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.

 

22 Apr 2021
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Long COVID-19, Just One Aftereffect of COVID-19

April 22, 2021 | 0 Comments | , , ,

With continued COVID-19 surges occurring worldwide despite the availability of a number of variations of vaccines, some patients continue to experience what is now being dubbed as “Long COVID-19” or “Post COVID-19 Syndrome”. Symptoms that are commonly experienced include a persistent cough, dyspnea, chest and/or joint pain, neuralgia, and headaches. These symptoms can last up to 12 weeks and in some cases, even longer. The more people that develop long COVID-19, the greater the strain on the healthcare system and need for appropriate diagnosis and treatment options.

A recent paper by A.V. Raveendran from January 2021 proposed diagnostic criteria to help confirm a diagnosis of long COVID-19. Depending on clinical symptomology, duration criteria and the presence or absence of a positive swab or antibodies, a long COVID-19 diagnosis can be categorized as confirmed, probable, possible or doubtful. Having an appropriate diagnosis will allow the practitioner to prescribe the relevant treatment plan.

In the United Kingdom, where the number of people exhibiting long COVID-19 continues to increase, a guideline has been developed by the National Institute for Health and Care Excellence to provide recommendations to help identify, assess, and manage the effects. As more evidence is collected, the plan is to update the document on a continuous basis to maintain its validity. The guideline takes into consideration clinical symptomology, duration criteria, and the presence or absence of a positive SARS-Cov-2 test. It also provides guidelines for suggested referrals, and a plan of care with follow-up and monitoring.

While the guideline manual has many useful suggestions, there are a number of gaps where further detailed information will be needed.  As new information is discovered, the goal is to include comprehensive reviews of symptomology, and pathology of the disease process and a better understanding of the variation in impact. Simultaneously, there needs to be an increase in rehabilitation and community resources to allow for individualized evidenced based care for those suffering from the debilitating effects of long COVID-19.

The Michigan Value Collaborative continues to assess data related to COVID-19 and will be sharing a dedicated COVID-19 push report with members in the coming months. If you would like access to the MVC registry, please request it here or via email michiganvaluecollaborative@gmail.com

15 Apr 2021
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Cardiac Rehab Stakeholder Meeting Motivates Improvements in Care

April 15, 2021 | 0 Comments | , , ,

On Monday, March 22, 2021, a “stakeholder meeting” was hosted by the Michigan Value Collaborative (MVC) Coordinating Center with multiple key players in cardiac rehabilitation (CR) from around Michigan. As MVC has written about before, cardiac rehabilitation is a highly valuable but underutilized service and is the focus of one of MVC’s ongoing value coalition campaigns. The goal of the stakeholder meetings is to bring together key constituents to work towards solving the problem of underutilization. Attendees included managers of cardiac and pulmonary rehab facilities, quality improvement leaders and executives from  several MVC members, our payer partners from Blue Cross Blue Shield of Michigan, and representatives from the Michigan Society for Thoracic and Cardiovascular Surgeons (MSTCVS), the Michigan Society for Cardiovascular and Pulmonary Rehab (MSCVPR), and the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2).

The stakeholder meeting occurred the week after MVC distributed new Master Cardiac Rehab reports, which detail several metrics on cardiac rehabilitation after percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), transcatheter aortic valve replacement (TAVR), and surgical aortic valve replacement (SAVR) procedures. The collaborative-wide average cardiac rehab utilization varied by procedure: 52.6% for SAVR, 30.1% for TAVR, 56.3% for CABG, and 32.3% for PCI (see Figure 1). The mean days to first cardiac rehab visit also varied by procedure: 46 days for SAVR patients, 43 days for TAVR patients, 45 days for CABG patients, and 34 days for PCI patients (see Figure 2).

Figure 1

Figure 2

The Master Cardiac Rehab reports were also distributed by our partners at MSTCVS and BMC2. The aim is to increase awareness of hospital-level CR utilization and encourage as many players as possible (cardiologists, cardiac surgeons, cardiac rehab staff, quality improvement staff, and executive leadership) to work together to increase CR utilization at every hospital. These reports were well-received at the March 22nd stakeholder meeting, with one attendee emphasizing that the information contained in the reports was “the envy of other states,” speaking to the utility of MVC data and the success of BCBSM Value Partnerships. Attendees also provided excellent suggestions for improvement which will be taken into account during the next report refresh later this year.

The data is distributed, and the stakeholder meeting is over, but the value coalition campaign is just getting started.  There’s still a lot of work to do in order to equitably increase cardiac rehabilitation use in our state, including studying barriers to entry, exploring the intricacies of benefit design, and making various operational changes hospital by hospital, health system by health system. Nevertheless, that Monday afternoon showed that sometimes, when you have the right people around the same (virtual) table, everyone can walk away connected, motivated, and ready to carry out their respective roles to improve health care.

The next cardiac rehab stakeholder meeting is scheduled for Monday, June 28, 2021 from 4:00-5:00pm. If you have an interest in joining this group, or if you have not received your Master Cardiac Rehab report, please email michiganvaluecollaborative@gmail.com.

08 Apr 2021
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Telehealth Use: Maintaining Access to Surgical Care During the COVID-19 Pandemic.

April 8, 2021 | 0 Comments |

The COVID-19 pandemic created a unique situation which led to the high use of telehealth in caring for the medical patient population. However, it was unknown whether these same patterns would transfer to surgical care. The Michigan Value Collaborative (MVC) registry allows health systems to leverage administrative claims data from a variety of sources and better understand trends in telehealth use. Using MVC BCBSM data, the Telehealth Research Incubator at Michigan Medicine found in their study that telehealth was a viable way for patients to access surgical care.

Historically, surgery is the medical field least likely to use telehealth. However, with in-person care constraints resulting from the pandemic and updated policies making it feasible for telehealth visits to be eligible for reimbursement, a large uptake in telehealth among surgeons was witnessed.

Approximately 60% of active surgeons used telehealth in some capacity during the pandemic. Specifically, our study examined telehealth use for new patient visits. We were curious if surgeons were able to use telehealth to evaluate new patients, and the results proved that this was a viable and beneficial option to provide care. Significantly,  27% of all active surgeons used telehealth for new patient visits.

As shown in Figure 1, at peak use, we found over a third of visits for new patients were performed using telehealth. This is in contrast to the fewer than 10 telehealth new patient visits in 2019.

 

Figure 1

In addition, the study indicated that telehealth was successfully used for many surgical visits across multiple different surgical specialties, with urology and neurosurgery being the highest utilizers. This is shown in Figure 2.

Figure 2

There were two distinct periods of telehealth use: an early pandemic (fast uptake) and late pandemic period (slow decline). The slow decline that occurred during the late pandemic period indicated the reopening of clinics in June, and an increase in more in-person visits being used again. These are shown as Period 2 and Period 3 in the preceding figures.

Of note, our study looks at new patient visits because of the way that claims data is collected. Anecdotal evidence suggests that surgeons used telehealth even more for their established patients and for follow-up visits post-surgery. Although telehealth might save patients time and money in traveling to clinic, needing child care, and missing work, this type of consultation would be most appropriate for patients without post-operative complications.

It was noticed that telehealth provided access to surgical care for a significant proportion of patients during the COVID-19 pandemic. Any sustained use of telehealth will require ongoing updated policies and infrastructure to ensure patients have continued access to this option for their care.

Please reach out to the Michigan Value Collaborative at michiganvaluecollaborative@gmail.com for further information.

01 Apr 2021
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Introducing Bradley Raine, MVC Analyst

Introducing Bradley Raine, MVC Analyst

April 1, 2021 | 0 Comments | ,

I am happy to join the Michigan Value Collaborative (MVC) in the role of Analyst and am looking forward to working with the MVC team to help improve the quality and value of healthcare provided in the state of Michigan.

I graduated from the University of Michigan with my Bachelors of Science in Biology in 2015, and spent nearly three years working in the prep lab for the Michigan Clinical Research Unit (MCRU) based at the Cardiovascular Center. There I developed an interest in research methodology and wanted to learn more about how research teams use their data to publish their findings. Therefore, I decided to pursue a degree in Statistics, and graduated from Central Michigan University in August 2020 with a Master’s of Science degree.

In order to complete my graduate degree, I worked on a visualization project for COVID-19 data using Tableau. I found this product to be a great tool for creating dashboards to tell stories about data, and am hoping to take the skills learnt and implement them in a professional setting.

As an analyst for MVC, I am excited to learn how to analyze data using medical claims information to identify areas for improvement in quality of care. This has been important to me ever since having worked at MCRU and seeing how much data can do towards improving patient outcomes.  I am looking forward to taking the knowledge and experience gained at Central Michigan University and using it for this purpose. If you have any questions or wish to get in touch, please feel free to email me at bjraine@med.umich.edu.

25 Mar 2021
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Reducing Admissions and Readmissions in the COPD Patient Population

March 25, 2021 | 0 Comments | , , , ,

At a recent MVC chronic obstructive pulmonary disease (COPD) workgroup, representatives from McLaren Physician Partners presented on their recent quality improvement initiative involving their COPD patient population. McLaren Physician Partners worked to identify areas for improvement within this specific patient population and found some common patient struggles consisted of higher utilization of the emergency department and in-patient settings, as well as higher readmission rates, specifically among their Medicare patients (38%). Five nurse managers were tasked with doing case reviews in order to identify possible areas for improvement. Five to ten patients that had three or more encounters in the last six months were taken from each nurse managers case load. Around 83% of those patients had other significant comorbidities (e.g. Diabetes Mellitus, Congestive Heart Failure, Hypertension.) Additionally, the reason for readmission was most often related to either respiratory insufficiency or a cancer treatment side effect.

Care managers then engaged the patients and went over a questionnaire with them. Approximately 68% of these patients had a misunderstanding of their medication, 26% had environmental barriers, 14% were not compliant with medication, and less than 15% reported an inability to afford medication/devices. Readmissions related to disease progression and inappropriate medication use were the major contributing factor to higher utilization of the in-patient setting and emergency department. Additionally, all admissions and readmissions were related to some form of respiratory insufficiency or a cancer treatment side effect.

Due to the time of implementation, COVID-19 impacted the type of intervention that could be put into place. McLaren Physician Partners opted to adopt a telephonic intervention in order to address education needs and remove barriers. Specific needs related to managing medications and compliance, triggers that led to an exacerbation, and developing a plan of action at the onset of first symptom were addressed. Additionally, the intervention sought to minimize and remove barriers where possible (e.g. cost of medications, transportation issues for visits). Lastly, a consideration was made if a patient was a candidate for palliative care.

Nurse navigators looked into possible ways to engage patients differently in order to hopefully prevent an exacerbation that caused an admission or a readmission. They were aware that what they were doing wasn't working, and needed some sort of upgrade. A toolkit was developed that was sent to the patient prior to a one to two-hour phone call scheduled in order to  help the patient understand this toolkit. The kit requires active participation and helps the patient develop specific goals and actions to take when they see signs of a potential exacerbation.

After implementation of this pilot program, all navigators came together to discuss their findings. Many things were noted, including the fact that patients did not know the difference between their inhalers (long-acting vs. rescue). Additionally, patients often didn't know that by identifying certain triggers, some symptoms may have been preventable. Of the patients who received and engaged in this telephonic intervention, the readmission rate for those who had been recently discharged decreased by more than 20%. Overall, McLaren Physician Partners saw a decrease in their hospitalizations due to the implementation of this program.