18 Nov 2021
0

CHF Workgroup Discusses Value of Outpatient Intravenous Diuresis

November 18, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) holds bi-monthly virtual workgroups on six different clinical areas of focus. The goal of these workgroups is to bring collaborative members together to discuss current quality improvement initiatives and challenges. These six different clinical areas include chronic disease management (CDM), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), diabetes, joint, and sepsis. At the most recent MVC CHF workgroup, the discussion centered around inpatient versus outpatient intravenous diuresis for the acute exacerbation of CHF.

The prevalence of heart failure in the United States is increasing, with one study indicating it affects more than 5.7 million people. The study reports that up to 80% of patients with acute decompensated heart failure (ADHF) visit their emergency departments and that 91.5% of those patients were thereafter readmitted to the hospital for diuresis.

With increasing prevalence comes greater direct and indirect healthcare costs associated with CHF, accounting for approximately $40 billion annually in the United States. For patients over the age of 65, it is a leading cause of hospitalization with annual costs of $11 billion.

Despite significant costs and healthcare burden associated with this condition, the same study finds that no official guidance exists regarding an appropriate location for therapy. Since hospital readmission reduction programs seek to incentivize reductions in readmissions, it is important to simultaneously provide guidance to providers and patients on safe and effective options for outpatient treatment and therapy.

To address this concern, the workgroup discussed the benefits and safety of outpatient intravenous (IV) diuresis and how the outpatient administration of furosemide can be safe and effective. MVC members shared their experiences with setting up these clinics, their inclusion criteria, and other protocols. A standard diuretic protocol could include each patient being given an IV furosemide bolus with continuous infusion within the most appropriate outpatient setting, which could include the patient’s home or in a mobile clinic.

While in the outpatient setting, patients undergoing this treatment would be monitored via cardiac telemetry and appropriate blood panels before and after the infusion. Patients on maintenance medications are instructed to continue their standard dose in the outpatient setting as appropriate based on their individualized treatment protocol. Patients should follow up with their cardiology and primary care teams to maintain their treatment and care maintenance plans. Following the outpatient IV diuresis encounter, the study reported patients had lower costs, fewer hospital stays, and lower mortality risk than CHF patients who did not receive outpatient IV diuresis.

Overall, studies indicate that outpatient CHF IV diuresis treatment is a safe and effective method of relieving CHF symptoms with a low risk of adverse events. The MVC members in attendance had positive thoughts and experiences regarding outpatient IV diuresis clinics and would recommend further discussion on them. The outpatient mobile CHF diuresis clinic was of notable interest to the MVC members in attendance and will be considered for a specialty topic in future workgroups and blog posts.

The MVC Coordinating Center is interested in hearing how your organization is improving CHF patient care and reducing CHF hospital readmissions. If you would like to present at or attend an upcoming MVC workgroup, please contact the MVC Coordinating Center at the michiganvaluecollaborative@gmail.com.

11 Nov 2021
0

Healthcare Leaders Issue Support for Climate Change Mitigation

November 11, 2021 | 0 Comments | ,

The past year forced healthcare to grapple with never-before-seen challenges. In response, facilities and clinicians found ways to think creatively, adapt, and find common ground with peers to best steward the health and safety of our communities. But the pandemic isn’t the only challenge requiring that kind of response. The healthcare industry is placing greater emphasis than ever before on the issue of climate change amidst the news and commitments coming out of the 2021 United Nations Climate Change Conference, also known as COP26.

The greater emphasis following this year’s conference is perhaps related to an increased overall focus on direct impacts to public health as well as the looming presence of a global pandemic that nearly all countries have struggled to manage. Countries like Britain are looking to reduce emissions by piloting a first-of-its-kind zero-emissions ambulance, citing that air pollution contributes to one out of every 20 deaths in the United Kingdom. The new vehicle was parked and promoted at the events in Glasgow. It is also notable that the healthcare industry has been increasingly concerned with variability in health outcomes due to social determinants of health; the impacts to human health by climate change and environmental pollution are also felt disproportionately by vulnerable communities.

The COP26 commitments included one from the U.S. Biden Administration to halve the United States’ greenhouse gas emissions by 2030. According to Health Care Without Harm (HCWH), an international nongovernmental organization concerned with mitigating healthcare’s impact on environmental health, “the U.S. health sector is responsible for 8.5% of U.S. greenhouse gas emissions and 27% of the global health care emissions… Addressing the climate crisis as a core driver of disease must be central to the health sectors’ mission today and in the future. As a fundamental sector in our society, and the only sector with healing as its mission, it makes sense for health care to lead the way to kick our addiction to fossil fuels, improve public health, and save billions of dollars in health costs in the process.”

They posited that healthcare has a unique relationship with climate change because of healthcare's role in bearing the financial costs and human health burden (see Figure 1 from the Centers for Disease Control and Prevention) from “increased disease spread and more frequent extreme weather events.”

Figure 1.

This belief is shared by at least 45 million healthcare workers (which represents 75% of the health professionals in the world) associated with letters urging immediate action on climate change. There are already leaders in these efforts throughout the U.S. The Healthcare Climate Council created a playbook (see Figure 2) for operationalizing climate solutions in areas such as energy, food, leadership, operating rooms, purchasing, infrastructure, transportation, and waste.

Figure 2.

The playbook contains success stories of facilities that have made meaningful changes, such as one about the Cleveland Clinic saving more than $4 million in 2019 by reducing air changes per hour during non-surgical periods as part of their Operating Room Setback Plan. They save 25 million kWh/year in energy use and $2.5 million annually. Similarly, Ascension deployed a data dashboard to report facility operations (energy, water, temperature, humidity, and air changes) on a real-time basis, and they implemented a pulse oximeter collection project that resulted in 664,000 medical devices collected and 66.4 tons of landfill waste avoided. They reported that this effort required collaboration between green teams, the purchasing department, environmental services, clinicians, facility managers, and the medical device reprocessing vendor.

Quality improvement efforts in healthcare have always been multifaceted, seeking to systematically reduce variation and improve outcomes by standardizing processes and structures. Quality professionals look at technology, personnel, culture, physical capital, leadership, training, operations, and procedures, among other areas. This means that healthcare’s quality improvement teams are uniquely positioned to support their leadership in identifying and implementing climate solutions. These changes that help mitigate climate impacts also often lead to more efficient, sustainable care delivery.

There are a number of professional organizations ready to assist and offer guidelines for practice improvement, including Health Care Without Harm, its sister organization Practice Greenhealth, the Alliance of Nurses for Healthy Environments, the American Society of Anesthesiologists, the Association of American PeriOperative Registered Nurses, and the American Academy of Family Physicians, among others.

Much like with the COVID-19 pandemic, the actions and decisions of one facility, community, or country ultimately have an impact on everyone else, which means a culture of collaboration is a prerequisite for the successful integration of climate change mitigation in healthcare. If your hospital or physician organization has achieved value or outcome improvements that relate to environmental health or sustainability, the MVC Coordinating Center can help share your story. Please contact the MVC team at michiganvaluecollaborative@gmail.com.

04 Nov 2021
0
View Post
Introducing MVC Engagement Associate Chelsea Andrews, MPH

Introducing MVC Engagement Associate Chelsea Andrews, MPH

November 4, 2021 | 0 Comments

I would like to take this opportunity to introduce myself as the Michigan Value Collaborative’s (MVC) new Engagement Associate. As the Engagement Associate, I will work closely with the Site Engagement Manager and Site Engagement Coordinator to foster collaboration among members and other stakeholders and drive outreach efforts that facilitate statewide cross-institutional learning. I am excited to join the MVC Coordinating Center and look forward to getting to know our sites and members.

Colleagues would call me a well-versed health and wellness leader with an authentic and collaborative approach to program management who creates a positive and high-performing culture. I have worked in healthcare and health research in various capacities over the past 11 years, ranging from direct patient care to administration, and have co-authored multiple medical encyclopedia entries and actively contributed to NIH research. I’m a Michigan State University alumna with a pre-medical Bachelor of Science in human biology; a specialization in bioethics, humanities, and society; and a Spanish minor. After working as a nurse assistant in various specialties, I left the state of Michigan to earn my Master’s in Public Health in health systems, management and policy at the University of Colorado. While in Colorado, I was part of the administrative team for Colorado Medicine’s Department of Obstetrics and Gynecology - Division of Maternal Fetal Medicine. Since my return to Michigan in 2019 and prior to joining the MVC, I worked at the University of Michigan School of Nursing as Program Coordinator for the Alliance to Advance Patient-Centered Cancer Care, where I defined and executed project goals and acted as a liaison between the national program office teams, grantees, and board members.

I am passionate about comprehensive patient-centric operational procedures, community engagement, and reducing healthcare disparities. When I’m not working, you can find me playing with my dog and three cats, adventuring outside, working on cars, or reading next to a fire (I’m always accepting book recommendations). If you have any questions, please reach out to me at andreche@umich.edu.

28 Oct 2021
0
View Post
October 2021 MVC Semi-Annual: Virtual Meeting Recap

October 2021 MVC Semi-Annual: Virtual Meeting Recap

October 28, 2021 | 0 Comments

The Michigan Value Collaborative (MVC) held its second virtual semi-annual meeting of 2021 on Friday, October 22nd. A total of 221 leaders from a variety of healthcare disciplines attended Friday’s virtual meeting, representing 70 different hospitals and 23 physician organizations (POs) from across the state of Michigan. These participants came together to hear about the planned adjustments to the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program for Program Year 2021 in light of COVID-19 and to discuss “the social risk and health equity dilemma” - a growing priority within the healthcare system generally, as well as within the MVC Coordinating Center.

MVC’s Director, Dr. Hari Nathan, started Friday’s meeting with an update from the MVC Coordinating Center, welcoming new collaborative members Munson Healthcare Manistee and Paul Oliver Memorial Hospital, and MVC’s newest Coordinating Center team members: Jana Stewart, Kristen Palframan, and Carla Novak. Dr. Nathan also highlighted some of the recent successes achieved by the Coordinating Center, including the launch of MVC’s new health equity report, increased custom analytic reporting, and the completion of over 50 virtual site visits with members this year.

Dr. Mike Thompson, MVC’s Co-Director, then shared information on the MVC Component of the BCBSM P4P Program with attendees. In investigating the impact of COVID-19 throughout the state in 2020, the MVC Coordinating Center found that 223 of the 25,627 (0.9%) episodes included in the P4P conditions from the first half of 2020 had a code for confirmed COVID-19 infection in the index event or other inpatient settings. The MVC Component of the BCBSM P4P program rewards hospitals for either making improvements over their baseline episode payment or for being less expensive than peer hospitals. The MVC team found that episodes of COVID-19 patients are generally more expensive than typical episodes. In addition, COVID-19 was not present in the baseline year of 2018 that hospitals stand to be evaluated against. Therefore, with approval from BCBSM, Dr. Thompson announced that, for Program Year 2021 only, the Coordinating Center will be removing any 2020 episode with a COVID-19 diagnosis on an inpatient facility claim during the 30-day episode if the COVID-19 ICD code is one of the first three diagnosis codes on the claim (see Figure 1). Looking ahead, a summary of participant selections for Program Years 2023 and 2024 were also shared, showing joint replacement as the most common condition selection, closely followed by congestive heart failure (CHF).

Figure 1. MVC Slide on Updates to MVC Component of BCBSM P4P Program for PY21

At MVC’s last semi-annual meeting in May, the Coordinating Center announced that Michigan Medicaid data had been added to MVC data sources and that the MVC Coordinating Center would be spending the subsequent months validating the data and getting it ready for member use. This work has now concluded and MVC’s Manager of Data Analytics shared what this new data source looks like. Michigan Medicaid now represents MVC’s third-largest data source, accounting for over 319,000 episodes since 2015, covering 256,889 beneficiaries, and making up 19.4% of all MVC episodes.  With this new addition, MVC data sources now comprise over 80% of Michigan’s insured population, all of which are available for members to utilize on the MVC registry.

To set the scene for our guest speakers, MVC Analyst Bonnie Cheng provided an overview of MVC’s recent health equity report (see Figure 2), highlighting racial, ethnic, and dual-eligibility variation across Michigan. The MVC Coordinating Center will look to build on this new report and undertake new activities in this area to support member activity moving forward. This will be supported by the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) collaborative – a new group recently launched as part of the Collaborative Quality Initiative (CQI) portfolio. With this in mind, MVC was joined by MSHIELD Program Manager Carol Gray to introduce this new collaborative and describe how MSHIELD will seek to interface with the health system and local communities to drive change (see Figure 3).

Figure 2. MVC Slide on New MVC Health Equity Report

Figure 3. MSHIELD Slide on MSHIELD's Role as a CQI

After hearing from MSHIELD, MVC welcomed guest speaker Dr. Nicole J. Franklin from McLaren Flint hospital. Dr. Franklin provided insight as to how McLaren Flint has devoted time and effort to bridge the gap between health and social care. This placed particular emphasis on the use of six representative sub-committees (employee resource, patient outcomes, community outreach, employee education, talent acquisition, and cultural calendar) to achieve McLaren Flint’s commitment to creating an inclusive and equitable environment where everyone is valued and empowered for success. Representing the Integrated Health Association (IHA), Leah Corneail shared how IHA has worked to actively screen and address patient social influencers of health (SIOH). This emphasized the importance of collecting actionable data through IHA’s SIOH questionnaire and the use of these data through an interactive population health dashboard (see Figure 4). The last guest speaker of the day was Melissa Gary, Community Liaison for Great Lakes Physicians Organization (GLPO). As well as providing an overview of GLPO, Melissa detailed how the organization has used a social determinants of health questionnaire and monthly tracking log to address the needs of over 2000 patients in 2020 alone.

Figure 4. IHA Slide on Social Influencers of Health Dashboard

To conclude Friday’s meeting, MVC Communications Specialist Jana Stewart provided a synopsis of the day and highlighted key upcoming activities. The slides from Friday’s meeting are available here and a recording of the meeting is available here. If you have questions about anything that was discussed at the semi-annual or are interested in finding out more about MVC’s offerings, please reach out to the MVC Coordinating Center (michiganvaluecollaborative@gmail.com). In the meantime, we look forward to seeing you all in person again soon.

21 Oct 2021
0
View Post
MVC Efforts to Improve Cardiac Rehab Enrollment in Michigan

MVC Efforts to Improve Cardiac Rehab Enrollment in Michigan

October 21, 2021 | 0 Comments | ,

Cardiac rehabilitation (CR) is designed to improve cardiovascular function and mitigate risk factors for future cardiovascular events through monitored exercise, patient education, lifestyle modifications, smoking cessation, and social support (1). For over a decade, CR has been a Class I indication in clinical guidelines for patients who have had a heart attack, chronic stable angina, chronic heart failure, or have undergone a percutaneous coronary intervention (PCI), surgical (SAVR) or transcatheter aortic valve replacement (TAVR), or coronary artery bypass grafting (CABG). The evidence supporting CR as a high-value therapy for patients is clear: better long-term survival, fewer secondary cardiovascular events, fewer readmissions, improved quality of life, and lower healthcare utilization (2–6). 

Unfortunately, only a fraction of Michigan residents eligible for CR attend a single session following hospitalization for a qualifying condition, with rates as high as 59% for patients undergoing CABG and as low as 4% for patients with congestive heart failure (CHF) (see Figure 1). These data highlight that we as a state are well short of the national goal set by the Million Hearts Initiative of 70% enrollment for all eligible patients. Data from Michigan also suggests wide variation in CR enrollment across hospitals that are not fully explained by differences in patient case-mix (7).

Figure 1. Collaborative-wide CR enrollment rates for qualifying conditions (01/2017-12/2019)

Since 2019 the MVC Coordinating Center sought to equitably increase participation in CR for all eligible individuals in Michigan in partnership with the Blue Cross Blue Shield Cardiovascular Consortium (BMC2) and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). In an effort to drive improvement in this area across the collaborative’s membership, MVC developed a number of resources and strategies. For example, the MVC Coordinating Center built hospital-level reports that provide members with information on CR enrollment across eligible conditions benchmarked against all MVC hospitals. This week the newest iteration of this CR report was distributed to members. The previous version of the report was sent in March 2021 with a reporting period of 1/1/17 – 12/31/19. The latest version shifted that reporting period by six months (7/1/17 – 6/30/20), included Medicaid episodes for the first time, expanded the time horizon from 90 days to one year, and added information on CHF and acute myocardial infarction (AMI) episodes. 

With the addition of CHF and AMI (both “high-volume” MVC conditions), the number of hospitals eligible to receive a CR report doubled from 47 to 95, so many MVC hospitals received this report for the first time this month. The most significant methodological change compared to the previous report was the expansion of the episode window from 90 days to 365 days (one year). Previous reports undercounted the number of CR visits by using the standard MVC episode length of 90 days when a full CR program consists of 36 sessions, which are often not feasible to complete in 90 days. Therefore, it was important to expand the time horizon to achieve a fuller count. The report instead looked one full year beyond the index event (either PCI, TAVR, SAVR, CABG, CHF, or AMI) to calculate CR utilization rates and number of visits.

The MVC team also convened a multidisciplinary stakeholder group of CR practitioners, physicians, and CQI leaders to foster discussion around barriers and facilitators to CR enrollment. Many of the recent changes to the CR reports were a direct result of suggestions from this stakeholder group. Quarterly seminars have also provided opportunities for local facilities to share ongoing quality improvement activities and to learn from national leaders about innovations in the delivery and quality of CR.

More recently, the MVC team conducted virtual site visits with several CR facilities around the state to learn about their programs, the successes and challenges they have encountered, and ways to improve collaboration in Michigan around CR enrollment. Common themes emerged as barriers to CR enrollment, including lack of patient or physician engagement, geographical and/or technological gaps in care between the hospital and CR facility, and insurance coverage and reimbursement. Through collaborative learning and dissemination of best practices, the MVC Coordinating Center believes that its members can begin to address many of these challenges moving forward. 

These efforts are all the more important as CR facilities begin to recover from the effects of the COVID-19 pandemic. Many facilities had to reduce capacity and staff as a result of the pandemic, and the number of CR visits declined significantly compared to pre-pandemic months (see Figure 2). While many CR facilities are back to operating at full capacity, continued efforts will be needed to return CR enrollment to pre-pandemic levels. Some sites in Michigan have adopted virtual, home-based, or hybrid versions of CR to continue providing care to patients throughout the pandemic, and its place as a substitute for facility-based CR will require continued exploration that can be supported through collaborative efforts.

Figure 2. Changes in CR enrollment from 2019 to 2020 over time and by qualifying condition

While many challenges remain to achieve the national goal of 70% enrollment in CR for eligible individuals, the MVC Coordinating Center is optimistic that its current and planned efforts will provide opportunities for Michigan to lead the way. If you are interested in joining our efforts to equitably increase CR enrollment for eligible patients in Michigan, please reach out for more information at michiganvaluecollaborative@gmail.com.

References

  1. Rubin R. Although Cardiac Rehab Saves Lives, Few Eligible Patients Take Part. JAMA [Internet]. 2019 Jul 17; Available from: http://dx.doi.org/10.1001/jama.2019.8604 PMID: 31314061
  2. Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001800. PMCID: PMC4229995
  3. Taylor RS, Long L, Mordi IR, Madsen MT, Davies EJ, Dalal H, Rees K, Singh SJ, Gluud C, Zwisler A-D. Exercise-Based Rehabilitation for Heart Failure: Cochrane Systematic Review, Meta-Analysis, and Trial Sequential Analysis. JACC Heart Fail. 2019 Aug;7(8):691–705. PMID: 31302050
  4. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004 May 15;116(10):682–692. PMID: 15121495
  5. Anderson L, Thompson DR, Oldridge N, Zwisler A, Rees K, Martin N, Taylor RS. Exercise‐based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev [Internet]. John Wiley & Sons, Ltd; 2016 [cited 2021 Jan 25];(1). Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001800.pub3/abstract
  6. Rejeski WJ, Foy CG, Brawley LR, Brubaker PH, Focht BC, Norris JL 3rd, Smith ML. Older adults in cardiac rehabilitation: a new strategy for enhancing physical function. Med Sci Sports Exerc. 2002 Nov;34(11):1705–1713. PMID: 12439072
  7. Thompson MP, Yaser JM, Hou H, Syrjamaki JD, DeLucia A 3rd, Likosky DS, Keteyian SJ, Prager RL, Gurm HS, Sukul D. Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care. Circ Cardiovasc Qual Outcomes. American Heart Association; 2021 Feb;14(2):e007144. PMID: 33541107
14 Oct 2021
0
View Post
MVC Releases New Physician Organization Joint Report

MVC Releases New Physician Organization Joint Report

October 14, 2021 | 0 Comments |

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

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

Figure 1.

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

The new PO Joint Replacement Report includes:

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

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

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

Figure 2.

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

Figure 3.

Figure 4.

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

Figure 5.

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

07 Oct 2021
0
View Post
MVC Component of the BCBSM P4P Program Year 2021 Update

MVC Component of the BCBSM P4P Program Year 2021 Update

October 7, 2021 | 0 Comments

The COVID-19 pandemic impacted hospitals throughout the state in 2020 and the MVC Coordinating Center deemed it necessary to evaluate the effect of COVID-19 on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) program. The goal was to determine if adjustments needed to be made to maintain fairness across the collaborative for index admissions in the calendar year of 2020, which will be used to score the 2021 program year.

The MVC Coordinating Center found that 223 of the 25,627 (0.9%) episodes included in the P4P conditions from the first half of 2020 had a code for confirmed COVID-19 infection in the index event or other inpatient settings. Pneumonia and congestive heart failure (CHF) were the most common conditions to have a COVID-19 diagnosis.

The MVC Component of the BCBSM P4P program rewards hospitals for either making improvements over their baseline episode payment or for being less expensive than peer hospitals. The MVC Coordinating Center has also found that episodes of COVID-19 patients are generally more expensive than typical episodes. Additionally, COVID-19 was not present in the baseline year of 2018 that hospitals will be evaluated against and hospitals were impacted differently.

Therefore, with approval from BCBSM, the MVC Coordinating Center will remove any 2020 episode with a COVID-19 diagnosis on an inpatient facility claim during the 30-day episode if the COVID-19 ICD code is one of the first three diagnosis codes on the claim. Please contact the MVC Coordinating Center with any questions at michiganvaluecollaborative@gmail.com.

30 Sep 2021
0
View Post
Fall Semi-Annual Meeting Agenda Highlights Health Equity Topics

Fall Semi-Annual Meeting Agenda Highlights Health Equity Topics

September 30, 2021 | 0 Comments | ,

The MVC Coordinating Center recently released the full agenda for its forthcoming fall Semi-Annual Meeting on Friday, October 22, 2021, from 10:00-11:30 am. The MVC Coordinating Center holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This year’s theme of “the social risk and health equity dilemma” is reflective of a growing priority within the healthcare system generally, as well as newer activities within the MVC Coordinating Center.

Speakers at semi-annual events are often members who share their stories of success, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers outlined on October’s agenda showcase the breadth and depth of knowledge that exists within the collaborative in the health equity space. They also represent a variety of stakeholder groups, including hospitals, physician organizations (POs), Collaborative Quality Improvement (CQIs) programs, and of course MVC Coordinating Center leadership.

The first guest speaker will be Carol Gray, Program Manager of the new Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) CQI. She leads the overall management, performance, and coordination of the MSHIELD program and Coordinating Center team. She has extensive experience managing public health research teams, communicating across and coordinating with multiple partnerships, and linking and engaging with community-based organizations in Detroit and academic faculty at the University of Michigan. Her presentation on, “Aligning Partnerships to Achieve Health Equity,” will speak to that expertise.

The meeting also features the expertise of Dr. Nicole J. Franklin, Assistant Medical Director at the McLaren Bariatric and Metabolic Institute. She provides psychological support to bariatric patients before and after weight loss surgery. In addition, Dr. Franklin is the chair of the Diversity and Inclusion Committee at McLaren Flint and has co-facilitated the Diversity Committee within all three local hospitals’ psychology training programs for the last 10 years. She is an Air Force veteran and a graduate of Wright State University’s School of Professional Psychology. Referencing her work within the greater Flint community, her session will address, “The Health Gap: An Exploration of how one hospital is working to bridge the gaps between health care and social care.”

Another perspective will be brought by Leah Corneail, Director of Utilization and Population Health at the Integrated Healthcare Association (IHA). In this role, she is responsible for leading utilization and cost improvement efforts, ensuring success in risk-based contracts and CMS demonstration programs, and collaborating with community partners to improve population health. Corneail has several years of experience in population health and health policy. Prior to joining IHA, she served as a Senior Project Manager in the Michigan Medicine Population Health Office, where she managed Michigan Medicine’s portfolio of value-based payment models and partnered with operations to implement care transformation initiatives. Leah received her Master of Public Health degree from The George Washington University’s Milken Institute School of Public Health. She will speak to, “IHA Efforts to Screen and Address Patient Social Influencers of Health (SIOH).”

Also representing the approach of a PO will be Melissa Gary, Community Liaison with the Great Lakes Physician Organization (GLPO). In this role, Melissa is responsible for bridging the gap between healthcare providers of GLPO and the local community agencies to better align the mission of GLPO. Utilizing her several years of experience in healthcare and nonprofit organizations, she has built the GLPO social determinants of health process. She is a passionate community servant with the ability to motivate and inspire individuals to identify their own potential and shares in the passion to serve others. Melissa is a graduate from Ferris State University where she studied nuclear medicine and healthcare administration. She has minors in science, biology, pre-pharmacy and paralegal.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about MVC’s Medicaid data, the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and general program updates.

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

  • MVC Hospital Site Coordinators and Champions
  • MVC Physician Organization Site Coordinators
  • Quality Leadership
  • Clinicians
  • Managers and front-line staff in the following clinical areas:
    • Population health
    • Chronic disease management
    • Post-acute care
    • Value-based care
    • Care coordination
    • Discharge planning
    • Social work
    • Others whose work addresses health equity or social risk factors

In addition, hospitals that have attended both of MVC's 2021 Semi-Annual Events (May 2021 and October 2021) will be eligible for one additional bonus point toward Program Year 2021 of the MVC Component of the BCBSM P4P Program.

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!

23 Sep 2021
0

Staffing Shortage Challenges Hospitals Across Michigan

September 23, 2021 | 0 Comments | ,

The past 18 months of the pandemic forced healthcare to be creative and responsive to the needs of the moment, and in that time the MVC Coordinating Center heard from members about how they are working to maintain a high quality of care. The challenges and pivots shared by members vary significantly because facilities were impacted at different points in time and with varying levels of severity. However, one challenge echoes loudly and consistently for hospitals big, small, urban, or rural: the staffing shortage. This problem isn’t specific to Michigan. Across the United States, hospitals don’t have enough staff to keep up with their normal standards of care, with many having to turn away patients and ration care.

Health professionals are the lifeblood of healthcare delivery, so attaining or maintaining a high quality of care is only achievable with appropriate staffing levels. The Institute of Medicine framework defines quality care with six aims: that it be safe, effective, patient-centered, timely, efficient, and equitable. Some of those aims have been directly exacerbated by the pandemic—such as health equity or safety—while many have been at least indirectly impeded by the strains on frontline workers.

An article published by the Detroit Free Press this month titled, “Michigan hospital staffing shortage nears crisis point as COVID-19 patients rise,” paints the current situation as dire. The article quotes Brian Peters, the CEO of the Michigan Health & Hospital Association, as saying, “I have never heard a consistent theme from across our entire membership like I have on this staffing issue." He adds that the shortage affects multiple sectors of the workforce, such as nurses, physicians, housekeeping, technicians, and food service personnel. These new staffing issues occur within an industry that was already concerned about an expected shortage of primary care physicians (PCPs). The Association of American Medical Colleges (AAMC) published data that predicts an estimated shortage of between 21,400 and 55,200 PCPs by 2033 (see Figure 1), in part due to a population that continues to grow and age.

Figure 1.

Some hospitals suggest burnout as the main culprit for the current staffing shortages. A literature review on the effect of burnout on quality of care defines burnout as a state of fatigue and frustration manifested as physical and emotional exhaustion characterized by dissatisfaction and stress, with symptoms such as, “physical fatigue, cognitive weariness, and emotional exhaustion.” Anyone in that condition cannot perform at their best. So as quality teams try to find treatment efficiencies for conditions such as chronic obstructive pulmonary disease (COPD) or congestive heart failure (CHF), the elephant in the room is that they may not be able to provide treatment if nurses, technicians, and physicians aren’t adequately staffed.

The industry is expecting the shortages to increase slightly in the coming weeks as vaccination mandate deadlines approach. Currently, those health systems requiring COVID-19 vaccination include Henry Ford, Michigan Medicine, Beaumont Health, Trinity Health, Spectrum Health, OSF HealthCare, Ascension Health, and Bronson Healthcare, along with Veterans Health Administration facilities.

A variety of strategies are being proposed to lessen the burden felt by the shortage. Since it takes time to recruit new people into medical fields, these approaches generally fall into one of two categories: 1) retain current staff, and 2) deploy current staff as efficiently as possible.

The approaches that hospitals have mentioned for retaining staff are short-term in nature, ranging from approval of overtime and bonuses to instituting new staff well-being programs and sharing mental health resources. Efficient staffing is a more complex approach, but long-term with the potential to reduce the expected burden from future PCP shortages. The Harvard Business Review published an article that outlines strategies for efficient staffing in response to the PCP shortage, which could be repurposed and applied to other healthcare workforces. Among their suggestions, they highlight Advisory Board research that proposes the threefold answer is, “better use of PCPs targeted at specific populations, greater use of non-physician labor where appropriate, and much broader deployment of technology to increase access to primary care.” These suggestions align with several other priorities often voiced to the MVC Coordinating Center by members, including equitable access to care, expanded telehealth offerings, and improved care coordination utilizing nurse practitioners and physician assistants.

The work ahead will be challenging, as it often is in healthcare. Hospitals will continue to shoulder a shared burden in the months ahead. MVC encourages all members and partners to share resources that may help a peer institution improve the quality of care for Michigan residents. Please continue to bring these ideas to future workgroups and networking events, and contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

16 Sep 2021
0
View Post
Approach to quality improvement unique for rural hospitals

Approach to quality improvement unique for rural hospitals

September 16, 2021 | 0 Comments | , ,

Quality improvement is a key effort for healthcare systems and a driving force behind the work of the Michigan Value Collaborative. It is also an increasingly complex task with significant implications. Not surprisingly, quality improvement is not a one-size-fits-all approach, with the challenges impacting hospitals varying significantly by factors such as size and location. This variability showcases the importance of sharing tailored resources among Collaborative members.

Critical-access hospitals (CAHs) are the newest type of members to join the Collaborative. They play an important role in the healthcare system by caring for rural patients who might not otherwise have access to inpatient services. Defined as hospitals maintaining no more than 25 acute care beds and located more than 35 miles from the nearest hospital, they are unique in their populations, services, and structure. The majority of their patients would have to drive 30 minutes or more for an alternative hospital, and many communities have no alternative. Their offerings and size are reflective of the communities they serve, with services such as emergency care, inpatient care, laboratory testing, rehabilitation, long-term care, maternity care, home health care, and even primary care. As a result, their capacities, priorities, and challenges differ from those of their larger colleagues, as do their quality improvement efforts.

For example, a 2015 report from the National Quality Forum titled, “Performance Measurement for Rural Low-Volume Providers,” highlights several challenges to quality improvement in rural areas including fewer providers, lack of information technology, and fewer people to share the workload. Furthermore, rural hospitals often don't meet patient volume thresholds that are required for meaningful comparative analyses. It is critical, therefore, that CAH facilities are connected to resources tailored to their circumstances. One such resource is the 2021 Small Rural Hospital Blueprint for Performance Excellence and Value, produced by the National Rural Health Resource Center.

The purpose of this Blueprint is to aid rural hospital leaders in taking a comprehensive systems approach to quality improvement using factors and strategies relevant to small rural hospitals. Guided by the components of the Baldrige Framework that first took hold in healthcare over 20 years ago, the Blueprint outlines typical challenges, factors for success, and relevant resources for seven key inter-linked focus areas (see Figure 1): leadership; strategic planning; patients, partners, and communities; measurement, feedback, and knowledge management; workforce and culture; operations and processes; and impact and outcomes.

Figure 1.

The Blueprint also incorporates specific comments and feedback shared during the Small Rural Hospital Performance Excellence Summit that was held in the spring of 2021. For instance, within the section on leadership, the Blueprint suggests that educating and engaging the CAH’s board members on healthcare trends and issues is a critical factor of success, in large part because board members in rural areas often do not have a healthcare background. A quote from the Summit on this issue reads, “changes in healthcare are complicated, particularly for those that don’t spend all day every day focused on it.” The Blueprint then recommends resources listed in its appendix that are specifically designed for engaging CAH board members. In addition, a full companion resource focused on related strategies and resources for state flex programs is also available.

CAHs are an important piece of the healthcare puzzle and, like their larger colleagues, they stand to benefit significantly from quality improvement efforts. In fact, an October 2019 CMS fact sheet, “CMS Hospital Value-Based Purchasing Program Results for Fiscal Year 2020,” looked at adjustments made for Medicare payments to hospitals based on their performance on a set of quality measures. Compared to urban hospitals, rural and smaller hospitals generally performed better in both efficiency and cost reduction, among other areas.

The MVC Coordinating Center established regions within its membership in order to help hospitals network and share practices with their peers. Many of the CAH members within the Collaborative operate in region 1 in the northern parts of the state, and a regional networking event was held for region 1 earlier this week. The Coordinating Center is proud of its diverse membership and continues to encourage facilities and POs to leverage the knowledge of peers who operate in a similar capacity so that, together, members can improve the value of healthcare for Michigan patients. If your facility or PO is utilizing a resource that would benefit the work of a peer institution, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com so it may be shared with the Collaborative.