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Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

The opioid epidemic continues to harm individuals and communities worldwide; over-prescribing, overuse, and related overdose deaths persist in the United States and abroad. Without proper intervention, the proliferation of opioid use disorder and its negative impact on population health will continue. Healthcare professionals and stakeholders eager to stem this crisis are investing in the development and iteration of interventions that improve control of opioid distribution. As part of this effort, one team of healthcare researchers recently published a paper in Urology investigating the impact of an insurance payer’s novel opioid reduction intervention on the adoption of opioid-sparing pathways.

The authors of this publication, including lead author Dr. Catherine S. Nam, M.D., and her colleagues from Michigan Medicine, sought to compare the percentage of patients who filled peri-procedural opioid prescriptions before and after Blue Cross Blue Shield of Michigan (BCBSM) launched a modifier 22 incentive for opioid-sparing vasectomies in Michigan. This program incentivized the utilization of an opioid-sparing post-operative pathway developed by the Michigan Opioid Prescribing Engagement Network (OPEN) by allowing the use of the modifier 22 reimbursement code for vasectomies performed with minimal or no post-operative opioids. Previous literature has demonstrated success in this approach for other medical procedures. The use of modifier 22 as an opioid reduction intervention was first launched by BCBSM in 2018 for select procedures and was expanded to include vasectomies in 2019. Typically, modifier 22 can be applied to select insurance claims with the primary procedure code when the work attributed to that procedure or medical intervention exceeds the typical amount of required labor. When approved, insurance companies may provide additional reimbursements of up to 35%.

The expanded eligibility for the modifier 22 into vasectomy presented substantial quality improvement potential given both how commonly this procedure is performed—approximately half a million times annually across the US—and the fact that a 2019 survey indicated more than half of urologists prescribed opioids for patients receiving a vasectomy, even though the procedure can be completed without them. For a vasectomy procedure to qualify for the modifier 22 program, a surgeon must intend to follow an opioid-free peri-procedural course as well as provide additional counseling to patients about post-procedural pain expectations, proper opioid disposal, and non-opioid pain management strategies.

Given the novel quality incentive for opioid-sparing pathway application to vasectomy with implications for payers, providers, patients, and policymakers, Dr. Nam and her colleagues were interested in evaluating the impact this policy change had within the state of Michigan.

To perform this analysis, Dr. Nam and colleagues leveraged Michigan Value Collaborative (MVC) administration claims data from beneficiaries in BCBSM’s preferred provider organization (PPO) plan. The data provided by MVC included men ages 20 to 64 who participated in urologic procedures between Feb. 1, 2018, and Nov. 16, 2020.

Between these dates, Dr. Nam and colleagues identified 4,559 men who underwent office-based vasectomies and 4,679 men in the control group, which consisted of men who underwent cystourethroscopies, prostate biopsies, circumcision, and transurethral destruction of prostate tissue. These procedures are all office-based and not eligible for opioid-sparing modifier 22, thus providing a point of comparison.

The results of the analysis demonstrated a strong association between the implementation of modifier 22 for vasectomies and filled opioid prescriptions. Before July 1, 2019—prior to the implementation of the expanded modifier 22 policy—32.5% of men filled an opioid prescription after receiving a vasectomy, whereas after implementation only 12.6% of men filled an opioid prescription post-procedure (see Figure 1). As highlighted in the figure below, Dr. Nam and colleagues found a 19.9% absolute reduction and 61% relative reduction in the percentage of vasectomy patients who filled peri-procedural opioid prescriptions.

Figure 1. Percent of Patients Filling Opioid Prescriptions Before and After Implementation of Modifier 22

Among the vasectomy patients in the analysis, for every three opioid prescriptions filled before the implementation of modifier 22, only one was filled after the initiative was implemented. They did not find a significant decrease in the percentage of patients who filled peri-procedural opioid prescriptions in the control group.

In addition to the decreased frequency of men filling peri-procedural opioid prescriptions for vasectomies, Dr. Nam and colleagues also found a significant decrease in the prescribed amount. After the implementation of modifier 22 for vasectomies, the oral morphine equivalents (OME) of peri-procedural opioid prescriptions fills dropped from 89.7 OME per prescription to 27.1 OME per prescription. Dr. Nam and colleagues estimated that this decrease in prescription size led to the distribution of approximately 8,473 fewer oxycodone 5mg pills in Michigan.

When asked about the significance of these findings, Dr. Nam explained, “This estimate helped us grasp the impact of the Modifier 22 policy change for patients as well as the community. If this was the impact in a bit over a year for a single procedure in one state, how large could this impact be annually? What could the impact be when quality incentive is expanded to additional procedures? What if the quality incentive could be expanded to other states?”

These findings suggest that the modifier 22 incentive does decrease the percentage of patients who fill peri-procedural prescriptions after a vasectomy and its implementation correlates with a reduction in the number of opioids circulating within the community. In addition to reducing the unnecessary presence of opioids in communities, this initiative also emphasizes a shift to refocus healthcare interactions on the patient. The required additional education about pain management and proper use of pain management medications implemented as part of the modifier 22 initiative provides patients with a better understanding of their care and encourages physicians to consistently deliver high-value care.

Despite the significant findings of this study, a question remained. If these practice changes were initiated by incentivized modifier 22 interventions, what would happen if BCBSM terminated the incentive? Since the publication of Dr. Nam and colleagues’ original study, BCBSM terminated the financial incentive using modifier 22 for opioid-sparing vasectomies on Dec. 31, 2021. This termination provided the group with an opportunity to observe the long-term impact modifier 22 had on physician prescribing patterns and patient opioid use after the incentive was no longer in place.

Dr. Nam and colleagues performed another interrupted time series analysis before and after the termination of modifier 22 using the same vasectomy and control groups. After analyzing the data provided by MVC, they observed no significant changes in the opioid fill rate compared to the rate observed when the modifier 22 program was in effect. This was true for both the vasectomy group and the control group (see Figure 2). The persistence of reduced opioid prescription sizes was also observed following termination of modifier 22. Prior to incentive termination, the mean opioid prescription amount was 59 OME, and after termination the mean further reduced to 36 OME.

Figure 2. Percent of Patients Filling Opioid Prescriptions Before and After Termination of Modifier 22

These critical findings demonstrate that physician opioid prescribing behavior remained constant after the removal of financial incentives. More research still needs to be done on the long-term impact of programs such as modifier 22; however, Dr. Nam and colleagues suggest that other payers could implement incentive programs like BCBSM’s modifier 22 initiative in order to spur similar changes in prescribing patterns and are hopeful that short-term financial incentives are part of the solution to creating lasting practice changes.

“This is the first example of a novel quality incentive targeting physicians to provide high-value care by incentivizing opioid-sparing pain pathway,” she said. “However, this incentive can be adapted to incentivize other high-value care – could we recognize physicians that are providing guideline-based care? How about ensuring that appropriate lab and imaging tests are ordered for patients as part of their care plan? And if so, could it be possible for there to be an investment made from the insurance companies to champion high-value care for a short period of time to have lasting effects?”

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. In partnering with clinical, administrative, and CQI experts to leverage MVC data for analyses, MVC aims to identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Catherine S. Nam, MD; Yen-Ling Lai, MSPH, MS; Hsou Mei Hu, PhD, MBA, MHS; Arvin K. George, MD; Susan Linsell, MHSA; Stephanie Ferrante; Chad M. Brummett, MD; Jennifer F. Waljee, MD; James M. Dupree, MD, MPH

Full Citation

Nam, C. S., Lai, Y.-L., Hu, H. M., George, A. K., Linsell, S., Ferrante, S., Brummett, C. M., Waljee, J. F., & Dupree, J. M. (2022). Less is more: Fulfillment of opioid prescriptions before and after implementation of a modifier 22 based quality incentive for opioid-free vasectomies. Urology, 171, 103–108. https://doi.org/10.1016/j.urology.2022.09.023.

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MVC Welcomes New Analyst, Kushbu Narender Singh, MPH

MVC Welcomes New Analyst, Kushbu Narender Singh, MPH

I would like to introduce myself as the Michigan Value Collaborative’s (MVC) newest data analyst. I am very thankful to be a part of this incredible team! I am an internationally trained dentist from India with over eight years of clinical and research experience. From childhood, I have been motivated to help people improve their health by overcoming barriers and getting timely access to quality healthcare. This led me to pursue a degree in health science and I greatly enjoyed treating dental diseases and conducting oral cancer research. My thesis research focused on studying the role of nestin - the cancer stem cell marker - in the initiation and progression of oral carcinogenesis.

After a few years of clinical practice, my curiosity about disease prevention increased. I wanted to be involved in providing data-driven healthcare solutions that would create a more significant impact on the community. I recently earned a Master of Public Health degree in epidemiology from the University of Michigan School of Public Health, which provided me with valuable knowledge and opportunities to explore the applications of data-driven research in solving real-world healthcare problems. My most recent research work focused on studying the association of statin usage with the incidence of head and neck cancer.

With this background and experience, I am excited to continue my journey - to integrate my research and clinical skills - working towards MVC’s mission. I look forward to learning and growing in my role as an analyst and continuing to fulfill my passion for improving people’s health outcomes. When not working, I enjoy gardening, bird watching, and hiking, and live by the motto ‘Live and Let Live.’ Please feel free to reach me at kushbu@med.umich.edu.

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MVC Welcomes New Analyst, Jiaying (“Janet”) Zhang, MPH

MVC Welcomes New Analyst, Jiaying (“Janet”) Zhang, MPH

Hello, I'm Jiaying Zhang (张佳莹), also known as Janet, and I am thrilled to join the remarkable team at the Michigan Value Collaborative (MVC) as an analyst. Hailing from China, my global and diverse experiences have shaped my approach to problem-solving and provided me with a unique perspective.

I recently earned a Master of Public Health (MPH) degree with a focus on global health epidemiology from the University of Michigan School of Public Health and earned a Bachelor of Medicine in public health from Capital Medical University in China. I also learned and grew from several incredible research and volunteering experiences in China, India, and Nicaragua that broadened my horizons and strengthened my adaptability and cultural awareness. Working in different sociocultural contexts has taught me the value of empathy, collaboration, and the power of embracing diverse perspectives.

Drawing from my international background and experiences, I bring a rich tapestry of insights and ideas to MVC. Data analysis is not just a job for me; it's my passion. During my previous work, I had the opportunity to contribute to critical projects that addressed significant public health challenges, including one such project that involved studying the norovirus epidemic in China. By examining large data sets and applying statistical models, I was able to identify key factors influencing the outbreak and propose targeted intervention strategies. As part of an international collaboration, I also worked closely with local healthcare professionals to assess the efficacy and reliability of the Sophia testing system for diagnosing infectious diseases.

I am excited to bring this expertise to MVC, where I can continue to contribute to impactful projects that inform strategic decision-making and drive positive change for patients and communities. If you have any questions, please reach out to me at janetzjy@med.umich.edu.

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MVC’s SNF and HH Push Report Latest in Post-Discharge Insights

MVC’s SNF and HH Push Report Latest in Post-Discharge Insights

MVC released another new push report recently with the first iteration of a skilled nursing facility (SNF) and home health focused report. MVC members frequently identify post-discharge care and SNF utilization as focus areas for quality improvement; therefore, this report was developed to help hospitals benchmark their performance in this area and identify opportunities to improve care coordination. Critical access hospitals (CAHs) received a tailored version of the report to allow for metric comparisons to only other CAHs.

This report highlighted various SNF and home health utilization metrics using 30-day claims-based episodes for MVC’s medical conditions: acute myocardial infarction (AMI), atrial fibrillation, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), endocarditis, pneumonia, sepsis, small bowel obstruction, and stroke. Patient episodes were included if they had an inpatient admission between 1/1/2021 and 6/30/2022 and had one of the following insurance plans: Blue Care Network (BCN) HMO Commercial or Medicare Advantage (MA), Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial or MA, or Medicare Fee-for-Service (FFS).

The first page of the report contained a SNF and home health profile table (Figure 1), which included nine metrics designed to give an overall look at post-discharge utilization patterns as well as information about a given hospital’s patient population. The first three metrics reflected all patients treated for medical conditions in this time period for the included payers and the metrics in gray were comprised only of patients that utilized SNF in the 30 days post-discharge from their episode's index hospitalization. Overall, MVC found that Medicare FFS patients utilized SNF and home health services more often than other payers. For CAHs, this table was not separated by payer.

Figure 1.

On the subsequent pages, 30-day overall SNF and home health utilization rates were provided in a caterpillar plot format to showcase variation across the collaborative (Figure 2). These rates varied between 5% and 25% for SNF utilization and between 10% and 40% for home health utilization.

Figure 2.

MVC also provided 30-day SNF and home health utilization rates broken out by condition to allow each hospital to benchmark rates across their site’s medical service lines and compared to the MVC average rate for each condition (Figure 3). Medical conditions were only included in this figure if a hospital had at least 11 cases between 1/1/2021 and 6/30/2022. On average across the collaborative, the highest 30-day post-discharge SNF utilization rates were observed in endocarditis (28%), sepsis (19.5%), and stroke (19.5%) patients.

Figure 3.

Hospitals also received a table identifying the most frequently utilized SNFs from a medical condition episode to help sites understand where their patients are going when receiving SNF care after discharge. A similar table was shown for home health providers.

The final page of the report included four caterpillar plots tailored to specific denominators. This included 30-day SNF and home health utilization rates for the cohort of patients discharged home. It also included readmission rates for patients who were discharged to SNF and readmission rates for patients discharged to home health. These plots were included to inform each hospital about patterns in their transitions of care and readmissions. There was significant variability in readmission rates following discharge to either a SNF or home health facility, with some hospitals averaging close to 5% readmission rates and some hospitals seeing an average of nearly 40% of patients readmitted during the 30-day post-discharge window (Figure 4).

Figure 4.

As part of its new Lunch & Learn series, MVC recently hosted a session focused on MVC data that included a walkthrough of its SNF/HH report and a deeper dive into those report metrics using MVC’s registry. Those who were unable to attend can watch a recording of the presentation here, which demonstrates how to replicate aspects of the push report on MVC’s registry in order to view additional episode spending and patient-level data.

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

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MVC Uses New ED-Based Episode Data in Latest Push Report

MVC Uses New ED-Based Episode Data in Latest Push Report

The MVC Coordinating Center recently distributed its first-ever report based on new emergency department-based episodes (“ED-based episodes”), sharing versions with site coordinators and quality improvement staff at 102 participating MVC member hospitals across Michigan. Reports featured each hospital’s own attributed ED-based episode data for five high-volume ED conditions: chest pain, abdominal pain, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), and cellulitis.

ED-based episodes are a new episode of care data structure developed this past year by MVC in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC), a BCBSM-funded Collaborative Quality Initiative with the goal of improving care and patient outcomes in Michigan emergency departments. MVC and MEDIC team members worked closely to develop 30-day episodes of care initialized by a patient’s visit to the ED and including all claims-documented care received in the 30 days following a patient’s index ED visit. MEDIC program director Dr. Keith Kocher, MD, talks more about the collaboration as well as advice on leveraging this data from an emergency medicine perspective in the video below.

These ED-based episodes are built using medical claims data from Medicare Fee-for-Service, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, and Blue Care Network HMO Commercial and Medicare Advantage plans. MVC’s ED-based episodes of care include both adult and pediatric patients, providing new opportunities for quality improvement insights at Michigan hospitals. Though this report provides metrics for five specific index conditions, MVC currently offers data for 15 ED-based index conditions, including abdominal pain, asthma, atrial fibrillation, cellulitis, unspecified chest pain, COPD, CHF, deep venous thrombosis, diabetes mellitus (short- and long-term complications), gastrointestinal bleed, pneumonia, pulmonary embolism, pyelonephritis/urinary tract infections, and syncope.

For each of the five index conditions included in the recent reports, hospitals received information on risk-adjusted and price-standardized 30-day total episode payments, same-day inpatient admission rates over time, utilization of healthcare services across the patient’s 30-day episode of care, and each hospital’s most frequent reasons for inpatient readmissions. Patient claims data were included for adult patients aged 18 and older who had an ED visit at a given hospital between 1/1/21 and 8/31/22, were insured by one of the insurance plans mentioned above, and had a primary diagnosis on their index claim matching standardized definitions for the five included conditions.

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payments (Figure 1) for the five reported conditions were highest for CHF ED-based episodes ($17,455) followed by COPD ED-based episodes ($11,001), and lowest for unspecified chest pain ($3,792). Within each condition, MVC 30-day total episode payments were consistently higher for episodes in which the patient had a same-day inpatient admission compared to episodes in which the patient did not have an inpatient stay begin on the date of their ED visit. With that information in mind, hospital members can also use their individualized reports to track their same-day inpatient admission rate by six-month intervals using trend graphs for each included ED-based condition (Figure 2).

Figure 1.

Figure 2.

A key goal for these ED-based episode reports was to provide insight into healthcare utilization following index ED visits. Therefore, reports included a dot plot (Figure 3) comparing their own hospital’s patient post-ED utilization to that of the appropriate general acute care hospital or Critical Access Hospital MVC comparison group. Dot plots provided information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and what percent of patients had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Also provided are rates of subsequent ED visits, receipt of outpatient services, home health, and skilled nursing facility care.

Figure 3.

Please share your feedback with the MVC team if certain report measures were helpful or if you’d be interested in seeing future ED-based episode reporting for certain conditions and metrics. MVC is now also accepting custom report requests using its new ED-based data. Contact MVC to learn more.

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MVC’s 2023 Cardiac Rehabilitation Reports Shared with Hospitals

MVC’s 2023 Cardiac Rehabilitation Reports Shared with Hospitals

Participation in cardiac rehabilitation (CR) programs is a crucial strategy for improving cardiac health outcomes. Participation reduces the risk of all-cause and cardiovascular-specific mortality, reduces readmissions, and enhances the patient’s quality of life. Despite the identifiable benefits, Michigan patients underutilize this high-value program, falling well below the 70% participation goal set by the Million Hearts Initiative. Therefore, the Michigan Value Collaborative (MVC) and several of its partners have identified CR as a high-value service for which they endeavor to drive improvement.

In support of this effort, MVC recently distributed the 2023 version of its CR reports to members with data on CR-eligible patients following discharge for heart attack (AMI), heart valve repair or replacement (TAVR or SAVR), coronary artery bypass procedure (CABG), percutaneous coronary intervention (PCI), and congestive heart failure (CHF). These reports were generated using MVC claims-based episodes of care with patient index admissions between 1/1/19-12/31/21 for multiple insurance plans, including Blue Care Network (BCN) HMO Commercial, BCN Medicare Advantage, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, and Medicare Fee-for-Service.

Hospitals received data on a specific procedure or condition if they had no fewer than 20 cases in the reporting period for that condition/procedure. The report pages include figures for a variety of CR metrics, including participation rates after discharge, quarterly trends in participation between 2019-2021, mean days to first CR visit among participating patients, and the mean number of visits completed among participating patients.

MVC generates these hospital-level reports as a product of the Michigan Cardiac Rehabilitation (MiCR) Network, a partnership between MVC, Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative (MSTCVS-QC). The MiCR Network strives to increase participation in CR for all eligible individuals in Michigan.

Given the current status of CR participation across the state, the MiCR Network is tracking progress toward two utilization goals: 1) for 40% of all eligible AMI, TAVR, SAVR, CABG, and PCI (referred to as the “Main 5”) patients to attend at least one CR session within 90 days of their hospital discharge, and 2) for 10% of all eligible CHF patients to attend a single CR session within one year of a CHF-related hospitalization.

In developing these reports, MVC found that the collaborative-wide average participation rate within 90 days of discharge for the "Main 5" procedures was approximately 36%, below the statewide goal of 40%. Similarly, MVC’s analysis found 3.2% of eligible CHF patients participated within 365 days of discharge, 6.8% below the statewide MiCR goal of 10%.

The report also offers patient population demographics intended to help hospitals identify disparities in participation. Research evidence suggests that white males are more likely to utilize CR than women or patients of color, likely due to several socioeconomic and cultural factors. Hospitals are encouraged to consider any gaps showcased in their demographic snapshot and consider the provision of additional, tailored strategies that increase referral and participation among those patients.

Other high-level findings from the report included varying averages in CR participation by the procedure type. CABG and SAVR, more clinically invasive procedures, had the highest utilization rates at 54.9% and 51.3% respectively, whereas patients being treated for the chronic condition of CHF were the least likely to attend (3.2%). There is also wide interhospital variation in utilization rates for each procedure. For example, the collaborative-wide CR utilization rate after PCI is 32%, but hospital rates range from just above 10% to nearly 60% (Figure 1).

Figure 1.

This variation aligns with published research on hospital-level variation in CR referral, even after accounting for patient characteristics, insurance status, and clustering within operators and hospitals. It also demonstrates that quality improvement is possible, with multiple sites in the collaborative excelling.

Several of the Collaborative’s top-performing sites and experts worked together last year to develop the MiCR Best Practices Toolkit. It includes several evidence-based strategies for increasing enrollment and participation, with step-by-step guidance and resources. Among the various best practices, there are pages dedicated to automating inpatient referrals, early and flexible scheduling approaches, and strategies that help reduce participation barriers for patients (e.g., lack of transportation, lack of reimbursement for CR sessions, etc.).

MVC encourages those working in this space to save the date for the MiCR Fall Stakeholder Meeting in Ann Arbor on Friday, October 27, from 10 a.m. to 3 p.m. It is a valuable opportunity to connect with peers and experts who can offer support or resources. Please contact the MVC Coordinating Center if you are interested in attending and haven't received the event's Save the Date, or if you would like more details on this report and other upcoming CR events.

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MVC Spring Collaborative-Wide Meeting Summary: Connecting the Dots for Value-Based Healthcare

MVC Spring Collaborative-Wide Meeting Summary: Connecting the Dots for Value-Based Healthcare

The Michigan Value Collaborative (MVC) held its first collaborative-wide meeting of 2023 last Friday. A total of 90 leaders registered, representing 52 different hospitals, 13 physician organizations (POs), and five stakeholder organizations from across the state of Michigan. This meeting’s theme of “Connecting the Dots: Celebrating 10 Years of Insights into Value-Based Healthcare” focused on interdisciplinary collaboration, care transitions, alternative sites of care, and MVC’s 10-year anniversary kickoff.

MVC Director Hari Nathan, MD, PhD, kicked off Friday’s meeting with an update from the MVC Coordinating Center (see slides). He welcomed MVC’s newest team members, Site Engagement Coordinator Kristy Degener and Senior Data Analyst Julia Mantey. Dr. Nathan highlighted the successes delivered by the Coordinating Center since October’s collaborative-wide meeting, including the release of MVC’s first Qualified Entity Public Report, which looked at 30-day unplanned rehospitalization for patients discharged to home health after high-volume medical and surgical episodes, as well as measures of post-discharge outpatient follow-up for congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Dr. Nathan also announced Medicare Part D pharmacy claims as MVC’s newest data source and highlight recent push report releases – sepsis, joint replacement, cardiac rehabilitation, and preoperative testing – aimed at increasing the amount of meaningful, benchmarked data available to members. Rounding out the welcome address, Dr. Nathan showcased a 10-year anniversary video featuring members of MVC’s leadership team, past and present.

MVC Co-Director Michael P. Thompson, PhD, MPH followed Dr. Nathan with an update on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, noting that final scorecards for Program Year (PY) 2022 were distributed in March. For the 2022 - 2023 program cycle, hospital members selected two conditions to be measured for the 30-day episode spending component of the program - chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement (hip and knee), pneumonia, or spine surgery - and are eligible to receive up to two bonus points for completing a survey on each of their episode conditions. Dr. Thompson presented a snapshot of the PY2022 evaluation (Figure 1), noting all participating hospitals scored at least two points and over a third of participating hospitals scored the maximum of 10 points (mean: 7.7 points, median: 8 points). Turning to PY2023, the group was reminded that mid-year scorecards will be distributed to participating hospitals in the summer of 2023 and bonus point questionnaires will be due in November.

Figure 1.

Following Dr. Thompson’s update on the MVC Component of the BCBSM P4P program, Senior Data Analyst Kristen Hassett, MPH, introduced MVC’s new Emergency Department (ED)–based episodes, which were developed in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC). The new ED-based episodes are initialized by an ED visit for a set of high-volume, ED-relevant conditions, and capture both adult and pediatric patients who may not be captured through MVC’s traditional inpatient/surgery-based episodes of care. The new ED-based episodes (Figure 2) provide MVC members with information on care transitions and trajectory of care for patients visiting the ED, quality improvement opportunities to prevent excess ED visits and inpatient hospitalizations, and patterns in post-ED care (e.g., inpatient admissions, outpatient visits, home health care, skilled nursing facility care, etc.). Ms. Hassett presented unblinded hospital and PO data using ED-based episode payments for CHF patients. Members who are interested in seeing their organization’s ED-based episode data can contact the Coordinating Center to request a report. MVC also shared a link to a video interview of MEDIC Program Director Keith Kocher, MD, MPH, about how sites can utilize MVC’s new ED-based episode structure to improve care for patients treated in the ED as well as how MEDIC supports quality improvement in the ED.

Figure 2.

Following the ED-based episode presentation, Caitlin Valley, Senior Population Health Project Manager with Trinity Health IHA Medical Group, delivered a presentation (see slides) on their strategies and approach to caring for patients across the continuum. She began by providing insights about care transitions and why they are important. She also shared Trinity Health IHA Medical Group’s team-based approach to care transitions (see Figure 3), which includes the use of a transitional support call center and care team navigators for post-discharge follow-up outreach, screening for social influencers of health (SIOH), and comprehensive medication reviews with a clinical pharmacist, among other strategies.

Figure 3.

Ms. Valley also shared several barriers to scheduling hospital follow-up appointments observed by Trinity Health, and the interventions they implemented in response, such as patient education, transportation resources, and creative scheduling solutions. She concluded her presentation by discussing post-acute care collaboration among providers, citing the use of a post-acute transitional care manager and the expertise of partners specializing in the post-acute care space.

Following Ms. Valley’s presentation, a poster session began, providing an opportunity to highlight recent quality improvement successes and encourage networking across the collaborative. The MVC Coordinating Center would like to thank the poster presenters:  Holland Hospital, MSU Health Care, Henry Ford Health System, Michigan Medicine, McLaren Port Huron, MARCQI, BMC2, and the Michigan Cardiac Rehabilitation Network.

Following a networking lunch, attendees participated in one of four breakout sessions: cardiac rehabilitation; post-discharge follow-up for CHF, COPD, and pneumonia; preoperative testing; and sepsis readmissions. In each breakout session, hospital and PO members reviewed unblinded data and shared strategies to address each of the topic areas.

The group reconvened after the breakout sessions for a closing presentation from Michael Sjoding, MD, MSc, Associate Professor of Internal Medicine in Michigan Medicine’s Division of Pulmonary and Critical Care Medicine, and Co-Director of the Inspiring Health Advances in Lung Care (INHALE) team, one of the newest population health CQIs in BCBSM’s Value Partnership program. Dr. Sjoding’s presentation (see slides) centered around how INHALE has leveraged MVC data to plan and implement the INHALE collaborative.

The meeting concluded with a summary of the day and upcoming MVC activities, led by MVC Program Manager Erin Conklin, MPA. The slides from Friday’s meeting have been posted to the MVC website. If you have questions about any of the topics discussed at the spring 2023 collaborative-wide meeting or are interested in following up for more detail, contact the Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Friday, October 20, 2023, at the Radisson Hotel at the Capitol in Lansing.

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MVC Kicks Off 10-Year Anniversary Celebration at May 19 Meeting

MVC Kicks Off 10-Year Anniversary Celebration at May 19 Meeting

The Michigan Value Collaborative premiered several new materials and offerings at this week's Spring Collaborative-Wide Meeting, including the kickoff of its 10-year anniversary celebration. Established in 2013 as part of the Blue Cross Blue Shield of Michigan Value Partnerships Program, MVC was envisioned as a Collaborative Quality Initiative (CQI) focused on "helping Michigan hospitals achieve the best possible patient outcomes at the lowest reasonable cost." This interest in improving the value of healthcare has set MVC apart from other CQIs in both its focus and data use. Furthermore, MVC's analytic and engagement efforts resulted in some notable success stories and improvements over the last decade.

To celebrate the ways in which MVC has grown, adapted, and succeeded over time, the Coordinating Center shared a celebratory video (Figure 1) with attendees during its opening presentations on Friday morning. This video included interviews with current and past leadership of MVC who spoke about accomplishments they were most proud of as well as changes and growth they've observed over the years. Some of the highlights included the steady and significant growth in MVC's data sources, observed collaboration and sharing between members, expansion within the Coordinating Center, diversification in MVC's members and partner groups, and MVC's recent certification by CMS as a Qualified Entity. These accomplishments and others were similarly highlighted in a 10-year anniversary timeline poster (Figure 2) and in a slideshow that was played at multiple points throughout the day.

Figure 1. MVC 10-Year Anniversary Celebration Video

Figure 2. MVC 10-Year Anniversary Timeline Poster

The video featured interviews with Director Hari Nathan, MD, PhD; Co-Director Mike Thompson, PhD, MPH; former Director and Senior Advisor Jim Dupree, MD, MPH; former Co-Director and Senior Advisor Scott Regenbogen, MD, MPH; Program Manager Erin Conklin, MPA; and Manager of Data Analytics Chelsea Pizzo, MPH.

MVC will continue to celebrate its 10-year anniversary throughout the remainder of 2023, including at its Fall Collaborative-Wide Meeting. The focus for the latter half of 2023 will be the celebration of case studies and success stories that feature MVC's members, partners, and other stakeholders. MVC looks forward to connecting with individuals to gather those stories in the coming months. If you have a story or quote from your experience partnering with MVC, please share it with the Coordinating Center.

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MVC Honors Mental Health Awareness Month with Workgroup

MVC Honors Mental Health Awareness Month with Workgroup

Mental illness and related conditions such as depression are increasingly prevalent and costly. More than 50% of patients will be diagnosed with mental illness or disorder at some point in their lifetime, according to a World Health Organization research survey, and one in four adolescents will experience depression by the age of 18, contributing to an estimated $406 billion in medical treatment costs in a single year in the U.S. To bring attention and awareness to this issue, the month of May is celebrated nationally as Mental Health Awareness Month. It represents an important opportunity for healthcare providers and hospitals to evaluate the ways in which they currently support patients experiencing mental health/substance use disorder (MH/SUD) conditions.

To help facilitate this conversation, the Michigan Value Collaborative hosted a workgroup yesterday focused on increasing access to high-quality mental health for patients and increasing support for providers. MVC’s guest speakers hail from the Michigan Collaborative Care Implementation Support Team (MCCIST), including Gregory Dalack, MD, MCCIST Co-Lead and Daniel E. Offutt III Professor and Chair of the Michigan Medicine Department of Psychiatry, and Karla Metzger, LMSW, MCCIST Program Manager.

The presenters highlighted the psychiatric Collaborative Care Model (CoCM), an evidence-based integrated behavioral health model that is primary care based and highly cost-effective. Research evidence suggests that up to $6 are saved in long-term healthcare costs for every dollar spent on collaborative care. The presentation included research evidence of the benefits of CoCM, an introduction to its components, tips for implementation and common challenges, and several success stories from both patients and providers.

Those unable to attend Thursday's MVC workgroup can access the full recording on MVC’s YouTube channel. Additionally, the American Psychiatric Association (APA) and Academy of Psychosomatic Medicine (APM) jointly developed a report on the CoCM that reviews current evidence, essential elements of implementation, and recommendations for better meeting the health needs of people with mental health conditions, which is available here.

The American Hospital Association has also compiled a variety of resources on its Mental Health Awareness Month webpage related to mental health information, suicide prevention, opioid stewardship, downloadable posters to help employees adopt respectful language, case studies, and other tools and resources.

For those working in the behavioral and mental health space, there is also a recently formed Collaborative Quality Initiative (CQI) focused on mental health. Established in 2022, the Michigan Mental Innovation Network and Clinical Design (MI Mind) CQI is a statewide partnership with providers and provider organizations that works to prevent suicide and improve outcomes by reducing suicide attempts and deaths. MI Mind offers access to and engagement in evidence-based services for providers with a focus on suicide prevention, with plans to expand into other behavioral health domains, such as depression, anxiety, and substance use disorders. For a closer look at MI Mind, read MVC’s blog about their formation and check out the MI Mind website.

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MVC Announces Summer Date for New Virtual Rural Health Meeting

MVC Announces Summer Date for New Virtual Rural Health Meeting

MVC will host a special virtual event this summer for its rural and northern Michigan members. The new MVC Rural Health Meeting is modeled after MVC’s collaborative-wide meetings that are offered in person in the spring and fall. This tailored member meeting differs in that its guest speakers and unblinded data presentations will focus on the unique challenges and opportunities in delivering value-based healthcare in rural or low-density communities. The event will take place over Zoom on Wednesday, August 9, 2023, from 10 a.m. - 12 p.m.

The Collaborative has diversified in recent years with the addition of more rural-based hospitals and physician organizations as well as more representation throughout Northern Michigan, including critical access hospitals. These sites play an integral role in the health system and have a unique care delivery experience.

According to the Centers for Medicare and Medicaid Services (CMS), rural providers have higher performance quality measures than their urban counterparts in areas such as safety, community engagement, efficiency, and cost reduction. At the same time, however, they also face unique challenges related to low patient volumes, higher rates of chronic disease, insufficient workforce recruitment and retention, and low reimbursement rates, among others.

It is these unique strengths and challenges that will be the focus of the August 9 agenda, along with unblinded MVC data that caters to priority conditions and areas of care for rural providers. If your hospital or physician organization is interested in presenting on a recent rural health initiative or would like to request data on a specific area of care, please contact the MVC Coordinating Center