I am delighted and grateful to have the opportunity to return to the Michigan Value Collaborative (MVC) as a Program Assistant.  Through my experiences, I have become passionate about the intersection of clinical care and quality improvement, and I am excited to be part of a team innovating in this space.

I am a recent graduate of the University of Michigan with a Bachelor of Science in biology, health, and society as well as gender and health. As such, I have just begun to venture into the multifaceted healthcare industry. With two years of experience as a DONA-trained birth doula, I have a particular interest in advocating for patient-centered care within the space of women’s reproductive health. In my free time, I volunteer as an on-call birth doula at the University of Michigan’s Von Voightlander Women’s Hospital, providing support to those in need during labor and delivery.

This past summer, I had the opportunity to work with MVC in the role of Marketing and Health Communications Intern. Working alongside the rest of the MVC team, I explored a new side of healthcare, learned about the impactful work of Michigan CQIs, and developed my communication and brand-building skills.

As Program Assistant, I look forward to continuing to collaborate with this wonderful team to improve the quality and value of healthcare in Michigan. If you have any questions or would like to connect, please reach out to shannobe@med.umich.edu.

I am a primary care physician, health economist and health policy researcher, and Assistant Professor of General Medicine at the University of Michigan. I’m excited to join the MVC team as a faculty advisor.

My research uses large administrative and financial databases to examine the bidirectional relationship between health and financial outcomes for patients. I obtained my Ph.D. from the Wharton School of Business at the University of Pennsylvania in 2015, and my M.D. from the University of Pennsylvania School of Medicine in 2017. My doctoral dissertation demonstrated that the Affordable Care Act’s mandate for insurance coverage of prescription contraceptives had a dramatic impact on out-of-pocket spending and utilization of birth control among commercially insured women, increasing their use of highly effective methods of contraception like intrauterine devices (IUDs). After completing my M.D./Ph.D. degrees, I went on to complete my clinical training in Internal Medicine/Primary Care at Brigham and Women’s Hospital in Boston.

Since beginning my faculty position at U-M in 2020, I have expanded my research agenda by studying the impact of the COVID-19 pandemic on the utilization of health services and out-of-pocket spending among vulnerable populations, and examining the impact of health shocks and policy changes on patient financial outcomes using consumer credit report data. These novel data overcome a measurement barrier—the lack of detailed health and financial data for large patient populations—that has limited prior work in this area. My ultimate goal is to produce research that will inform the development of health and social policies that improve patient health outcomes and protect them from the financial consequences of illness.

I’m thrilled to join the MVC team as a faculty advisor because I believe strongly that the impacts of research should not stop when the work is published, but need to be translated and communicated to policymakers, providers, and health insurers so that patients can reap the benefits of what we learn from our work. MVC uses large administrative datasets and advanced analytics to help providers improve the quality of care delivered to patients in Michigan; this is exactly the type of research translation to which I’m excited to contribute. I’m particularly excited to help MVC expand their work in the areas of health equity, new data sources, and new patient populations.

On behalf of the MVC Coordinating Center, I’d like to start by wishing you all a very happy and healthy new year! MVC had an outstanding 2023, which included celebrating our 10th anniversary and continued support of our hospital and physician organization members along with CQI partners.

Throughout 2023, MVC welcomed three new hospital members to the collaborative, distributed 17 push reports, grew its analytic offerings by adding ED-based episodes of care, delivered 24 custom analytic requests, hosted 24 virtual workgroups across six focus areas, advanced both of its value coalition campaigns, completed 37 member meet and greets, and hosted two collaborative-wide meetings. Additionally, several exciting improvements were made to the MVC registry, including new reports for payment and value metrics for Program Year (PY) 2024-2025 of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program along with new measures and filters for long term acute care hospital utilization.

As MVC begins its 11^th year, the Coordinating Center is excited to continue to advance the vision of more sustainable, high-value healthcare in Michigan. As highlighted in a recent blog outlining MVC’s refreshed strategy, there are a number of developments planned to advance our work in the areas of population health management, sites of care across the continuum, patient-centeredness, and equity. In addition to these strategic pillars, MVC has several operational plans for the coming year that I am excited to share with you.

New Engagement Point Menu for PY 2024

For hospital members participating in the MVC Component of the BCBSM P4P program, PY 2024 kicks off the new engagement point component of the program cycle’s scoring structure, which was developed as a mechanism for increasing and enhancing collaborative learning across the MVC network. Using MVC’s engagement point menu, participating members can choose the MVC engagement offerings that best meet the needs of their site to earn up to two points toward their PY 2024 score. Please visit MVC’s PY 2024 Engagement Point Menu for a complete list of offerings. For additional information on MVC’s PY 2024 engagement point component, you may access the MVC PY 2024 Engagement Point Webinar.

Actionable Data through MVC Push Reports

In 2024, MVC will continue to provide members with site-specific push reports to support quality improvement. Several new reports will be added to MVC’s suite of reporting in 2024, focusing on topics such as statewide health equity, pharmacy utilization, and alternative sites of care. The Coordinating Center will work closely with members, the broader CQI community, and other stakeholders to ensure the continued distribution of novel and valuable reporting.

Collaborative-Wide Meetings and Virtual Workgroups

The MVC Coordinating Center will host two collaborative-wide meetings in 2024. MVC’s spring 2024 meeting will take place on Friday, May 10 at the H Hotel in Midland, and the fall 2024 meeting will be held on Friday, October 25 at the VistaTech Center in Livonia. We are in the process of planning engaging agendas and are excited to see you in person at these events. Keep an eye on MVC’s blog as additional details are announced throughout the year.

Additionally, the Coordinating Center’s suite of peer-to-peer virtual workgroups will continue to provide a highly accessible online platform for hospital and PO members to come together, collaborate, and share practices. The 2024 workgroups will include series focused on MVC’s PY 2024-2025 P4P value metrics – cardiac rehabilitation, post-discharge follow-up, preoperative testing, and sepsis – along with a health in action series and a newly launched rural health series. To review the complete list and register for specific workgroup dates, please visit MVC’s 2024 Events Calendar.

Assessing Value and Site-Specific Opportunities

The MVC Coordinating Center continued its efforts in 2023 to help partners measure the impact of their initiatives from an investment and value perspective. MVC’s expertise in this area and its strong relationships throughout the CQI portfolio led to the commission and completion of three value assessment exercises last year with additional value assessments underway for 2024. Similarly, MVC continues to offer its members the ability to request custom analyses to better understand site-specific areas of interest and opportunity. If you are interested in a custom report, please submit a Custom Analytics Request and a member of the MVC team will follow up.

As we kick off 2024, I’d like to thank our hospital members, PO members, and CQI partners for their continued collaboration and support. We look forward to working with you throughout the coming year!

You may have noticed MVC celebrating something special this year. If you haven’t guessed from our celebratory blogs, collaborative-wide meeting spotlights, and rather subtle email signatures, MVC is now 10 years old. It’s something as a Coordinating Center that we are incredibly proud of, and we thank each of you for your partnership in helping to grow the collaborative over the years.

MVC’s evolution as a collaborative has been informed by continued member insights and driven by dedicated strategic planning and considered implementation. As we look ahead to the next 10 years of operation and ensure MVC’s support offering continues to align with the future of value-driven healthcare, this practice of leveraging member feedback to shape development will continue to take center stage.

Over the last six months, we engaged with our members and other stakeholders to gather input on what is working well and needs to be protected, as well as taking time to identify where there are opportunities to introduce new service offerings. If we haven’t engaged with you directly and you have ideas, we’d love to hear them. The insights we received to date helped inform our collective vision as to what value-driven healthcare truly looks like and ultimately where MVC fits into this puzzle. I’m excited to share some of this thinking and highlight a number of new related developments we will tackle in the coming years.

As we see it, the pursuit of value in healthcare requires recognizing and embracing three key imperatives. First, although fee-for-service reimbursement will persist for the foreseeable future, population health management will continue to be the chief lever used by policymakers, payers, and providers to manage risk and cost. As payment arrangements further embrace two-sided risk, healthcare providers will need to refine internal processes to strengthen their understanding of their patient population, appreciate its heterogeneity, and respond nimbly to anticipate and optimize resource utilization. Understanding the entirety of the patient’s care pathway across providers and facilities is critical to identifying opportunities to optimize health, coordinate care, and mitigate utilization for acute illness, especially for patients with chronic conditions.

Inpatient care will continue to be a major driver of expenditures, and benchmarking of hospital-based services will continue to be a valuable tool to improve quality and control costs. However, there is an opportunity to conceptualize care delivery more broadly. Developing a more holistic approach to understanding utilization will not only allow for a more complete assessment of where expenditures occur but will also help better identify opportunities for savings. Sites of care exist along a continuum that includes large referral hospitals on one end but stretches as far as the patient’s home on the other. There are multiple options on this continuum—including community hospitals, physician offices, community health centers, ambulatory surgery centers (ASCs), hospital outpatient departments (HOPDs), pharmacies, skilled nursing facilities (SNFs), hospital-at-home, telehealth, and even wearable technology. All must be considered as options to rationalize sites and providers of care and right-size resources to the needs of the patient.

Finally, morbidity and mortality will continue to be important quality metrics, but our definition of quality needs to expand to include patient-centeredness and equity. We need to avoid adverse outcomes and promote positive behaviors, attitudes, and interactions with the healthcare system. Inadequate attention to the social and physical context in which patients live and work will diminish the effectiveness of health interventions and lead to waste. More importantly, understanding and accounting for social influencers of health is a critical element in the shift from treating illness to promoting health.

These three elements will be used to help shape our activity moving forward, both in terms of strengthening existing analytic and engagement platforms and delivering new innovative offerings to help drive member quality improvement efforts. Here’s a sneak peek of some of MVC’s future development areas:

Incorporating Pharmacy Claims

To better understand utilization, pinpoint where expenditures occur, and identify where savings can be made, we will look to consider all sites and providers of care that exist along the continuum. This includes pharmacies and related prescription drug spending. MVC now possesses pharmacy-level data for all sources, and efforts will be directed toward successfully integrating these claims across our existing infrastructure and future planned activity.

Integrating Michigan Medicaid and ED Episode Data

To help strengthen member understanding of their respective patient populations, MVC will leverage the recent receipt of Medicaid data to develop new value-add data offerings in the areas of health equity, women’s health, and pediatric care. Similarly, the creation of new episodes initiated by emergency department (ED) visits will be built upon to provide actionable information on care transitions and the trajectory of care for patients visiting the ED.

Broadening Beyond Inpatient Episodes

The various avenues a patient may take as part of their care pathway highlight the challenges of delivering and understanding coordinated care delivery. An episode-based approach helps to navigate these problems but only takes us so far, with some patients (e.g., those with ambulatory care-based events) still being overlooked. To reflect the importance of population health management, sites and providers of care, patient-centeredness, and equity in all MVC work, efforts will be directed to creatively broaden our data offering beyond inpatient episodes.

Incorporating Ambulatory Surgical Centers

To achieve our aim of considering all sites that exist along the care pathway, our efforts will first be directed towards incorporating ASCs into the collaborative. Many questions regarding the cost and quality of care provided at ASCs remain unanswered. This effort will aim to leverage MVC’s existing infrastructure and explore the introduction of innovative activities to answer such questions and encourage ASC participation.

Reflecting System Level Activity

In recent years, there has been a notable rise in hospital consolidation across Michigan. These developments have placed increased emphasis on the need for MVC to explore, develop, and implement new approaches aimed at supporting quality improvement efforts at the system level. This will look to build on our existing system reporting and engagement activity to better understand how these entities approach care delivery, what the related patient pathway looks like, and how this impacts other pieces of operation, including related incentive programs.

Emphasizing Equity in Healthcare

MVC has successfully integrated health equity and social risk measures into its existing reporting infrastructure. Moving forward, the Coordinating Center will look to discuss these different offerings and their perceived value with members to better understand their priorities and gaps in knowledge. From our discussions with members to date, it has been evident that many are still in an information-gathering phase and desire consensus around best practices. MVC will seek to identify differing approaches to health equity across the collaborative. Through enriching its understanding of member initiatives in the health equity space, MVC can identify common ground and communicate those findings through existing engagement platforms.

As always, we want each of these new developments to be reflective of member needs and feedback. If you have a particular interest in any of these areas or have ideas on what would be most helpful to your daily activities, please get in touch (Michigan-Value-Collaborative@med.umich.edu). We look forward to hearing from you and continuing to work together to improve the health of Michigan through sustainable, high-value healthcare.