22 Jun 2023
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MVC Welcomes New Analyst, Jiaying (“Janet”) Zhang, MPH

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

June 22, 2023 | 0 Comments

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.

15 Jun 2023
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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

June 15, 2023 | 0 Comments | , ,

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.

07 Jun 2023
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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

June 7, 2023 | 0 Comments | , ,

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.

01 Jun 2023
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MVC’s 2023 Cardiac Rehabilitation Reports Shared with Hospitals

MVC’s 2023 Cardiac Rehabilitation Reports Shared with Hospitals

June 1, 2023 | 0 Comments | , ,

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.

25 May 2023
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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

May 25, 2023 | 0 Comments

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.

19 May 2023
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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

May 19, 2023 | 0 Comments | , ,

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.

11 May 2023
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MVC Honors Mental Health Awareness Month with Workgroup

MVC Honors Mental Health Awareness Month with Workgroup

May 11, 2023 | 0 Comments | , ,

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.

04 May 2023
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MVC Announces Summer Date for New Virtual Rural Health Meeting

MVC Announces Summer Date for New Virtual Rural Health Meeting

May 4, 2023 | 0 Comments | ,

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 

27 Apr 2023
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Latest MVC Push Reports and Resources Draw Attention to Low-Value Preoperative Testing

Latest MVC Push Reports and Resources Draw Attention to Low-Value Preoperative Testing

April 27, 2023 | 0 Comments | ,

This week MVC distributed its first of two preoperative testing push reports of 2023, providing members with an opportunity to benchmark their testing practices. MVC first introduced its preoperative testing push reports in 2021 to help members reduce the use of unnecessary testing for surgical procedures. Preoperative testing for low-risk surgeries, especially for young and healthy patients, often provides no clinical benefits yet is ordered regularly at hospitals across Michigan.

The report distributed this week had many similarities to versions distributed last year, namely that members continued to see their rates across a variety of tests for three elective, low-risk procedures performed in outpatient settings: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated for the index event as well as 30 days prior to the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function.

The latest report utilizes claims from Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans exclusively, including both the commercial and Medicare Advantage plans. This allows members to see MVC’s most up-to-date data, which includes episodes with index admissions from 7/1/2020 through 6/30/2022. Members only received reports if they had 11 or more cases in at least one of the three conditions and at least 20 cases across all three conditions.

The reports received by members this week included a patient snapshot table that defined rates for preoperative testing and no preoperative testing in patients of varying races as well as those with zero, one, or two or more comorbidities. Generally speaking, patients with no comorbidities were more likely to have no preoperative testing than patients with one or more comorbidities. There were also observed differences in testing by age; patients who had preoperative testing were older on average than patients who had no preoperative testing.

A key finding in the report is the average testing rate for all three procedures combined for the entire collaborative, which continues to showcase the wide variability across hospitals in Michigan. Some in the collaborative have an average testing rate close to 10% and some nearly 100% (Figure 1). Individual hospitals receiving a report will see on this figure where they fall compared to other hospitals in the collaborative, as well as their average rate for the three separate procedures to help deduce which procedure is driving their average rate.

Figure 1.

Another trend that continued in this April 2023 report is the consistency of average testing rates for combined procedures over time. A trend graph showed members how their overall rate for any preoperative testing compared in 2020, 2021, and the first half of 2022, with data points for their hospital, the MVC average, and their regional comparison group (Figure 2). There continues to be very little change in testing rates over time when looking at aggregated preoperative testing practices. The prevalence of low-value preoperative testing has remained high on average across the collaborative for three years and likely longer.

Figure 2.

A third figure included in this report shows the absolute change in the rate of any preoperative testing for their hospital’s highest volume surgical condition among laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy (Figure 3). In this figure, positive values represent an increase in annual preoperative testing from 7/1/2020 to 6/30/2022, and negative values represent a decrease. The MVC average for this metric was -2.3%, so there was a small net decrease in the average rate of any testing in that time period. Once again, the variation across the collaborative was notable, with some hospitals seeing greater than 40% swings in either direction – though some sites may see drastic changes to their rates if case counts are smaller.

Figure 3.

The remaining figures in the report provide preoperative testing rates for specific types of tests, with caterpillar plots for each condition to help benchmark performance to other hospitals across the state. The types of tests with the highest average testing rates across conditions are blood tests—which include complete blood count, basic metabolic panel, and coagulation tests—and electrocardiography tests. For a majority of hospitals, their testing rates are highest within the lumpectomy patient population regardless of test type, with the exception of urinalysis testing rates that are heavily driven by the cholecystectomy population.

The last time MVC shared preoperative testing reports was in July 2022, and since then MVC contributed to and launched resources to help healthcare providers implement changes. MVC members now have access to a sample preoperative testing decision aid for low-risk surgeries, developed in partnership with the Michigan Surgical Quality Collaborative (MSQC) and the Michigan Program on Value Enhancement (MPrOVE), and MVC (Figure 4). The decision aid also comes with a supplemental suggested preoperative testing chart that identifies which tests are recommended for patients who are classified by the American Society of Anesthesiologists (ASA) as Class III or above and undergoing low-risk surgery (Figure 5). Both resources are intended as guides and can be downloaded in their original file formats so hospitals may edit and adapt them within their institution. These resources were developed with input from one institution’s surgery, anesthesiology, and preoperative clinic teams, and based on clinical recommendations put forth by a number of professional societies.

Figure 4.

Figure 5.

These resources were added to a new resource website developed in partnership with MPrOVE, MSQC, and MVC. The goal of the site is to help providers safely “waive the workup” by providing the latest research, national recommendations, arguments against common myths, and frequently asked questions.

In addition, the MVC team is holding several workgroups in 2023 dedicated to preoperative testing. The first took place on March 15 and was heavily attended by MSQC and MVC members working to reduce preoperative testing as part of their P4P programs. A full recording of the workgroup is available here. MVC also has a preoperative testing workgroup scheduled for August 1, from 1-2 p.m., featuring guest presenter Nick Berlin, MD, MPH, MS, who has published several papers on patterns and determinants of low-value preoperative testing. A third preoperative testing workgroup is tentatively scheduled for October 26, from 11 a.m. to 12 p.m. Sites are encouraged to attend these events in order to learn best practices and collaborate with peers on common barriers.

For additional analysis or consultation on your hospital’s preoperative testing rates or practices, reach out to the MVC team for assistance at Michigan-Value-Collaborative@med.umich.edu.

20 Apr 2023
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MVC Evaluates Impact of MOQC Antiemetic Initiative on Healthcare Utilization During Chemotherapy

MVC Evaluates Impact of MOQC Antiemetic Initiative on Healthcare Utilization During Chemotherapy

April 20, 2023 | 0 Comments | , , ,

Chemotherapy-Induced Nausea and Vomiting (CINV) is among the most feared side effects of chemotherapy among cancer patients. It impairs the patient's quality of life and also adds to the morbidity and cost of therapy. That is why the Michigan Oncology Quality Consortium (MOQC)—a physician-led, voluntary collaborative of medical and gynecologic oncologists who work to improve the quality and value of cancer care in Michigan—initiated its Antiemetic Initiative. Through this initiative, MOQC supports participating oncology practices in aligning with current guidelines for use of prophylactic antiemetics, including olanzapine, in patients receiving chemotherapy. The Michigan Value Collaborative (MVC) recently partnered with MOQC to evaluate the impact of this initiative and estimated a cost savings of $334,095 across the course of chemotherapy from the increased use of olanzapine and decreased inpatient admissions in this cohort of patients.

Olanzapine is underused in patients receiving high-emetic-risk chemotherapy, despite evidence of efficacy and good patient tolerance (Navari et al., 2016). Olanzapine is a long-used medication (originally in higher doses for the treatment of psychosis) that is highly effective at decreasing nausea and vomiting. Uptake of olanzapine has been low, however, in part due to oncologists' lack of familiarity with the medication, lack of awareness or agreement with the guidelines, and lack of olanzapine inclusion on prepopulated order sets. The current labeling of olanzapine as an antipsychotic poses an additional barrier since this labeling generates additional concerns about stigma and side effects among patients. A benefit to this medication, in addition to its effect on nausea and vomiting, is its low cost compared with other medicines used to prevent the side effects of chemotherapy; the cost for each pill is about 25 cents.

Practices participating in MOQC’s Antiemetic Initiative receive performance data and baseline assessments in the area of CINV guideline adherence, support in identifying gaps in care and quality improvement measures, and resources for provider and patient education. To help evaluate the impact of this work on guideline-concordant olanzapine use, MOQC first reached out to MVC in 2022 to leverage its robust claims-based data. MOQC hypothesized that patients treated in medical oncology practices with low rates of olanzapine prescribing would have higher rates of healthcare utilization, including hospitalizations, emergency department (ED) visits, and unplanned outpatient visits between treatment cycles. The goal of this analysis was to estimate the initiative's overall impact on healthcare utilization for breast cancer patients undergoing chemotherapy as well as any related cost savings that improved the value of care delivery.

Methodology

The cohort for this analysis was comprised of female patients with a 90-day claims-based MVC episode of care for lumpectomy or mastectomy in 2016-2021 who received combination chemotherapy with doxorubicin and cyclophosphamide as either neoadjuvant or adjuvant chemotherapy. The cohort included patients covered by Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN HMO MA, and Medicare Fee-For-Service. The resulting MVC analysis included episodes for 1,891 patients who had a breast cancer resection, received both chemotherapy drugs on the same day, and were attributed to a MOQC provider/practice. Patients were attributed to 45 of MOQC's participating practices.

Practice-level olanzapine data collected by MOQC was then used to assess whether each patient's first chemotherapy receipt was during a time when their attributed practice had high or low prescribing rates of olanzapine. The threshold for high versus low prescribing at a particular practice was set at a 25% prescribing rate. Once a practice reached 25% prescribing rates of olanzapine in MOQC's data, that practice was considered to have "high" olanzapine prescribing rates in all subsequent months for this analysis. Using that distinction of whether the practice was a high or low prescriber during the course of the patient's chemotherapy regimen, MVC compared post-chemotherapy healthcare utilization among patients treated by high- versus low-prescriber practices. Sub-analyses further restricted the cohort to patients attributed to a practice that ever became categorized as having high olanzapine prescribing rates. When limiting the analysis to practices that became high prescribers at any point, the cohort was narrowed down to patients attributed to 15 MOQC practices.

Limitations

The nature of claims data limited MVC's ability to identify patients attributed to participating oncologists at MOQC practices; the requirement of each patient in the cohort having a MOQC provider NPI on one of their claims reduced the analytic cohort to a smaller size than what would be seen in clinical data. Another limitation is that the findings may include period effects not controlled for in this analysis. Practice behavior and availability of inpatient beds may have differed between when a practice was a low olanzapine prescriber compared to when they began prescribing olanzapine at a higher rate. Finally, payment calculations included in this analysis are limited to dollars saved among the attributed claims-based population and, therefore, do not reflect savings that may be attributed to olanzapine use among the broader population of interest.

Impact & Next Steps

A key finding in the analysis included a significant difference in healthcare utilization across the course of chemotherapy among patients treated by high olanzapine prescribing MOQC practices compared to when they had low olanzapine utilization. Among the patients with cancer who received their first cycle of chemotherapy when their provider's practice had a high prescribing rate (≥25%), 10% were hospitalized (Figure 1). This inpatient admission rate was significantly lower than for those patients undergoing chemotherapy regimens at practices with low olanzapine prescribing rates, 15% of whom were hospitalized (p=0.02). This finding was based on a subset of patients attributed to practices who eventually became high olanzapine prescribers during the study period (922 patients at 15 practices).

Figure 1. Rates of Inpatient Admission Across Patients' Course of Chemotherapy, by Practice's Utilization Rate of Antiemetics at the Start of Chemotherapy (N=922)

This analysis further discovered a significant difference in the percentage of patients who had either an ED visit or inpatient admission. Of the patients receiving chemotherapy at MOQC practices, fewer patients at high-prescribing practices had either an ED visit or inpatient admission (19%) across the course of their treatment compared to patients receiving care at low-prescribing practices (26%).

MVC estimated a cost savings of $334,095 across the course of chemotherapy from the increased use of olanzapine and decreased inpatient admissions in this cohort of patients. Dollars saved were calculated by taking the number of patients whose chemotherapy began when their practice was a high prescriber (525), multiplied by the difference in the percentage of patients with an inpatient admission across the course of chemotherapy attributed to practice antiemetic prescribing rate (5.3%), multiplied by the average price-standardized payment for an inpatient admission during a 90-day episode of care among breast cancer resection episodes for the included payers ($12,007).

This analysis demonstrated further evidence that the use of prophylactic olanzapine is an effective strategy for managing CINV-related ED visits or hospitalizations. It furthermore identified tangible CQI impact in the form of patients who underwent breast cancer treatment being less likely to visit the ED or be hospitalized over the course of their chemotherapy regimen, as well as in the form of dollars saved on facility inpatient costs across the course of chemotherapy. Ongoing work will continue to support practices to make changes in the use of olanzapine, not only in patients receiving combination therapy with doxorubicin and cyclophosphamide but also in other high-emetic-risk regimens.

MVC’s expertise and data frequently result in partner projects like this; MVC completed a number of CQI impact assessments last year, as well as several more so far in 2023. MVC also participates in collaborative activities with peer CQIs through new condition and report development, data analysis and metric consultation, and data matching exercises that pair clinical and claims-based data. To request a copy of any of MVC’s completed CQI impact assessments, please contact the MVC Coordinating Center.