30 Jun 2021
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Introducing MVC’s Newest Analyst, Kristen Palframan, MPH

Introducing MVC’s Newest Analyst, Kristen Palframan, MPH

June 30, 2021 | 0 Comments

I am excited to have joined the Michigan Value Collaborative (MVC) this month as a data analyst. I’m really looking forward to working with the MVC team and using my experience in data management and analysis to support the goal of improving the quality and value of healthcare in Michigan.

My background is primarily in research and data analysis. I have a Bachelor of Science degree in Animal Behavior from Bucknell University. After conducting behavioral research and wildlife disease fieldwork with animals throughout and following college, I developed an interest in disease prevention and came to Michigan to pursue a Master of Public Health (MPH) degree from the University of Michigan School of Public Health. During my MPH program I took a variety of epidemiology and statistics courses, and I particularly enjoyed those that involved programming in SAS and SQL. After graduating from the University of Michigan with an MPH degree in Epidemiology in 2018, I worked for three years as an epidemiologist for the U.S. Department of Veterans Affairs (VA) in the Office of Mental Health and Suicide Prevention. At the VA, I worked on analyses, reports, dashboards, and manuscripts focused on supporting suicide prevention among U.S. Veterans. My work for the VA primarily used electronic medical record data from the Veterans Health Administration as well as mortality data from the Centers for Disease Control and Prevention’s National Death Index.

Now I am thrilled to use my experience in healthcare data analysis to support MVC’s mission and I’m looking forward to growing as an analyst and gaining experience working with claims data. If you have any questions or would like to contact me, please feel free to email me at kpalf@med.umich.edu.

24 Jun 2021
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Continuous Glucose Monitoring Has Potential in Inpatient Setting

June 24, 2021 | 0 Comments | , ,

One of the most prevalent comorbidities in the United States is diabetes; as many as 1 in 10 Americans are diagnosed with this condition, and 90-95% having potentially preventable Type 2 diabetes. It is well documented that unstable blood glucose levels can contribute to increases in morbidity, mortality, and healthcare costs.

In the inpatient setting, the current standard of care for monitoring and testing blood glucose levels in diabetic patients is point-of-care (POC) testing, which combines a specific testing schedule and approved devices to measure blood glucose levels. A recent study involving 110 adults with Type 2 diabetes looked at implementing real-time continuous glucose monitoring (RT-CGM) in order to better manage inpatient glycemic levels. The patients were on a non-intensive care unit (ICU) floor, and received either the standard of care or the RT-CGM with Dexcom G6 monitoring—where a tiny sensor wire is inserted just beneath a person’s skin using an automatic applicator. Data was transmitted from the bedside wirelessly, and monitored by hospital telemetry. The bedside nurses were notified of any abnormal glucose levels or trends and the patients were treated accordingly. The results indicated that patients in the RT-CGM group demonstrated lower mean glucose levels and less time in hyperglycemia.

Another study that evaluated the efficacy of RT-CGM discussed the effect that uncontrolled glycemic levels can have on clinical outcomes and healthcare costs. Currently, hospitals use POC glucose testing in order to monitor and treat hypoglycemia, and it is recommended that POC testing occur four to six times per day. However, this leaves many hours throughout the day where hypoglycemia can go undetected. RT-CGM using a glucose telemetry system (GTS) offers an alternative method to monitor these glucose values. A total of 82 patients participated in this study. Patients in the RT-CGM group experienced 60.4% fewer hypoglycemic events compared to the POC group. Figure 1 below illustrates the number of hypoglycemic events per patient for both the CGM/GTS and the POC.

Figure 1.

RT-CGM has yet to be implemented in inpatient settings for several reasons. The primary reason is the lack of U.S. Food and Drug Administration (FDA) approval. Additionally, institutional challenges may act as a significant barrier. For instance, staff need to be prepared for increased workload and educated on appropriate protocols and procedures. Technological support is required to ensure hardware compatibility and maintain a robust internet network with minimal interference in transmission of results and alerts. Additional factors within the hospital setting include certain medications, procedures, nutrition, acute illness, and any other condition that may affect glucose control. All of these challenges have the potential to impact CGM and its associated workload because of the effect they may have on the patients’ blood glucose levels. Although challenges remain to the implementation of RT-CGM in the inpatient setting, the benefits may outweigh the risks; thus, it is worth considering, especially given the successes in the outpatient arena.

The Michigan Value Collaborative hosts diabetes workgroups where topics such as continuous glucose monitoring are discussed by Collaborative members. If you are interested in attending the next MVC diabetes workgroup, please connect with the MVC Coordinating Center at: michiganvaluecollaborative@gmail.com.

17 Jun 2021
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Custom Hospital Analytics Result in Case Study for Collaborative

June 17, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) Coordinating Center encourages its members to seek out custom analytics to inform and support ongoing quality improvement activities. These requests can help hospitals and physician organizations dig deeper into specific aspects of their administrative claims data and, as a result, better understand areas for improvement.

As custom analytics have been prepared and shared with respective members, the Coordinating Center has endeavored to learn the extent to which these analytics have been utilized. The resulting feedback has enriched MVC’s understanding of its members’ quality initiatives, and presents a great opportunity for MVC to educate its members about the successes and lessons learned of their peers.

In that spirit, the Coordinating Center has sought the permission of various hospitals to generate case studies based on this collaborative work. One such case study featuring McLaren Port Huron Hospital was created this past year and shared with the entire Collaborative via the MVC Newsletter (Figure 1). It features a custom analytics request about the rates and adherence of follow-up visits in their congestive heart failure (CHF) population as well as readmission rates for chronic obstructive pulmonary disease (COPD). The resulting custom analytics reports prepared by the Coordinating Center were also accompanied by best practice sharing sourced from other Collaborative members.

Figure 1.

The Coordinating Center plans to continue to generate shareable case studies about similar requests if those facilities have provided their permission. Similarly, MVC will continue to identify such opportunities for information sharing and networking across facilities in order to support its members.

If any members of the Collaborative are interested in pursuing custom analytics in the future or have ideas to share across hospitals, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com.

10 Jun 2021
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Virtual Site Visits Underway with MVC Members

June 10, 2021 | 0 Comments | , ,

The COVID-19 pandemic affected hospital operations in a myriad of ways, with many Michigan Value Collaborative (MVC) members experiencing circumstances that could impact their score on the MVC Component of the BCBSM Pay-for-Performance (P4P) program. In order to mitigate some of the effect of COVID-19, the MVC Coordinating Center introduced two extra bonus points to be earned for Program Year 2021 only. One bonus point can be achieved by attending both MVC semi-annual events; the first was held in May and the second will be held in October. The second bonus point can be earned by undertaking a virtual site visit with the MVC Coordinating Center.

To date, the Coordinating Center has completed 26 site visits, and a further 25 “visits” are scheduled with a variety of hospitals around the state. During these 90-minute virtual visits, MVC provides an overview of the collaborative, our data, and engagement activities. Hospitals receive a quality improvement slide (Figure 1) in advance that they complete and return prior to their scheduled date. These responses drive the main discussion of the site visit.

Figure 1.

Much has been learned about various quality improvement projects being implemented and what hospitals are focusing on for 2021 and 2022. MVC plans to use the information from these slides to connect hospital members with peers interested in implementing similar projects.

In addition, the Coordinating Center is interested in learning: who is utilizing the registry and any individualized reports, the types of MVC data that are most useful, and any challenges hospitals have with using the data. This feedback will help MVC make improvements to the registry and individualized reports to make them more actionable for members.

Finally, the hospital relationship with physician organizations (POs) is discussed. One of MVC’s goals is to help facilitate collaboration between POs that have patients attributed to each hospital, especially in the patient outcomes and quality of care arenas.

If you have not yet scheduled a site visit, please do so here. Slots are available between now and October. If you have any questions or would like further information on a site visit, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

03 Jun 2021
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Identifying and Solving Potentially Preventable Hospitalizations

June 3, 2021 | 0 Comments

As hospitals continue to work on reducing readmissions, another area of focus to reduce costs is through preventing potentially preventable hospitalizations, especially in chronic conditions. Potentially preventable hospitalizations, known as PPHs, are unplanned hospitalizations that have the potential to be avoided if timely and appropriate outpatient care had been received. However, in order to reduce these admissions, there has to be a means of identification. A number of methods have been reviewed to try and develop a way to identify those patients at risk of having a PPH.

In Australia, a Preventability Assessment Tool (PAT) was developed to attempt to identify patients at high risk of PPH The use of the tool compared to a similar assessment performed by an expert panel was assessed to learn if the tool identified appropriate patients. The  findings were recently published in a journal article. The expert panel consisted of a hospital physician, a primary care physician (or general practitioner (GP)), and a community nurse with expertise in the chronic conditions. The publication identified that the carefully constructed and developed PAT, when compared to the assessment of the expert panel, did not effectively identify those at risk of a PPH.

Another method to potentially identify these types of admissions is a hospital outreach program, also implemented in Australia. In the program, the patient record is flagged for areas of concern such as general health, medication, and wellness. Red flags are specific to disease or symptoms that have the potential for hospitalization. Trained telehealth guides reach out on a frequent basis (greater than weekly), while patients and caregivers can call in to the program at any time. Analysis of the flags being triggered through these phone calls may alert personnel to a deterioration in patient health, concerns about medications or a lack of support, and allow for outpatient care to be provided in a timely manner to avoid a hospitalization.

A study within the United States compared deep learning against a logistical regression model to identify prediction models for preventable hospitalizations, emergency department visits, and costs in heart failure patients. The study found that deep learning approaches identified these preventable areas more accurately than the traditional methods, indicating that outcomes are contributed to by clinical, demographic, and socioeconomic factors. The study found the main predictors for preventable hospitalizations in heart failure patients were diuretic usage, orthopedic surgery, and age (see Figure 1).

Figure 1.

Research suggests that although hospitals can work to identify who is at risk for a preventable hospitalization or preventable emergency department visit, a more preferable method of reducing these is improving not only quality of care but also access to care within the primary sector of the community. By reducing barriers to healthcare and improving local community services, population health outcomes can potentially be enhanced which, in turn, may lead to a reduction in potentially preventable hospitalizations.

The Michigan Value Collaborative is interested in hearing how your facility is working towards identifying potentially preventable hospitalizations and ED utilization. Please contact us at michiganvaluecollaboarative@gmail.com.

27 May 2021
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Introducing Jana Stewart, MPH, MS Communication Specialist for MVC

Introducing Jana Stewart, MPH, MS Communication Specialist for MVC

May 27, 2021 | 0 Comments

I am excited to join the Michigan Value Collaborative (MVC) as Communications Specialist. This new position will help highlight MVC’s success stories, support MVC member events and engagement activities, and promote MVC services throughout the state of Michigan. I look forward to getting to know MVC members and hearing their feedback in the coming months.

I have worked in communications in various capacities over the past 10 years, and as a result my writing has been published in academic journals, newspapers, magazines, and K-12 curricula. I started out in journalism as a sports writer, copy editor, and then managing editor of a regional newspaper, during which I earned writing awards from the Michigan Press Association and the Society of Professional Journalists. My time as a journalist allowed me to write about a wide range of topics, from city government and local business to high school sports and crime.

When I left journalism for a position at the University of Michigan, I continued to provide broad communications support to administrative offices and research labs. Through this work I developed a strong interest in programs that sought to improve the long-term health of people and places. As a result, I also enrolled as a dual-degree master’s student in public health and environmental science. I have three degrees from the University of Michigan in total, including a Bachelor of Arts in Kinesiology, a Master of Science in Environmental Psychology, and a Master of Public Health (MPH).

Following the completion of my MPH program, I spent several years in the field working for primary prevention programs. I worked for a hospital-based farm in the St. Joseph Mercy/Trinity Health network, and then with Michigan Medicine’s Project Healthy Schools program. Implementing interventions in the field helped me to see first-hand the impact that such programs can have on a population or institution. Now I am truly excited to support the mission and vision of the MVC as I return to communications full-time. I know there are tremendous untold stories about the impact of MVC’s efforts on Michigan hospitals and patients. If you have a story to tell or a question to ask, please reach out to me at janaemil@med.umich.edu. I would love to hear from you!

21 May 2021
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Supporting the Mental Health of Healthcare Workers During COVID-19

May 21, 2021 | 0 Comments

Over the last year, the way in which care is delivered has changed and in turn, healthcare workers are faced with potentially high levels of anxiety and depression. These front-line workers, already at risk for high-levels of stress and burnout, are now experiencing even higher levels of stress. Mental Health America recently shared  an article  that discussed a survey distributed to healthcare workers from June-September of 2020. This survey was designed to gain an understanding of the experiences of healthcare workers working during the COVID-19 pandemic and to create better resources moving forward.

Around 93% of the 1,119 healthcare workers surveyed reported feeling stress, with approximately 86% of respondents noting experience of anxiety. The majority of respondents (76%) were worried about exposing loved ones such as children, spouses or even an older family member.  Additionally, emotional and physical exhaustion were common changes reported over the previous three months, with healthcare workers often faced with a lack of emotional support. Despite these results, over half of survey respondents felt they were receiving emotional support from their family and over a third felt supported by their work colleagues.

While emotional and physical exhaustion is taking its toll, anxiety and depression in healthcare workers has also been caused by the uncertainty of how the pandemic will play out. There is a lot of unpredictability regarding the virus as new strains occur, surges continue, and people hesitate or decline vaccination. To help support healthcare workers, the National Academies of Sciences, Engineering and Medicine are responding by putting together a coronavirus resources section that has resources to support healthcare workers. These resources include information and webinars geared towards clinician well-being such as “Supporting Clinician Well-being During COVID-19” and “Taking Action Against Clinician Burnout”.

The Michigan Value Collaborative is committed to supporting collaborative members during the COVID-19 pandemic, and we know hospitals and physician organizations are working diligently to help support their individual staff during this time. To share the ways you are supporting your healthcare workers at your organization, please email us at michiganvaluecollaborative@gmail.com.

13 May 2021
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MVC Semi-Annual Meeting May 2021 – Virtual Meeting Recap

MVC Semi-Annual Meeting May 2021 – Virtual Meeting Recap

May 13, 2021 | 0 Comments | , , , , ,

The Michigan Value Collaborative (MVC) held its first virtual semi-annual meeting of 2021 on Friday, May 7th. A total of 221 leaders from a variety of healthcare disciplines attended Friday’s virtual meeting, representing 74 different hospitals and 30 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 BCBSM P4P Program for Program Years (PY) 2022/23 and to discuss variations in transitions of care and ED utilization practices across Michigan.

MVC’s Director, Dr. Hari Nathan, started Friday’s meeting with an update from the MVC Coordinating Center, welcoming the eleven new hospital members who have joined the collaborative since the turn of the year and highlighting recent improvements to MVC data sources and push reporting. This included the “soft launch” of Medicaid data. MVC has now added Medicaid data to our data portfolio, meaning that MVC data sources now comprise over 80% of Michigan’s insured population. The Coordinating Center is in the final stages of validation and will have this new data source live for use by members in the coming months.

Dr. Mike Thompson, MVC’s Co-Director, then shared information on the MVC Component of the BCBSM P4P Program with attendees. An overview of PY20 was first provided, showing that participants earned an average of six points during this program year, an increase of around one point from the 2019 program year average. In an effort to continually improve the MVC Component, the Coordinating Center has introduced two methodological changes for the next two-year cycle (PY22 & PY23). Dr. Thompson walked through each of these changes, which include placing “Improvement” and “Achievement” on the same scoring scale, and introducing a new qualitative questionnaire for earning bonus points. The MVC Coordinating Center will be sharing further information on these changes and disseminating service line selection reports for the next program cycle with members in early June. Two dedicated P4P webinars will also be held around this time to assist members with selection.

Attention was then turned to looking at transition variations in Michigan hospitals, highlighting payment and ED utilization differences across MVC members, as well as the top reasons for readmission within the collaborative. To expand on this further, we were joined by guest speakers from the hospital, physician organization, and CQI setting to share their insights and learning. Dr. Robert Nolan and Michael Getty from Spectrum Health Lakeland were the first guest speakers of the day, discussing their organization’s efforts to reduce the cost of ED utilization and readmission rates. This highlighted the importance of real time data visuals, integrating documentation tools with best practices, and ensuring an effective longitudinal plan of care that is blended into natural work flows to enable physician buy-in. Dr. Nolan and Mike Getty were also able to spotlight the use of MVC data in these efforts, a custom option available to all MVC members.

Representing Professional Medical Corporation (PMC) and the Consortium of Independent Physician Associations (CIPA), Dr. Kyle Enger then shared how both entities have worked to promote appropriate emergency care in recent years. Again, this emphasized the importance of monthly data report cards to provide physicians with actionable data to guide activity, as well as the need to continue promoting urgent care as a viable alternative in certain situations. Our last guest speaker of the day was Dr. Keith Kocher, Director of the Michigan Emergency Department Improvement Collaborative (MEDIC). As well as providing a brief overview of the purpose of MEDIC and sharing some vital statistics relating to ED utilization across the US, Dr. Kocher discussed how best to approach the “ED readmission problem” and how local solutions can be used to minimize its impact.

To conclude Friday’s meeting, MVC’s Site Engagement Coordinator, Jeff Jameel, 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 can also be viewed here. If you have any questions on anything that was discussed at Friday’s semi-annual or are interested in finding out more about MVC’s offering, 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.

06 May 2021
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Monitoring Chronic Disease Utilizing Social Media and Sensors

May 6, 2021 | 0 Comments | , , ,

According to the Centers for Disease Control and Prevention, “treating individuals with chronic diseases accounts for 86% of health care costs.” While the number of those living with chronic conditions and the associated costs may be increasing, the Michigan Value Collaborative (MVC) is committed to providing you with current data around providing the right care, at the right time, at the right cost. Technological advances in healthcare are changing how and where chronic disease care is being delivered, how these patients interact with providers, and how organizations exchange information.

Both diabetes and abnormal blood pressure (BP) are extremely common in chronic disease patients and cause various complications, including an increased risk of cardiovascular events. When thinking about the way in which these chronic diseases should be managed moving forward after the COVID-19 pandemic, technological advances offer promising solutions.  Most devices in the healthcare industry have been digitalized. This advancement allows for routine monitoring using various devices that some patients may already own, such as a smart phone or a smart watch. These devices contain sensors that can be used to obtain information that can then be transmitted straight into the electronic health record (EHR). Other devices that can be used to collect patient information include a glucometer sensor, pulse oximeters, temperature sensors, scales, and many more. However, this method is not without its limitations.

The amount of data that is generated from these devices is vast and not all systems are capable of storing and processing it efficiently for precise and real time monitoring. In order to negate this issue, a framework was recently published that can be seen in Figure 1 below. This framework utilizes the cloud environment along with a large analytics engine layer to help store and process the data. The recently published study identifies the importance of utilizing wearable sensors and social networking platforms in collecting patient data, but identifies the challenges that come with this such as issues with data storage and running correct analyses.

Figure 1. Layers in the proposed healthcare monitoring framework

Chronic disease management patients may use social media platforms in order to seek support or learn new ways in which they may be able to reverse certain symptoms. Other ways in which monitoring is done through social networks include patient and provider conversations through application programming interfaces (APIs). Through these APIs, providers can pick up on tone or social connection status. Through this proposed framework of social media and sensor monitoring, providers can closely monitor chronic disease management patients.

MVC hosts chronic disease management workgroups where collaborative members discuss their current initiatives and connect on ways in which they can work together to better the health of Michigan. If you have any questions about upcoming chronic disease management workgroups, please feel free to contact the coordinating center at michiganvaluecollaborative@gmail.com

29 Apr 2021
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MVC Launches New Physician Organization Reports

April 29, 2021 | 0 Comments | , , ,

The goal of the Michigan Value Collaborative (MVC) is to improve the health of Michigan through sustainable high-value healthcare. The primary focus at inception in 2013 was the development of hospital based metrics to improve patient outcomes, reduce healthcare costs, and encourage hospitals to collaborate in best practice sharing. With the knowledge that hospitals are not the healthcare entity capable of such changes, MVC invited Physician Organizations (POs) to join the collaborative towards the end of 2018.

To date, PO members have been able to see hospital level data for their attributed facilities. This has proved helpful for our PO members but we have heard consistent feedback that being able to view metrics that display a PO’s specific attributed patient population would be welcome. This value added request was appreciated by MVC, and so the Coordinating Center began a collaboration with representatives from the Blue Cross Blue Shield of Michigan (BCBSM) Physician Group Incentive Program (PGIP) to develop new PO patient specific metrics. MVC has also engaged other parties in the development of these new metrics, including the Michigan Data Collaborative (MDC) and hearing directly from our PO members.

As a result of this collaboration, the first MVC PO population level report, containing data for both BCBSM PPO Commercial (Comm) and BCBSM Medicare Advantage (MA) between 1/1/19 and 12/31/19, was sent out to all 40 MVC PO members on Tuesday, April 20, 2021. The report contains data on health care utilization and allows POs to benchmark themselves against all MVC participating physician organizations for the metrics listed in Table 1.

Table 1. Initial PO Reporting Metrics

Each metric was stratified by payer to account for differences in patient populations, as well as to serve as a proxy for age stratification (Figure 1).

Figure 1. Sample PO Metric: Percent of Attributed Members with at Least One Inpatient Stay

As engagement with our PO members builds, and further feedback and requests are processed, MVC plans to continue to build on the metrics highlighted in this report. As the most recent reports are at a population level, the Coordinating Center intends to delve further into the metrics for more granular level detail.

If you are interested in sharing feedback about the PO reports, have any specific analytic requests, and/or would like more information about the Michigan Value Collaborative,  please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.