center updates as well as announcements about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This will be followed by a new engagement awards ceremony and a presentation about statewide trends in quality improvement efforts, both presented by MVC Engagement Manager Jessica Souva, MSN, RN, C-ONQS.

The meeting includes a mid-morning poster session with 11 presenters highlighting success stories and research across the broader CQI portfolio. This is one of several opportunities to network with peers.

MVC Associate Program Manager Jana Stewart, MS, MPH, will present on recent MVC partnerships with other CQIs that drove site-level quality improvement initiatives. In addition to providing updates on these partnerships and their respective progress, Stewart will also share new priorities related to cardiac rehabilitation, preoperative testing, and ED-based episodes of care. This presentation will include unblinded data on key measures for all three topics, including new data on mental health comorbidities among patients treated in the emergency department. Attendees will be able to benchmark their site’s performance on a variety of metrics and come away with ideas for site-level interventions to implement.

After lunch and open networking, the afternoon features 10 concurrent interactive roundtables covering a wide variety of topics. From collaboration across academic and system units, behavioral health, and data reporting topics to a variety of patient-centered initiatives and more, the roundtables offer something for everyone. Attendees will join between two and three 15-minute discussions as they rotate to different roundtable speaker presentations. One of these options includes a longer 30-minute fireside chat with Hari Nathan, MD, PhD, on system-level approaches to quality improvement.

New this year is an innovation station that will be available throughout the day. It will feature a variety of stations where attendees can interact, leave suggestions, and connect with peers. The day will conclude with closing remarks and next steps with Jana Stewart, MS, MPH.

The deadline to register for MVC’s spring collaborative-wide meeting is April 28. We look forward to seeing you there!

 

16 Apr 2025
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State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

April 16, 2025 | 0 Comments | , , , ,

Hospitals across Michigan are increasingly focused on using their available data to assess care delivery gaps, inefficiencies, and areas for improvement. The Michigan Value Collaborative (MVC) developed its 2024 Statewide Health Equity Report to provide a detailed summary of how hospitals across Michigan are approaching this process with a health equity lens. By analyzing MVC claims data along with survey responses from 52 hospitals and 11 health systems, the full report captures how hospitals are leveraging data to evaluate patient care, identify disparities in outcomes, and develop interventions that improve the overall value of care delivery.

Data Collection and Utilization

One of the key highlights of the report was the varied approach and capacity for collecting, measuring, and utilizing data on health equity. Many hospitals utilize readmission rates, clinical quality indicators, and demographic information to identify variations in care. However, the extent to which this data informs hospital-level decisions varies. While some hospitals remain in the early stages of collecting and organizing health equity data, others are beginning to analyze and apply these insights to shape their initiatives. Nearly a third of respondents indicated they were using data to guide funding and program priorities, while a smaller percentage integrated equity metrics into quality improvement strategies.

To further support hospitals in taking action, MVC used its robust medical insurance claims-based data to highlight established disparities for specific service lines. A notable finding was the difference in rates of birth complications by race (Figure 1). Women who identify as Asian and/or Pacific Islander had higher rates of postpartum hemorrhage than other race categories, and patients identified as Black had higher rates of hypertension and severe maternal morbidity (SMM) than the overall population.

Figure 1. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity During Index Hospitalization, Overall and by Patient Race/Ethnicity, 2021-2024

Another notable finding was sex differences in cardiac rehabilitation enrollment (Figure 2). Women are significantly less likely to enroll in cardiac rehab within 90 days of discharge for eligible cardiac procedures, take longer to enroll in their first session, and attend fewer sessions on average than male patients. These patterns point to differences in how patients access and engage with follow-up care, and these gaps are present even among hospitals with strong cardiac rehabilitation enrollment rates.

Figure 2. Rates of Cardiac Rehabilitation Utilization within 90 Days of Discharge from a Qualifying Event by Sex, 2015-2023

These MVC claims-based investigations into healthcare outcomes across populations can assist hospitals in setting or enhancing their health equity goals.

Efforts to Improve Healthcare Access

Beyond data collection and analyses, the report summarized a range of efforts to improve healthcare access. Most hospitals have expanded telemedicine services, increased clinic hours, deployed mobile health units, support non-emergency medical transportation programs, and offer rideshare assistance to reach a variety of patient populations who struggle to access care in their community. Language accessibility has also been a focus, with nearly 90% of hospitals offering translated materials and on-site interpretation services. Financial barriers remain a concern, with 79% of hospitals reporting efforts to support patients dealing with medical debt or lacking insurance coverage.

There were also several hospitals implementing community-based programming and solutions in response to gaps for specific disease impacted communities or underserved groups. The most common types of solutions currently supported by hospitals across the state included:

  • Food Security Initiatives: Many hospitals are addressing food insecurity by screening patients for social needs, partnering with community food programs, and even launching hospital-based farms and Healthy Food Rx programs to encourage nutrition-based health interventions.
  • Community Health Workers (CHWs): Increasingly, hospitals are integrating CHWs into their care models to bridge the gap between clinical care and community-based support, particularly in rural and underserved areas.
  • Incorporating Patient Voices: Hospitals are utilizing Community Health Needs Assessments (CHNAs), patient experience surveys, and community advisory boards to ensure that patient perspectives inform quality improvement initiatives.

Looking Ahead

Although most hospitals have taken steps to improve care delivery across all patient populations, they face significant organizational barriers, such as insufficient funding for dedicated staff and programming, lack of staff training or expertise in community-focused challenges, and difficulty communicating the business case or return on investment of such efforts. These barriers and new ones will likely grow in the coming months and years as the field’s federal funding streams shift.

Amid that uncertainty, MVC hopes to play the role of facilitator by supporting hospitals with actionable equity data, facilitating peer learning opportunities through dedicated meetings and sharing of success stories, and financial incentives through the MVC Component of the BCBSM P4P Program. In addition, the MVC Coordinating Center regularly consults with the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) team on best practices for data collection and equity-centered quality improvement. MVC will demonstrate this commitment via its quarterly MVC member spotlight blog—which will highlight successful initiatives across MVC’s membership—and via dedicated learning sessions at MVC’s Oct. 10 collaborative-wide meeting in Livonia.

If you are interested in pursuing a health equity initiative, MVC has a robust registry of claims data that can be utilized, as well as site specialists who can help facilitate connections with peers doing similar work. Please reach out to us by email if you have a success story to share or want to learn more about related MVC data.

09 Apr 2025
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CQI Spotlight: Michigan Collaborative for Type 2 Diabetes

CQI Spotlight: Michigan Collaborative for Type 2 Diabetes

April 9, 2025 | 0 Comments | , , , ,

Type 2 Diabetes (T2D) affects over 1 in 9 adults in Michigan and increases the risk of kidney and cardiovascular disease, hypertension, nerve and eye damage. Although newer interventions have demonstrated effectiveness in treating and preventing T2D, barriers to equitable, widespread dissemination and implementation remain a challenge. Delivering evidence-based diabetes care to all T2D patients in Michigan is essential for creating a future where diabetes is no longer a chronic progressive disease.

With this vision in mind, the Michigan Collaborative for Type 2 Diabetes (MCT2D) launched in 2021 and aims to accelerate implementation of and eliminate barriers to guideline-concordant care, through supporting its participating practices with quality improvement efforts. MTC2D is currently focused on three evidence-based strategies: dietary and lifestyle changes based on the use of continuous glucose monitors (CGMs), guideline-directed antihyperglycemic medications, and low-carbohydrate eating patterns. MCT2D recognizes the importance of utilizing these strategies to reduce T2D incidence and to slow disease progression to improve health in Michigan and lower health care costs.

In three short years, MCT2D’s quality improvement efforts have already resulted in major achievements. As MCT2D Program Director and Associate Professor of Family Medicine at the University of Michigan Lauren Oshman, MD, MPH, stated,

So far, MCT2D has recruited more than 400 primary care, endocrinology, and nephrology practices across the state. Their efforts have resulted in a 12% relative reduction in patients with an A1c greater than 8% from 2021 to 2023, as well as an increase in CGM prescribing from 17% to 31% for patients who were on insulin (2021-2023).

MCT2D’s recent successes stem from its commitment to placing patients at the heart of their efforts. The MCT2D patient advisory board meets six times a year to guide the activities of the collaborative, including reviewing medication handouts, low-carbohydrate meal plans and grocery lists, instructional videos on injectable medications, and guides for using continuous glucose monitoring devices (Figure 1). This ensures materials are accessible and patient friendly. Patients are also invited to attend collaborative-wide and regional meetings to share their stories alongside healthcare professionals, further emphasizing the central role of the patient in MCT2D’s quality improvement initiatives.

Figure 1.

In addition to supporting patients, MCT2D addresses the needs of clinicians by offering guidance on clinical best practices, as well as insurance coverage and cost-related issues. MCT2D also hosts regional meetings twice a year and monthly educational webinars where guest speakers deliver presentations on topics requested by collaborative members. Sessions have covered topics such as “Mental Health and Diabetes,” “Working with Specialists,” and “Metabolic Surgery for Type 2 Diabetes.”

Achieving health equity is essential in all aspects of healthcare, but it is particularly crucial in the prevention and management of chronic diseases. All of MCT2D’s initiatives aim to advance health equity in communities across Michigan, ensuring that everyone—regardless of race, ethnicity, socio-economic status, insurance coverage, or geographic location—has access to high-quality care for T2D. MCT2D has established six health equity goals aimed at reducing the prevalence and complications of T2D, while enhancing the quality of life for all patients (Figure 2). To achieve these goals, MCT2D has launched several equity-focused initiatives, including a collaboration with Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) to complete one-on-one consultations with practices on their social determinants of health screening processes.

Figure 2.

MCT2D’s impact on the quality of T2D care is dependent on strong collaborative partnerships with its 23 participating physician organizations.  While MCT2D brings together physician participants from primary care, endocrinology, and nephrology, it centers the crucial role of other members of the care team, including pharmacists, nurse practitioners and physician assistants, care managers, nurses, and dietitians. As Dr. Oshman explains, "Taking care of people with T2D is a team sport. The strength of our collaborative comes from our diversity."

Over the past year, MCT2D and MVC have collaborated in several ways. MVC provides claims-based data and analytic consultation to support MCT2D in establishing quality improvement benchmarks. MVC also collaborated with MCT2D in 2024 to develop a statewide report on T2D in Michigan. This report provided a comprehensive overview of the demographics, healthcare visits, and prescription utilization patterns of patients with T2D in Michigan. The report highlighted key trends in healthcare utilization within this patient population, including emergency department visits, hospitalizations, and consultations with primary care providers (PCPs) and specialists.

MVC is currently partnering with MCT2D on a value exercise to compare the use of guideline concordant medications and change in cost and outcomes among T2D patients in MCT2D practices compared to non-participating practices. This work significantly enhanced the MVC team's understanding of pharmacy claims data from BCBSM and BCN and provided valuable insights that will inform future projects and analyses using pharmacy claims data.

MVC is proud to partner with MCT2D in advancing T2D care across Michigan. The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement, and MVC is excited to continue showcasing the innovative contributions of individual CQIs and the ways in which MVC’s data analytics are supporting high-value care initiatives across the portfolio.

02 Apr 2025
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March Workgroups Highlight Chronic Kidney Disease Detection in Primary Care and Population Health Program

March Workgroups Highlight Chronic Kidney Disease Detection in Primary Care and Population Health Program

April 2, 2025 | 0 Comments | , , , , ,

In March, MVC hosted two virtual workgroup presentations – the first, a rural health workgroup focused on enhancing early detection of chronic kidney disease (CKD) in primary care and the second, a post-discharge follow-up workgroup focused on the impact of launching a population health program. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to provide resources and support best practice sharing across the state.

March Rural Health Workgroup: National Kidney Foundation of Michigan & Michigan Center for Rural Health

In support of National Kidney Month, MVC’s first rural health workgroup of 2025 featured a presentation by Mary Wozniak, Program Manager for the National Kidney Foundation of Michigan (NKFM) and Jill Oesterle, Director of Provider Solutions for Michigan Center for Rural Health (MCRH). The joint presentation focused on the partnership between NKFM and MCRH on a 2024 Medicaid Impact and Expansion grant.

Low recognition of CKD is a chronic health problem. Nearly 35.5 million Americans are projected to have CKD but according to the Centers for Disease Control and Prevention (CDC) up to 90% of patients are unaware of their CKD status. Additionally, among Medicaid beneficiaries with CKD, the average estimated healthcare costs per year is more than six times the average cost per person when compared to patients without CKD.

Despite the availability of diagnostic tests like estimated glomerular filtration rate (eGFR) and albumin: creatinine ratio (ACR), fewer than half of individuals with diabetes and less than 10% with hypertension receive annual CKD screenings, even though both groups face heightened CKD risk. For more information about testing, Wozniak recommended the guidelines for CKD screening and management from KDIGO and KDOQI.

Knowing that CKD can be diagnosed with two simple evidence-based laboratory tests, NKFM and MCRH teamed up to combat low CKD screening rates. To start, Wozniak and Oesterle explained that the partnership established a CKD Learning Collaborative Initiative made up of four rural health clinics: Cass City Family Practice, Cass City Medical Practice, St. Helen Mclaren Primary Care, and Clare McLaren Central. These sites were identified based on data indicating a high CKD prevalence or low CKD screening rates within their Medicaid patient populations.

The collaborative aimed to increase awareness of the importance of early detection and management of CKD among Medicaid eligible populations at Rural Health Clinics (RHCs) using a three-pronged approach:

  1. Increase provider and clinical education
  2. Promote referrals to evidence-based lifestyle change programming (through NKFM)
  3. Provide support and guidance to implement screening into clinical workflows

Each pilot site participated in an initial assessment including the collection of baseline data. NKFM then provided one-hour tailored clinical education sessions on various CKD topics from diagnosis and staging to lifestyle and nutrition approaches for prevention and management. Wozniak and Oesterle attribute the collaborative’s ability to adapt these trainings to each clinic based on their identified needs, capabilities, and goals to the successes observed in increased screening and diagnoses made at these pilot sites when compared to baseline data.

Amongst the four pilot sites, the collaborative found CKD screening rates in patients with diabetes increased on average by 27%, while in patients with hypertension (HTN) screening increased on average by 17% (Figure 1). Overall, CKD diagnosis increased by an average of 6.5% when compared to baseline.

Figure 1. CKD Learning Collaborative Data Findings

Empowering the healthcare team and patients with actionable recommendations was another strategy identified to be especially helpful in moving the needle on screening rates. Ensuring laboratory representation from the beginning of the project was especially helpful in overcoming challenges related to laboratory test ordering and reporting. Moving forward, the presenters note that the project timeline may need to be adjusted to build in enough time to identify clinic champions and develop buy-in with clinic staff.

Throughout the project, NKFM and MCRH met monthly with all the pilot sites together, as well as separately. This allowed them the opportunity to collaborate on shared successes and barriers while also offering an opportunity to cater education and guidance of interventions to each site’s needs. While each pilot site ended the project with different next steps, all will continue to receive support from NKFM and MCRH as they progress on their journeys to diligently increase CKD screening, diagnosis, and referrals to lifestyle management programs.

Using the remaining funds from this grant, NKFM and MCRH built on their successes by developing a CKD toolkit for rural providers. The toolkit allows them to broaden the reach of the CKD Learning Collaborative’s impact to more clinics across Michigan. While the toolkit does cater to a rural health clinic audience, any clinic interested in learning more about enhancing CKD care can access the suite of provider and patient education resources, workflows, and screening tools on MCRH’s website.

Mar. 11, 2025: MVC Rural Health Workgroup

March Post-Discharge Follow-Up Workgroup: Oaklawn Hospital

This month, MVC’s post-discharge follow-up workgroup featured a presentation by Morgan Albright, Director of Case/ Care Management and Population Health at Oaklawn Hospital and Zach Chapman, Executive Director of Oaklawn Medical Group. Their co-presentation centered on Oaklawn Hospital and Oaklawn Medical Group’s collaboration to integrate Medicare Annual Wellness Visits (MAWVs) into their population health program.

MAWVs focus on preventive care and health maintenance and include a health risk assessment, review of medical history, and development of a personalized prevention plan (Figure 2). Unlike a preventive physical exam (IPPE) or routine physical exam, MAWVs do not include a comprehensive physical exam. Albright explained that while MAWVs are a standard benefit for Medicare beneficiaries, these visits were infrequently completed due to the limited time available during a PCP visit. Additionally, since these visits are hands off assessments and previously stand-alone appointments, patient satisfaction following these visits was generally low.

Figure 2. Comparison of Medicare Physical Exam Coverage

In January of 2023, three population health nurses were integrated across Oaklawn’s outpatient offices with the goal of conducting dual and/or phone-prep MAWV appointments. Combining an MAWV with another regularly scheduled visit has helped to alleviate the barriers that existed for the Medicare patient population. Benefits of completing the MAWV include increased care planning, depression screening, and patient satisfaction.

An additional benefit to the integration of the population health nurses and MAWVs has been in the improvement of billing and revenue. Albright explained that while an initial MAWV does not necessarily generate revenue, any subsequent MAWVs, such as those focused on depression screening or social determinants of health (SDoH) concerns, are billable. Champman notes that in 2022, only 66 depression screenings were billed, compared to close to 4,000 in 2024. Similarly, billing for advanced care planning has increased from 94 cases in 2022 to 1,100 in 2024. Chapman estimates the return on investment is about 150% of the cost of a dedicated population health RN. He also noted the impact the introduction of population health support staff has had on reducing the primary care physician’s workload.

In addition to the MAWV assessments, Albright and Chapman note Oaklawn has initiated a chronic care management program. This program is a collaborative effort between Oaklawn’s care managers and a third-party chronic care management vendor. These check-ins take place between regularly scheduled appointments to ensure patients have the resources (access to medications, transportation, etc.) to be successful in management of their chronic conditions. The depth and breadth of the resources available between these two groups allows them to reach out to over 800 patients monthly. Identified downstream effects of this program have been reduced emergency department (ED) utilization and reduced length of stays (LOS).

Paired together, the addition of MAWVs and the chronic care management program have robustly increased Oaklawn Hospital and Medical Group’s ability to reach their aging Medicare patients. Overall, roughly 50% of Oaklawn’s eligible population completed MAWVs in 2024, compared to just 11% in 2021. This translates to about 1,800 wellness visits in 2021 versus 5,500 in 2024. Oaklawn’s next steps include intentionally working to engage with the remaining 50% of eligible Medicare patients to ensure they do not miss out on valuable healthcare resources.

To learn more about Medicare Wellness Visits including coding and billing requirements, visit the Centers for Medicare and Medicaid Services education website.

Mar. 20, 2025: Post-Discharge Follow-Up Workgroup

If you are interested in pursuing a healthcare improvement initiative, MVC has a robust registry of claims data that can be utilized, as well as site specialists who can help facilitate connections with peers doing similar work. Please reach out to us by email if you are interested to learn more about MVC data or engagement offerings. Please also join us for upcoming workgroups by registering on MVC’s website.

26 Mar 2025
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Overcoming Barriers to Healthcare Access: A Success Story at Marshfield Medical Center-Dickinson

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

March 26, 2025 | 0 Comments | , ,

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

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

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

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

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

Photo courtesy of Marshfield Medical Center-Dickinson

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

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

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

19 Mar 2025
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MVC Refreshes Registry Reports with New Data & Methods

MVC Refreshes Registry Reports with New Data & Methods

March 19, 2025 | 0 Comments | , , ,

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

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

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

Refreshed Multi-Payer Cardiac Rehabilitation Reports

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

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

Figure 2. Statewide Rankings for Cardiac Rehab Utilization within 90 Days After Discharge from PCI, 1/1/2024-9/30/2024

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

Refreshed Multi-Payer Preoperative Testing Reports

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

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

MVC’s registry contains an extensive collection of multi-payer, P4P, and payer-specific views and metrics. If you are newer to the registry or would like a refresher on how best to leverage the information, reach out to the MVC Coordinating Center for information about a custom registry review.

12 Mar 2025
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MVC Welcomes Its Newest Senior Analyst, Steven Ellinger

MVC Welcomes Its Newest Senior Analyst, Steven Ellinger

March 12, 2025 | 0 Comments | , ,

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

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

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

05 Mar 2025
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February Workgroups Highlight Hybrid Cardiac Rehab Delivery and Patient Journey Mapping

February Workgroups Highlight Hybrid Cardiac Rehab Delivery and Patient Journey Mapping

March 5, 2025 | 0 Comments | , , ,

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

February Cardiac Rehab Workgroup: Henry Ford Health

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

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

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

Figure 1. AACVPR/AHA Cardiac Rehab Performance Measures

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

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

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

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

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

Feb. 11, 2025: MVC Cardiac Rehab Workgroup

February Health in Action Workgroup: MVC Coordinating Center

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

Using Patient Journey Mapping to Improve Patient Outcomes

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

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

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

Patient Experience – Key Barriers That Impact Patients

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

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

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

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

Feb. 27, 2025: Health in Action Workgroup

If you are interested in pursuing a healthcare improvement initiative, MVC has a robust registry of claims data that can be utilized as well as site specialists who can help facilitate connections with peers doing similar work. Please reach out to us here if you would like to learn more about MVC data or engagement offerings.

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

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

February 26, 2025 | 0 Comments |

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

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

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

Figure 1.

Figure 2.

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

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

Figure 3.

Figure 4.

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

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

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

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

February 18, 2025 | 0 Comments | , ,

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

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

Figure 1.

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

Figure 2.

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

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

Figure 3.

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

Figure 4.

Figure 5.

Figure 6.

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