19 Oct 2023
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MVC Refreshes Sepsis Push Reports for Hospital Members

MVC Refreshes Sepsis Push Reports for Hospital Members

October 19, 2023 | 0 Comments | ,

The Michigan Value Collaborative distributed refreshed sepsis push reports this week, providing its hospital members with updated figures and measures using the latest MVC episode data. In addition, the latest reports were also distributed to members of the Michigan Hospital Medicine Safety Consortium (HMS), a valued partner in the initial development of this service line within MVC's registry.

This week’s reports included MVC’s updated race and ethnicity categories, which were modified and expanded to ensure greater inclusivity and accuracy. MVC also recently adopted a methodological change to its identification of patients admitted with COVID-19 that impacted the episode data used in this analysis. MVC episodes were flagged as containing significant COVID-19 care if a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim during the 90-day episode. Previously, MVC looked for COVID-19 diagnosis in the first three diagnosis code positions. These episodes are often excluded from MVC’s push reports but have historically been included in sepsis reporting to help hospitals gauge the impact of COVID-19 diagnosis on their sepsis metrics. Combined with the natural decline in disease prevalence, there was a significant reduction in the percentage of patients with a COVID-19 diagnosis who were treated for sepsis, compared to the previous reporting period.

The version shared with MVC members this week continued to provide price-standardized, risk-adjusted benchmarking for total episode payments, as well as length of inpatient stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality or discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. MVC’s general acute care hospital (GACH) and Critical Access Hospital (CAH) members were provided with tailored versions using comparison groups most suitable to their hospital category.

Sepsis is currently the third leading cause of death in U.S. hospitals, so inpatient mortality and discharge or hospice were included in MVC’s sepsis reports as important quality checks. The average inpatient mortality rate among patients hospitalized for sepsis was 13.3% across member GACHs (Figure 1) and 6.5% for CAHs (Figure 2). Rates for discharge to hospice at home or a medical facility were lower.

Figure 1.

Figure 2.

The latest report also investigated differences in 90-day readmission rates for patients hospitalized for sepsis. Within GACH, patients with Medicare FFS coverage exhibited the highest average readmission rate (30.4%), followed by patients insured by BCBSM/BCN MA plans (25.6%) and BCBSM/BCN Commercial plans (16.4%), respectively (Figure 3). BCBSM/BCN Commercial patients had a younger average age and lower average comorbidity count than patients with Medicare or MA plans. Within CAHs, the average 90-day readmission rate was 22.4%.

Figure 3.

The report also included benchmarking for average index length of stay by specific payer groups as well as for all payers combined. The average index length of stay across all payers was 8.7 among GACH patients and 5.5 among CAH patients.

Another significant finding was the difference in post-acute care utilization by service type among patients hospitalized for sepsis (Figure 4). On average across GACHs in the collaborative, outpatient services had a noticeably higher utilization rate (59.3%) compared to home health (29.4%) or skilled nursing facility (21.9%). The same was true for CAHs (Figure 5), with a much higher average utilization rate for outpatient services (75.2%) compared to home health (29.5%) or skilled nursing facilities (18.6%).

Figure 4.

Figure 5.

These reports were prepared using 90-day MVC episode data with index admissions from 7/1/19 – 6/30/22 for the following insurance plans: Medicare Fee-For-Service (FFS), Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage (MA), and BCN MA.

MVC welcomes your recommendations for enhancing these reports and welcomes your feedback on how collaborative members are using these data to support their quality improvement efforts. Please don't hesitate to contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.

12 Oct 2023
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MVC’s Refreshed Common Conditions Report Coming to Hospital Members Soon

MVC’s Refreshed Common Conditions Report Coming to Hospital Members Soon

October 12, 2023 | 0 Comments |

MVC members will receive their next batch of updated push reports in the coming days with a refreshed version of MVC’s common conditions report. These reports provide insight into episodes of care for eight medical and surgical conditions that are commonly a focus for quality improvement efforts at MVC hospitals: acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), total knee and hip (joint) replacement, pneumonia, and spine surgery. MVC’s general acute care hospital and Critical Access Hospital (CAH) members will receive tailored versions of the report, with each group receiving benchmark data specific to their own category of hospitals.

Although the metrics provided vary by condition and case count, report pages generally focus on 30-day total episode payments, readmission rates, common reasons for readmissions, and post-acute care utilization. MVC price standardizes total episode payments to Medicare FFS amounts so that comparisons can be made across hospitals and over time. Payments are risk adjusted for patient age, gender, payer, comorbidities, and high or low prior healthcare utilization/payments.

Post-acute care utilization benchmarking for each of the eight medical and surgical conditions includes graphs displaying the percentage of each hospital’s patients who used home health care, inpatient/outpatient rehab, skilled nursing facility care, outpatient services, or emergency department care in the 30 days following their index hospitalization or surgery. Across the collaborative, reports show high use of 30-day home health care and outpatient services for these common conditions. For patients initiating their episode of care at a general acute care hospital within the collaborative, the home health care utilization rate was highest following CABG (69%) and joint replacement (50%).

Patients with a CABG episode were also high utilizers of outpatient services in the 30 days post-index (Figure 1), with a 73% average utilization rate. Patients with episodes for CHF (58%) and AMI (53%) were also high utilizers of outpatient services. Across conditions, use of outpatient services in the 30 days post-index was generally higher among episodes originating at CAHs than among episodes originating at general acute care hospitals.

Figure 1.

Reports also assess the setting of care for joint replacements and spine surgeries. For total knee and hip replacements, MVC data shows that the percent of joint replacements performed in an outpatient setting at general acute care hospitals across Michigan continued to rise from January 2021 through September 2022 (Figure 2).

Figure 2.

The patient population in these reports comprises adult patients who had surgery or an inpatient hospitalization at an MVC-participating hospital between January 2021 and September 2022. Measures are based on 30-day inpatient and surgical-based episodes of care data, incorporating paid claims from Blue Cross Blue Shield of Michigan and Blue Care Network Commercial and Medicare Advantage plans as well as paid claims from Medicare Fee-for-Service. Episodes meeting any of the following criteria were excluded from calculations: patients transferred to another acute care hospital or to hospice, patients who died during their index stay, and patients with a primary diagnosis of COVID-19 received in an inpatient setting at any point during their 30-day episode.

We hope our collaborative participants find these reports valuable, and as always, we welcome MVC members to contact MVC with any questions or analytic requests.

04 Oct 2023
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MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

October 4, 2023 | 0 Comments |

I feel fortunate to have the opportunity to become a part of the impactful work that MVC began a decade ago. Joining a team that is so committed to improving healthcare quality across Michigan has renewed my passion for driving change to achieve equity in healthcare.

I began my career in healthcare as a nurse over 21 years ago. I have worked as a clinical nurse in the adult and pediatric emergency departments, labor and delivery, and ambulatory care.  In 2018, I earned my Master of Science in Nursing (MSN) from the University of Michigan before transitioning into the quality improvement realm of healthcare in 2019 as a site engagement coordinator for the Obstetrics Initiative (OBI). During my time with OBI, I supported hospital quality improvement teams by applying data analytics to support the implementation and sustainability of health equity initiatives. I believe that healthcare cannot achieve optimal quality without equity in service delivery.

In my time between OBI and MVC, I worked within the care management department at Michigan Medicine, developing workflow processes to launch the University of Michigan Physician Advisor Program, and provided strategic planning support to the nursing and medical directors.

When I am not working, I enjoy cheering on my youngest daughter’s softball team, kayaking, and traveling to new places as much as possible. Please don’t hesitate to reach out to me at jlbishop@med.umich.edu if you have any questions.

28 Sep 2023
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MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

September 28, 2023 | 0 Comments | ,

MVC will soon distribute the 2023 version of its chronic disease management follow-up reports to members. This refreshed version provides summary data on patients eligible for follow-up care after discharge from hospitalizations for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

MVC defines timely follow-up care as receipt of an in-person or remote outpatient follow-up visit within 30 days of hospital discharge to home or home health care and before any readmission, emergency department (ED) visit, or procedure. Patients admitted to a skilled nursing facility, long-term acute care hospital, or inpatient rehab within the 30-day episode were excluded. MVC’s follow-up analyses was performed using claims-based episodes of care with index hospital admissions between 7/1/2019 and 06/30/2022 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial and MA, and Medicare Fee-for-Service insurance plans. For each of the two chronic conditions included in the report, hospitals with at least 11 episodes per year for a given condition received that condition-specific data.

The report offers a comparison of demographic characteristics for CHF and COPD patients who received a follow-up visit within 30 days versus those who did not receive follow-up. Demographic characteristics tabulated for each condition include the percent of patients living in “at-risk” or “distressed” Zip codes as defined by the Economic Innovation Group’s Distressed Community Index, patients’ average number of comorbidities, the mean age of patients, and the distribution of race and ethnicity. MVC recently refined and expanded its reporting of race and ethnicity identities, and these updates were reflected in the report. Patients are grouped as Hispanic if their insurance provider categorized their combined race/ethnicity as Hispanic or their ethnicity as Hispanic. Additionally, MVC no longer combines smaller groups and discontinued its use of the terms “other” and “unknown.”

On the first page provided for each condition, hospital follow-up rates are provided for three windows of time compared to those at other MVC hospitals (Figure 1), as well as trends over time for each follow-up window (Figure 2). For CHF, follow-up rates are provided in 3-day, 7-day, and 14-day time windows. For COPD, follow-up rates are provided in 7-, 14-, and 30-day time windows.

Figure 1.

Figure 2.

The second page of condition-specific feedback includes a summary of average 30-day risk-adjusted, price-standardized total episode payments by follow-up status compared to statewide and regional averages. Among general acute care hospitals included in the analysis, the statewide total average payment for CHF episodes was $17,235 for patients who received follow-up and $20,069 for those who did not; for COPD episodes, the statewide average payments were $13,815 among those with follow-up and $16,056 among those without. In reports generated for Critical Access Hospitals (CAHs), payments were compared to averages across all MVC CAH members. Rates of 30-day follow-up were also compared by payers across the same groups.

The final figure (Figure 3) in the report for each condition is a summary of follow-up method among those who received any follow-up care. Patients who received follow-up were categorized as having received only in-person follow-up visit(s), only remote follow-up, or both in-person and remote follow-up. MVC found that more than 80% of CHF and COPD patients statewide exclusively received in-person follow-up after a hospitalization.

Figure 3.

If you have any questions or feedback about this report, please contact the MVC Coordinating Center.

21 Sep 2023
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MVC Implements a Variety of Data Updates to Episode Methodology

MVC Implements a Variety of Data Updates to Episode Methodology

September 21, 2023 | 0 Comments | , , ,

Throughout the past few months, the MVC team has made several methodological updates to its claims-based episodes of care data underlying the metrics shared via MVC’s online registry and push reports. Some of these updates were part of regular claims data maintenance, whereas others were improvements identified and implemented by the MVC team.

Long-Term Acute Care Hospital Utilization Added as Post-Acute Care Category

A new category of post-acute care utilization was generated within MVC episodes of care: long-term acute care hospital (LTACH) stays. Previously, facility claims were grouped into seven major categories: inpatient, inpatient rehab, outpatient rehab, emergency department, skilled nursing facility, home health, and outpatient/other. An area of opportunity was identified by the MVC Coordinating Center and MVC members to add LTACH to this list. Formerly in MVC data, claims for stays at LTACH facilities were grouped in with inpatient claims and thus counted towards “inpatient readmissions” in the context of an MVC episode of care. LTACH is now its own category of care within MVC episodes and is assessed separately from inpatient stays at general acute care hospitals and Critical Access Hospitals. To count towards post-index LTACH care in an MVC episode, a facility claim must contain bill type 011X and the billing facility NPI for the claim must be primarily affiliated with taxonomy code 282E00000X. LTACH claims will continue to be price standardized in the same manner as other inpatient claims.

As a result of LTACH being added as a separate category of care in MVC episodes, MVC members can now also look at their patients’ use of LTACHs on the MVC registry. By index condition, members can view their attributed episodes’ rate of post-index LTACH utilization as well as their average LTACH payment per episode within the Payment by Condition reports for all payers. To do so, users must navigate to the Payment by Condition report, scroll down to the “Payment Measure” filter on the left side of the registry, and select “LTACH ($)” or “LTACH (%)” to look at average payments or utilization rates, respectively.

Updates to Hierarchical Condition Category (HCC) Identification

Another update made to MVC data this year was the application of components from the most recent specifications around hierarchical condition categories (HCC) from the Centers for Medicare & Medicaid Services (CMS). HCCs are patient comorbidities that both CMS and MVC use as part of risk-adjustment processes. When creating episodes of care, MVC uses each patient’s claims data in the 180 days prior to a given index event to retrospectively assess the comorbidities diagnosed for that patient prior to their MVC episode of care. Formerly, diagnoses indicated as “present on admission” on a patient’s index claim were also used to ascertain a patient’s HCCs, but MVC has updated its methodology such that no diagnoses from the index claim will be used in the assessment of patient HCCs going forward. MVC continues to create 79 HCCs according to HCC V22, with new diagnosis codes added each year.

Furthermore, we note that the category hierarchies created by CMS have been applied to the HCC comorbidities that MVC assesses and displays on the registry. The “hierarchical” aspect of the condition categories is applied to groups of similar diagnoses with a goal that patient comorbidities are not over-counted. For example, a patient diagnosed with diabetes may have multiple similar diagnoses reported on claims over a six-month period, such as diabetes without complications, diabetes with chronic complications, and diabetes with acute complications. Rather than describing that patient as having all three diagnoses, a hierarchy is applied so this patient will simply be described as having the most severe of the group of diagnoses (i.e., diabetes with acute complications). To look at the prevalence of HCC comorbidities among your patient population for one of MVC’s 40+ inpatient or surgical episodes of care, members can navigate to the “Comorbidities” report on the registry.

New Medicare Severity Diagnosis-Related Group (MS-DRG) Version

As part of annual maintenance to accommodate newly introduced billing codes, MVC recently updated the version of Medicare Severity Diagnosis Related Codes (MS-DRGs) being used to re-group inpatient claims into categories of similar inpatient stays. MS-DRG v40.1 is now being used by MVC to categorize all inpatient claims containing ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes.

Inpatient Claim Outlier Length of Stay Methodology

MVC updated the method by which inpatient claims with a particularly long length of stay are identified and price standardized. MVC price standardizes each inpatient claim by adding up three components: a standard DRG-based payment, an inpatient transfer payment (if applicable), and a length of stay-based outlier payment (if applicable). An outlier payment is added to the total price-standardized payment amount for a given inpatient claim if the covered patient remained in the hospital significantly longer than an average patient with the same DRG. In the past, MVC identified these “outlier” long length of stay inpatient hospitalizations using publicly available national long length of stay thresholds for every DRG from TRICARE, the uniformed services healthcare program. MVC’s updated outlier methodology uses Medicare Fee-for-Service (FFS) claims to identify the 99th percentile in length of stay (days) among inpatient claims for each MS-DRG. The hospitalization length of stay on each inpatient claim is then compared against the newly identified 99th percentile threshold for the corresponding DRG. Claims with stays exceeding that length threshold are considered outliers. The outlier payment added to that claim’s price-standardized payment amount is then calculated with an unchanged formula as follows: Outlier Payment = (Number of Days Over DRG-Specific Length of Stay Threshold) * $2,500.

All-Cause Readmissions Assessed for All MVC Conditions

New this year, all-cause inpatient readmissions following index hospitalizations will be assessed for all MVC conditions whenever readmission metrics are shown. Specifications around the identification of readmissions will not vary by index condition.

Episodes Containing COVID-19 Care Now Identified by Primary Diagnosis Codes Only

Finally, MVC has modified the identification of episodes containing care for COVID-19. Episodes are now flagged as containing significant COVID-19 care if they meet the following criteria: at any point during the 30- or 90-day episode, a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim categorized as inpatient, inpatient rehab, skilled nursing facility, or LTACH. These episodes are often excluded from metrics displayed in MVC push reports. To exclude episodes containing COVID-19 care from metrics shown on the registry, members can use the registry filter called “COVID Cases.” Users should select “Exclude 30-Day COVID” to exclude episodes in which COVID-19 was found within the index event or 30 days post-index. Selecting “Exclude 90-Day COVID” will exclude episodes where a primary COVID-19 diagnosis was found within the index event or 90 days post-index.

For more information on MVC episodes of care data, please refer to MVC’s data guide. MVC members with questions not covered within the data guide are welcome to reach out to the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

14 Sep 2023
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MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

September 14, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce open registration for its upcoming Fall Collaborative-Wide Meeting on Friday, Oct. 20, 2023, from 10 a.m. – 3 p.m., in Lansing, MI. This meeting’s theme is “High-Value Care for All: Collaborative Approaches to Equitable Healthcare,” and will focus on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

This meeting will include presentations on health equity frameworks for quality improvement, insights from claims-based data, and inter-organizational partnerships to improve patient outcomes. MVC is thrilled to be joined by Renée Branch Canady, PhD, MPA, CEO of the Michigan Public Health Institute (MPHI), as its keynote speaker. Dr. Canady has extensive experience in diversity, equity, and inclusion (DEI) efforts, and was recognized as Crain’s 2021 Notable Executives in DEI. She received this honor for her work implementing incremental changes in health equity and social justice at MPHI. Under her leadership, MPHI established the Staff of Color Affinity Group, the Center for Health Equity Practice (CHEP), and the Center for Culturally Responsive Engagement (CCRE). She also recently published a new book titled Room at the Table: A Leader’s Guide to Advancing Health Equity and Justice.

The MVC Coordinating Center will also present MVC data linked with supplemental social determinants of health data sets, updates about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and other Coordinating Center updates.

MVC’s fall collaborative-wide meeting will also feature a new roundtable format with insights from a wide variety of guest speakers, including Nora Becker, Michigan Medicine; Diane Hamilton, Corewell Health Trenton; Matthias Kirch, Michigan Social Health Interventions to Eliminate Disparities (MSHIELD); Laura Mispelon, Michigan Center for Rural Health; Amanda Sweetman, the Farm at Trinity Health; Larrea Young and Noa Kim, Healthy Behavior Optimization for Michigan (HBOM); and Thomas West, U-M Health West. Attendees will rotate through several mini-presentations and discussions about specific health equity topics, such as demographic data collection and patient screening practices, developing and funding community benefit programs, addressing transportation access barriers, support programs within rural communities, tobacco cessation interventions, financial toxicity risks for patients, and more.

Attendees will have multiple opportunities to network and learn from their peers. The meeting includes a mid-day poster session to highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions through 10/5/2023 that feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to health equity or MVC conditions/data, authored by clinicians and non-clinicians alike, or presentations already shared at a recent conference or event. Instructions for submitting a poster are available on MVC’s events page. The meeting also includes breakout sessions in the afternoon focused on regional trends and opportunities using MVC data and member insights, as well as an optional networking reception at the conclusion of the event, from 3-4 p.m.

Those able to attend MVC's fall collaborative-wide meeting may register here. MVC hosts two collaborative-wide meetings each year to bring together healthcare quality leaders and clinicians from across the state.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

Hari Nathan, MD, PhD; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH; Kristy Degener, MPH

06 Sep 2023
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MVC Publishes its 2023 QECP Public Report as a Qualified Entity

MVC Publishes its 2023 QECP Public Report as a Qualified Entity

September 6, 2023 | 0 Comments | , , ,

Today the MVC Coordinating Center published its annual Qualified Entity Certification Program (QECP) public report for 2023. One of the requirements of being a qualified entity (QE) with the Centers for Medicare & Medicaid Services (CMS) through the QECP is the annual dissemination of a public report created using claims data. MVC shared its first public report last year, making the 2023 report the second iteration.

As with last year, the 2023 MVC QECP Public Report provides unidentified aggregated data on Michigan hospitals for two measures: rates of 30-day rehospitalizations following start of home health care, and rates of outpatient follow-up received after hospitalization for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD). Both measures were created using data from episodes of care initialized by inpatient hospitalizations or surgeries between 1/1/2018 and 12/31/2021.

For 2018-2021, the overall rate of 30-day unplanned rehospitalizations from home health among MVC member hospitals in Michigan was 11.3%. Risk-adjusted rates by index hospital ranged from 1.6% to 18.5% (Figure 1). By home health provider, risk-adjusted rates ranged from 2.0% to 23.6%. Patients whose episode of care began with an index event for endocarditis, COPD, CHF, or percutaneous coronary intervention (PCI) were more likely than patients with other index conditions to experience an unplanned rehospitalization in the 30 days after they started home health care.

Figure 1. Risk-Adjusted Rates of 30-Day Unplanned Rehospitalization from Home Health, by MVC Hospital

Across the 102 MVC hospitals with attributed episodes of care data underlying this report, the unadjusted rates of patients receiving outpatient follow-up were higher following index hospitalizations for CHF than for COPD (Figures 2 and 3). This was the case whether follow-up occurred three days (16% vs. 13%), seven days (45% vs. 37%), 14 days (63% vs. 54%), or 30 days (72% vs. 64%) after discharge.

Figure 2. 30-Day Follow-Up After CHF by MVC Hospital

Figure 3. 30-Day Follow-Up After COPD by MVC Hospital

For more information and the entire set of findings, we invite you to read the full report, which is available online to any member of the public on the MVC Resources page or directly here.

QE certification status allows MVC to provide hospital members with additional data from Medicare Fee-for-Service (FFS) claims at a level of granularity not otherwise available under standard CMS data use agreements. Reports located under the “QE Data” icon on the MVC registry allow hospital registry users to see unsuppressed data that include case counts <11 as well as utilization rates and average payments based on case counts <11. In addition, on any QE Data registry report, members can click on specific data points to load a list of all episodes underlying that data point. From that episode list, it is possible to view drill-down information on any individual listed episode to learn more about the claims and price-standardized payments comprising that episode.

MVC members representing one or more MVC-participating hospitals can send an email to Michigan-Value-Collaborative@med.umich.edu to learn more about data available through MVC’s QECP reports and to receive the forms necessary to gain access to those registry reports.

29 Aug 2023
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MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

August 29, 2023 | 0 Comments | , , ,

After childbirth, all individuals should have access to patient-centered counseling about birth spacing, and, if desired, contraceptive methods to help fulfill their personal reproductive goals. Promoting patient-centered contraceptive care and equitable access to contraceptive methods for those who desire them may improve population health outcomes.

Researchers and medical professionals are increasingly recognizing the impact of social determinants of health (SDOH) on individuals’ access to care and overall health outcomes. Unmet social needs may affect contraceptive initiation after childbirth by influencing individuals’ preferences for future childbearing, as well as individuals’ access to high-quality contraceptive care. To better understand this relationship, a group of clinician investigators used MVC data in a paper published in the American Journal of Obstetrics and Gynecology to evaluate the association between living in a neighborhood with high social vulnerability and the use of long-acting reversible contraception (LARC) and sterilization methods during the postpartum period.

Lead author Michelle H. Moniz, MD, MSc, Program Director of the Obstetric Initiative (OBI), and her colleagues utilized MVC administrative claims data to identify childbirth episodes from Jan. 2016 to Dec. 2019 with outcomes including LARC and sterilization use by 60 days into the postpartum period. Social vulnerability was determined using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). The SVI measures a community’s economic and social resilience by integrating 15 U.S. Census variables to generate composite scores across 4 themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.

In 140,345 delivery episodes at 79 hospitals, 8% of patients initiated LARC devices, and 8.3% initiated sterilization by 60 days postpartum. Dr. Moniz and colleagues observed independent associations between social vulnerability and postpartum contraceptive use. It appeared that different SVI themes such as socioeconomic status, minority status and language, household composition and disability, and housing type and transportation aligned with varying use of LARCs or sterilization (Figure 1). Individuals living in neighborhoods with the highest socioeconomic vulnerability and minority status/language vulnerability were more likely to utilize LARC methods. Individuals living in neighborhoods with the highest household composition vulnerability were less likely to initiate LARC methods.

Figure 1. Adjusted LARC and Sterilization Use by 60 Days Postpartum (Using SVI Theme)

Conversely, sterilization was more likely among populations living in neighborhoods with highest housing/transportation vulnerability and less likely among those living in neighborhoods with highest socioeconomic vulnerability and minority status/language vulnerability.

Dr. Moniz and colleagues suggest that “structural factors—such as distance to clinic, fees for parking and transportation, clinic hours, childcare access, ability to miss work to seek healthcare, and out-of-pocket costs for healthcare—may affect postpartum contraceptive use.” They also note that more research is needed to fully understand the means by which SDOHs influence an individual’s healthcare preferences and choices. Additional investigations could shed light on the mechanisms by which unmet social needs influence reproductive wishes and access to patient-centered contraceptive counseling and methods after childbirth.

In all sectors of healthcare and medical research, but especially in maternal health where inequities in health outcomes have worsened in recent years, further studies must be done to better understand the impact of SDOHs. While medical advancements and the pursuit of best practices are critical to ensuring improvement in healthcare delivery, these innovations cannot impact outcomes for all patient populations until we understand the structural factors affecting patient access and goals.

MVC is committed to using data to improve the health of Michigan through sustainable, high-value healthcare. Therefore, one of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. MVC shares its data with clinical, administrative, and CQI experts for investigative analyses to help identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Michelle H. Moniz, MD, MSc; Alex F. Peahl, MD, MSc; Dawn Zinsser, BA; Giselle E. Kolenic, MA; Molly J. Stout, MD, MS; Daniel M. Morgan, MD

Full Citation

Moniz, M. H., Peahl, A. F., Zinsser, D., Kolenic, G. E., Stout, M. J., & Morgan, D. M. (2022). Social vulnerability and use of postpartum long-acting reversible contraception and sterilization. American Journal of Obstetrics and Gynecology, 227(1). https://doi.org/10.1016/j.ajog.2022.03.031

24 Aug 2023
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Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

August 24, 2023 | 0 Comments |

This week the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. PY2023 scores achievement and improvement points for each hospital’s selected episode spending conditions using index admissions from 2022 as the performance year against admissions in 2020 as the baseline year. Hospitals can earn up to five points for each condition using the higher of a hospital's achievement and improvement point scores. This is the second year of a two-year (PY22-23) P4P cycle.

This cycle also offers hospitals bonus points for completing and submitting a survey for each selected condition by November 15, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and support practice sharing between members. The full methodology for this program cycle can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the current distribution of total hospital points out of 10. The average points scored across the mid-year scorecards was 6.4/10 before including the survey bonus points. This is 0.4 points higher than the average points scored at the conclusion of PY22 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition. Hospitals could earn up to five points for each condition. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.6 points. Much of the success observed for the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than two points on average.

Figure 2.

These mid-year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2022 claims are incorporated. Hospitals can track their score through the P4P PY22-23 reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points in one place (bonus points are not reflected on the registry). These registry reports can be filtered by selected conditions to make the tracking of P4P points easier. Contact the MVC Coordinating Center for a walkthrough of your hospital’s PY23 mid-year scorecard or P4P registry reports.

18 Aug 2023
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MEDIC Helps EDs in Michigan Improve Care for Adults, Children

MEDIC Helps EDs in Michigan Improve Care for Adults, Children

August 18, 2023 | 0 Comments |

Serving a spectrum of functions, emergency departments (EDs) provide essential care and services, operating in the critical space between outpatient and inpatient care. EDs also serve as a safety net within the US healthcare landscape by performing necessary clinical services for populations who may not otherwise have access. Patients visiting the ED may undergo a wide range of rapid diagnostic and treatment options, ranging from unscheduled procedures, laboratory testing, utilization of basic and advanced imaging studies, and admission of patients to the hospital. Despite the ED’s critical role and services, there are few coordinated, scalable efforts to improve care quality in the ED. These realities within emergency medicine made it a prime opportunity for quality improvement (Kocher et al., 2019), which was the impetus for adding an emergency medicine-focused Collaborative Quality Initiative (CQI) to the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio.

The Michigan Emergency Department Improvement Collaborative (MEDIC) was founded in 2015 to address the critical gap in coordinated quality improvement in the ED, including intervention design through implementation and evaluation, at scale, across health systems. Michigan Value Collaborative (MVC) members recently heard about MEDIC and its work as part of the launch of MVC’s new ED-based episodes and reporting; MEDIC and MVC collaborated on the development of this new episode of care data structure.

MEDIC’s quality improvement efforts to date have included initiatives such as improved appropriateness of head CT imaging utilization for children and adults with minor head injuries, greater CT diagnostic yield for adults with suspected pulmonary embolism, decreased use of chest x-rays in children with respiratory illness (i.e., asthma, croup, bronchiolitis), higher rates of ED discharge for children with asthma and adults with low-risk chest pain, and increased distribution of take-home naloxone to patients with opioid use disorder (OUD) or who experience opioid overdose or withdrawal.

MEDIC Success Stories

Since 2017, MEDIC participating sites have significantly improved collaborative-wide performance on all MEDIC quality measures. By reducing unnecessary imaging utilization and decreasing unwarranted hospitalization rates from the ED, MEDIC positively impacted the emergency care experience for thousands of patients in Michigan who received more evidence-based care and fewer low-value services. These improvements also contributed to an estimated total reduction in the ED cost burden in the millions of dollars (Figure 1).

Figure 1.

Zach Sawaya, MD, an emergency physician at MyMichigan Medical Center, reflected positively on the benefits of partnering with MEDIC on specific quality improvement initiatives. "MEDIC has pushed our group to be more cognizant of our imaging use, in particular in the pediatric population,” he said. “We've seen significant improvements in our rates of pediatric head CTs and chest X-rays that have been driven by MEDIC-provided data and decision-making resources.  In particular, we've seen wait times on pediatric head injuries go down as parents have been very open to discussion of PECARN rules and foregoing head imaging.”

The fact that MEDIC’s efforts support patients of all ages within its participating sites is unique; MEDIC is one of only a few CQIs with initiatives focused on pediatric patients. The MEDIC 2023 pay-for-performance incentive program, for example, focused on performance improvement on its pediatric-specific metrics. A key goal of this work was to ensure that children receiving emergency care in community hospital EDs received the same high-quality evidence-based care delivered in a pediatric emergency center. Since there are only three Michigan pediatric centers—all members of MEDIC—most children receive emergency care in community hospital EDs, and MEDIC observed disparities in the quality of emergency care delivered to children treated in community EDs. Children seen in community EDs were less likely to receive evidence-based care, as measured by our quality initiatives, than those seen in pediatric centers. In an emergency, patients can’t often choose which ED to go to, rather they need to go to the closest option. Over time and with participation in MEDIC, the data indicate MEDIC community hospitals improved their collective performance on MEDIC pediatric measures to be nearly on par with that of pediatric specialty hospitals.

The COVID-19 pandemic and its resulting impact on EDs also put MEDIC in a unique position. Within days of the pandemic being declared in the US, the MEDIC team pivoted from its standard work to support the COVID-19 response by leveraging its collaborative-wide learning network to support frontline efforts. MEDIC rapidly assembled a platform for informal and formal discussion between member EDs, which manifested as a series of virtual town halls and Grand Rounds focused on information exchanges among colleagues to rapidly innovate and meet challenges as the situation evolved.

This series began with lessons learned from the experience of its southeast Michigan EDs where the pandemic first unfolded in Michigan. This allowed sites in other areas of Michigan to understand what they would likely experience in the coming weeks or months, giving them valuable preparation time. Over several weeks, these well-attended sessions focused on the following topics: conservation of PPE, management of COVID-19 respiratory failure, special considerations for the pediatric population, and supporting the wellness of the ED workforce.

MEDIC – ED Partnerships

EDs partner with MEDIC in two primary ways: data collection and collaborative engagement in quality improvement. To participate in MEDIC, a partner ED must establish a flow of electronic health data for all ED visits to the MEDIC data registry as well as provide additional abstracted data, facilitated by a data abstractor hired with support from BCBSM. This then allows MEDIC to provide detailed evaluation and performance reporting on all measured quality initiatives, which in turn helps facilitate and inform site quality improvement interventions. MEDIC provides member hospitals with a level of insight into their ED practice patterns that would not be possible without participating in the collaborative.

In addition to being able to understand their data, participating in MEDIC allows hospitals to learn from one another, which significantly shortens the learning curve for improvement. Each site’s emergency medicine physician champion and abstractor(s) lead local intervention design and implementation, participate in MEDIC tri-annual collaborative-wide meetings, and share experiences and lessons learned with collaborative peers. MEDIC provides quality improvement evidence, guidelines, standardized performance measurement, data visualization, evaluation, and support for local intervention efforts.

MEDIC currently partners with hospital EDs across the state. Any sites not currently partnered with MEDIC are encouraged to visit their recruitment page for more information on becoming a member and contacting the team.

As MVC continues to build its offerings for members, the coordinating center is cognizant that hospitals and providers partner with multiple CQIs. MVC posts regular blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with questions.