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MVC to Honor Medical Pioneers for February’s Black History Month

MVC to Honor Medical Pioneers for February’s Black History Month

Black History Month is an opportunity to celebrate the triumphs and reflect on the struggles of African American or Black persons throughout the history of the United States. In honor of this celebration, the MVC team is highlighting some of the Black pioneers who opened doors to medical fields and advanced the field of health through research.

It seems logical to begin by highlighting the work of James McCune Smith (Figure 1), notably America’s first Black physician. He received a medical degree from the University of Glasgow in 1837, when African Americans were denied admission to medical schools in the U.S. He also later became the first Black man to operate a pharmacy as well as the first Black author to be published in a medical journal. He applied his scientific mind and expertise to debunking poor science, outdated assumptions, and racist theories related to African Americans. As an abolitionist and close friend of Frederick Douglass, he wrote the introduction to Douglass' book, My Bondage and My Freedom.

Figure 1.

He was followed by many inspiring African American and Black healthcare providers who made history in their respective fields. There were leaders such as Daniel Hale Williams (1856-1931), who founded the Provident Hospital and Training School for Nurses in Chicago, America’s first Black-owned and interracial hospital. He is also known for having performed the world’s first successful heart operation, which saved the life of a man who had been stabbed in the chest.

Then there was Robert F. Boyd (1858-1912) who in 1895 co-founded the National Medical Association, the nation’s oldest and largest organization representing Black physicians and health care professionals. He served as its first president.

Alexa Canady (Figure 2), born in 1950, is also a Black physician of great strength and impact. She fought her way into one of the most competitive and exclusive fields of medicine when she became the first Black female neurosurgeon in the U.S. in 1981. She is an alumnus of the University of Michigan Medical School who specialized in pediatric surgery. She became chief of neurosurgery at the Children’s Hospital of Michigan from 1987 until her retirement in June 2001.

Figure 2.

As representation and institutional support grew, so too did the voice of African Americans in published medical research. Prominent physician and researcher Charles Richard Drew (1904-1950) studied blood transfusions and helped develop large-scale blood banks deployed during World War II. Patricia Bath (1942-2019), an ophthalmologist dedicated to blindness prevention in marginalized communities, was the first Black female physician to be awarded a medical patent for her invention of a laser cataract treatment.

A wealth of researchers working today dedicate their expertise to studying disparities, race, and ethnicity in healthcare. The Agency for Healthcare Research and Quality (AHRQ) honored Black History Month recently by highlighting the work of its grantees. Dr. Fabian Johnston, for instance, studies early utilization of palliative care for African Americans using culturally informed patient navigation, and Dr. Mya Lee Roberson evaluates geographic variation in breast cancer surgical outcomes among Black women in the South. AHRQ’s spotlight for Black History Month also includes an expansive list of recent research findings and publications related to race and health equity.

These professionals and countless others had a profound impact on medicine, research, and society. However, Black History Month is also a time to acknowledge the struggles and ongoing challenges experienced by the African American and Black communities. While much of the 20th and 21st centuries allowed for a series of “firsts,” they also bore witness to abhorrent racism that resulted in gruesome experiments, forced sterilizations, harmful research studies, and undertreatment for pain. As a result, there is rampant mistrust of the healthcare system within the Black community, even among some medical professionals. This was evident throughout the COVID-19 pandemic; hospitalized patients who did not trust healthcare providers were less likely to believe they were at increased risk of severe illness and were less likely to become vaccinated.

The MVC Coordinating Center is committed to emphasizing equitable care in Michigan by providing members with equity metrics and collaboration opportunities. The MVC team set several concrete goals to share research findings and resources throughout 2023 in service of members’ equity-related initiatives. Some of these resources may be used to build communication and trust with patients and solicit their input on healthcare practices.

In addition, those who follow MVC on Twitter or LinkedIn will see additional stories about African American medical pioneers throughout the remainder of February. If you have a colleague or individual you would like to nominate to be featured this month, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

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MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

The birth of a child is a life-changing experience and a significant clinical event, with those experiencing pregnancy and childbirth hoping for a positive experience and healthy outcome. Yet the maternal mortality rate in the United States was 23.8 per 100,000 live births in 2020, and four in five pregnancy-related deaths were preventable according to the CDC. One in four of these deaths occur on the day of delivery or within one week, with considerable evidence that negative outcomes are more likely for patients of color. These findings are evidence of the need for quality improvement initiatives that ensure all people who are pregnant or postpartum receive the care they need. In light of this, the Michigan Value Collaborative (MVC) recently collaborated with the Michigan Health and Hospital Association (MHA) Keystone Center on the development of a statewide report on birth outcomes.

MVC claims data comprise approximately 84% of Michigan's insured population; these data are processed into 30- and 90-day price-standardized and risk-adjusted episodes of care that allow MVC to identify practice variation and measure the value of care. MVC creates episodes for over 40 medical and surgical conditions, including vaginal and cesarean childbirth delivery. MVC used a subset of claims from its data on Michigan childbirth episodes to create this new statewide report. The goal was to highlight statewide disparities in care and support the MHA Keystone Center and the Michigan Alliance for Innovation on Maternal Health (MI AIM) in their efforts to increase equitable care and decrease preventable severe maternal morbidity and mortality in Michigan.

MVC’s new statewide childbirth episodes report provides information on total episode payments, mode of delivery, patient characteristics, and rates of certain birth-related complications using 90-day episodes of care for vaginal and cesarean delivery. Measures in this report are based exclusively on Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial episodes for childbirth index admissions that occurred at MVC-participating hospitals between 1/1/19 and 12/31/21. Hospitals in this report were unidentified and each was required to have a minimum of 20 childbirth episodes across the reporting period to be included. Similarly to other MVC reports, several metrics were displayed by the index hospital’s geographic region of Michigan as categorized by MVC (see MVC regions here), with others stratified by race or mode of delivery.

The analysis found an average price-standardized, risk-adjusted 90-day total episode payment of $7,765 for vaginal delivery and $10,264 for cesarean delivery (Figure 1), with average index lengths of stay of 3.1 and 4.0 days, respectively. Additionally, the overall rate of cesarean delivery was 32.3% in July-Dec. of 2021, a slight increase compared to cesarean rates in 2019 and 2020 (Figure 2).

Figure 1. Average Price-Standardized and Risk-Adjusted 90-Day Total Episode Payments by Mode of Delivery, Overall and by Hospital

Figure 2. Rates of Cesarean Delivery, 2019 Through 2021, Overall and by Region of Michigan

Overall, 7.5% of patients had a diagnosis of hemorrhage, 4.2% had a diagnosis of hypertension, and 1.8% had a diagnosis of severe maternal morbidity (SMM) during their index birth hospitalization. A notable finding was the difference in rates of these complications by race (Figure 3). Patients who were identified as Asian or Pacific Islander had higher rates of hemorrhage than other race categories, and patients who were identified as Black had higher rates of hypertension and SMM than the overall population. This is consistent with other research findings related to disparate health outcomes for non-white patients.

Figure 3. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity (SMM), Overall and by Race

Health disparities such as these are an area of focus within the MVC Coordinating Center’s broader strategic framework. MVC’s health equity sub-committee meets regularly to strategize how to emphasize equity among its membership and support related quality improvement initiatives. The Coordinating Center’s aim is to use MVC data to help members identify areas of opportunity and support quality improvement through collaboration with peers. To this end, MVC is currently developing a hospital-level adaptation of the new statewide birth outcomes report to share site-specific data with its members later this year.

“Claims data such as those included in MVC’s episodes of care present a great opportunity to use state-wide data to highlight important findings and disparities related to birth outcomes in Michigan,” said Kristen Hassett, the lead MVC analyst for the analysis. “This report represents an important step in MVC’s work to identify areas of health inequality and then support initiatives to reduce those disparities.”

For the MHA Keystone Center, the statewide report provides valuable data to further inform its work.

“We are proud to partner with organizations like the Michigan Value Collaborative to collect and examine critical data related to childbirth within Michigan health systems,” said Sarah Scranton, vice president of safety and quality at MHA and executive director of MHA Keystone Center. “By evaluating hemorrhage, hypertension and severe maternal morbidity rates across several regions of the state, we are able to address the challenges facing Michigan mothers and birthing centers.”

The MVC statewide childbirth episodes report will aid MHA’s field engagement team while they engage with hospitals not yet partnering with MI AIM. Since its adoption in Michigan in 2016, MI AIM has contributed to significant improvement in hemorrhage-related SMM, hypertension-related SMM, and overall SMM through the implementation of hemorrhage, hypertension, and sepsis patient safety bundles with Michigan birthing hospitals.

To view the complete report, visit the MVC website. The Coordinating Center welcomes any additional questions about the report findings or any custom report analyses inspired by its creation. Contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.

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MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

Next week marks the kickoff of American Heart Month, commemorating the more than 600,000 Americans who die from heart disease each year and raising awareness about strategies that support heart health. Cardiac rehabilitation (CR) is one of those critical strategies, with the second full week of February each year dedicated to promoting its role in reducing the harmful effects of heart disease. In support of efforts to promote this life-saving program, MVC will host a CR-focused workgroup on Feb. 16, from 2-3 p.m., with MVC Co-Director Mike Thompson, Ph.D., assistant professor in the Department of Cardiac Surgery at Michigan Medicine, as its guest speaker. He will highlight some recent efforts to increase patient enrollment.

This is the third time MVC has hosted a workgroup dedicated to CR utilization; the first took place during last year’s CR week in February 2022 and featured guest presenters Steven Keteyian, Ph.D., Director of Preventive Cardiology at Henry Ford Medical Group, and Greg Merritt, Ph.D., patient advocate, in a discussion about strategies for increasing CR use. The second in November 2022 featured Diane Hamilton, BAA, CEP, of Corewell Health Trenton Hospital, who discussed addressing transportation barriers as an obstacle to CR attendance.

CR is a medically supervised program encompassing exercise, education, peer support, and counseling to help patients recovering from a cardiac event, disease, or procedure. There is high-quality evidence that it saves lives and money. A 2016 meta-analysis estimated that for every 37 coronary heart disease patients who attended CR, one of their lives was saved on average. Additionally, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) and the Michigan Value Collaborative (MVC) came together recently to measure the impact attributed to CR for percutaneous coronary intervention (PCI) patients treated between 2015 and 2019, and estimated 86 lives saved, 145 readmissions avoided, and approximately $1.8 million in savings.

Despite the evidence in favor of its clinical impact and cost-effectiveness, CR remains heavily underutilized, with only one in three eligible Michiganders participating. MVC’s hospital-level cardiac rehab reports showcase similar findings (Figure 1). These reports were rebranded recently under the new Michigan Cardiac Rehabilitation Network (MiCR) umbrella in partnership with BMC2. They measure whether and when patients started CR at MVC hospitals and how long they kept going. The collaborative-wide average for PCI patients, for example, was 38.3%, with hospital rates ranging from approximately 10%-60%. Such a wide range in patient participation rates suggests MVC member hospitals would benefit from the insights of top-performing peers.

Figure 1.

MVC is pursuing several strategies to address this critical gap in utilization. The upcoming Feb. 16 workgroup will be one of several CR-focused workgroups offered throughout 2023. The Coordinating Center decided to offer workgroups on this topic in part because of its recent incorporation of a CR measure into the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. MVC member hospitals were recently asked to make metric selections for the upcoming Program Year 2024-2025 cycle, and as of February 2023 just over one quarter of hospitals elected to be scored on their CR rates for the new value metric component of the MVC measure. These hospitals will receive more P4P points if their CR utilization rate improves over time or is greater relative to their peers. These hospitals are currently treating the patients who will make up their performance year data for Program Year 2024 of the MVC measure. Therefore, MVC aims to offer tailored workgroups to support those sites being scored on CR utilization, most likely incorporating some unblinded data presentations and highlighting key resources and practices for quality improvement purposes.

The MVC team hopes these efforts to facilitate peer learning within the collaborative will help hospitals across the state improve CR participation. Doing so would save the lives of patients and improve the value of healthcare in Michigan. Sites that selected CR as their value metric component of the MVC P4P measure are encouraged to attend; however, anyone interested in this area of healthcare is welcome. Those interested in attending may register here. Please contact the MVC Coordinating Center with any questions at Michigan-Value-Collaborative@med.umich.edu.

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Healthy Weight Awareness Month Inspires Workgroup Collaboration

Healthy Weight Awareness Month Inspires Workgroup Collaboration

This January, healthcare organizations and advocacy groups across the country are promoting Healthy Weight Awareness Month, as well as innovations in weight loss procedures. In alignment with this national conversation, MVC recently hosted its first workgroup of 2023 with a guest presentation by Oliver Varban, MD, FACS, FASMBS, Associate Director at the Michigan Bariatric Surgery Collaborative (MBSC), about obesity in Michigan, the main challenges of treatment, and how MBSC uses data to improve surgical management outcomes. The aim of such workgroups is to impart relevant data, best practices, and success stories for the benefit of MVC members and partners working in that clinical area.

According to data from CDC, the prevalence of obesity increased from 30% to 42% over the past 20 years, with 41% of Americans currently considered clinically obese. Excess body weight is associated with many different conditions and comorbidities (e.g., certain types of cancer, heart disease, diabetes, and stroke) and is a risk factor for increased severity and fatality of various conditions, such as those who experienced more severe illness from COVID-19 infection. Clinical management interventions range from screening and lifestyle changes to medication and surgery.

Identification and treatment of obesity often begins by measuring a patient’s body mass index (BMI), an estimate of body fat based on height and weight. The CDC uses BMI to measure obesity, but this measure falls short in several ways. For one, the accuracy of the measurement is lower among men, the elderly, and those in the intermediate BMI ranges. In addition, racial groups experience differing levels of disease for a given BMI. On its own BMI is not an accurate predictor of health. There are also a number of complex connections to social determinants of health since patients residing in environments with more limited access to healthy food and physical activity often have higher BMIs.

MBSC has been working to support quality improvement in healthy weight management since 2005 and aims to innovate the science and practice of metabolic and bariatric surgery through comprehensive, lifelong, patient-centered obesity care. MBSC utilizes its extensive clinical registry data to generate tools that support clinicians and patients in decision-making, including several patient- and provider-facing tools that outline a patient’s likely risks, benefits, and costs for various treatment pathways.

Given obesity’s prevalence and association with other chronic conditions, improved outcomes for patients managing obesity have far-reaching implications. Therefore, MVC and MBSC partnered last year to measure the value of bariatric surgery in treating diabetes, one of the most common and costly chronic conditions. According to the American Diabetes Association, $1 in $7 healthcare dollars are spent treating diabetes and its complications, and patients diagnosed with diabetes face 2.3 times the average person's healthcare costs. The analysis performed by MVC and MBSC was largely driven by existing evidence in the literature that bariatric surgery resolved or improved Type 2 diabetes symptoms in a large proportion of patients (Varban et al., 2022). Using its rich administrative claims data sources, MVC helped analyze pre-surgery and post-surgery receipt of diabetes medications, which was used to estimate the overall impact across Michigan and its estimated cost savings due to a decrease in post-surgery diabetes medication prescription fills.

The most impressive finding of the analysis was a significant decrease in the percentage of bariatric surgery patients who filled any diabetes prescription post-surgery (Figure 1), with over 50% of patients who previously used diabetes prescriptions taking no medications within 120 days post-surgery. This amounted to an annual cost savings of about $4,133 per patient. Five years post-surgery, the continued estimated cost savings from reduced reliance on prescriptions ($20,665) surpassed the average price-standardized total episode cost of bariatric surgery ($14,832). These results provide evidence of statewide clinical outcome improvement and cost savings for Type 2 diabetes following bariatric surgery. A summary of this return-on-investment analysis was developed and publicized by MBSC and MVC in August 2022.

Figure 1.

This analysis was also evidence of the opportunities for cross-collaboration and information sharing in obesity care—between primary care providers, chronic disease management care teams, and bariatric surgeons; between collaborative quality initiatives with varying clinical, value-based, and socioeconomic focuses; and between providers, their patient, and their patient’s families. Obesity is a clinical diagnosis with extensive social complexities and implications for one’s physical and mental health. Improving support and care for those in seek of treatment requires intentional, innovative collaboration.

The complete recording of Dr. Varban’s recent MVC Health in Action workgroup presentation and the discussion that followed are available on MVC’s YouTube channel. Those with questions about any of the above-mentioned materials or analyses are welcome to contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu. MVC’s next workgroup takes place on Tues., Jan. 24, from 11 a.m. - 12 p.m., featuring a guest presentation by Karla Stoermer Grossman, MSA, BSN, RN, AE-C, Clinical Site Coordinator at the Inspiring Health Advances in Lung Care (INHALE) Collaborative Quality Initiative. Register to join us and hear about INHALE’s approach to improving outcomes for patients with asthma and chronic obstructive pulmonary disease.

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Latest PO Joint Replacement Report Adds Outpatient Rehab Rates, Demographics, and More

Latest PO Joint Replacement Report Adds Outpatient Rehab Rates, Demographics, and More

MVC proudly partners with 40 physician organizations (PO) spanning the state of Michigan and continues to refine and add to the resources tailored to these members. As part of this work, MVC recently refreshed and shared PO joint replacement reports in December. These PO-level reports were first shared in October 2021 with a focus on the shift away from inpatient surgeries as well as post-acute care utilization for combined joint procedures.

The recently refreshed reports carried forward many of the joint episode metrics included previously, but with additional stratification and detail. For instance, whereas the 2021 version presented figures for all joint surgeries combined, many of the figures in the December 2022 version provided data stratified by hip procedure, knee procedure, and all joint procedures. Similarly, some figures are stratified by the location of the procedure (inpatient vs. outpatient). This new differentiation was intended to help POs more easily understand the underlying drivers of their metrics. For example, the blinded hospital below (Figure 1) could observe that its average 30-day price-standardized total episode payment is driven more by hip surgeries ($17,399) than knee surgeries ($16,643). This site could also observe that its overall total episode payment is below both the collaborative-wide PO average and the average in their region, and at the average for other POs of a similar size.

Figure 1.

Additional detail was also added to the patient attribution table, which now identifies the top 10 index facilities (rather than five) where a PO’s attributed patients underwent joint replacement surgery. This table now also includes each index facility’s percent of joint episodes performed in an outpatient setting as well as their average 30-day price-standardized total episode payment for attributed patients. This change was intended to inform quality improvement discussions between POs and partner hospitals or Ambulatory Surgical Centers (ASCs).

Also new to this report were 30-day outpatient rehabilitation rates and a patient population snapshot table to help POs better understand the demographics of patients included in the report. The table included mean age, top two patient Zip codes, the percent of patients living in an “at-risk” or “distressed” Zip code according to the Distressed Communities Index, the proportion of patients belonging to different racial categories, their average length of stay, and their 30-day post-surgery complication rate. Each of these categories was summarized separately by insurance plan.

This report utilized administrative claims from attributed members spanning 1/1/19 – 6/30/21 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM Medicare Advantage, and Medicare Fee-for-Service. Reports were prepared for all POs that participate in MVC and had at least 20 joint replacement episodes in 2019 and 2020, and at least 11 episodes in the first half of 2021.

In general, report findings indicated that utilization of outpatient surgery settings continued to increase in 2021 on average (Figure 2). However, there was still significant variation between MVC’s 40 PO members in their average rate of joint replacement surgeries taking place in outpatient settings (Figure 3). For joint episodes in 2019 through the first half of 2021, outpatient surgery rates ranged from just over 20% to nearly 80%.

Figure 2.

Figure 3.

On average across the collaborative, POs still had low rates of skilled nursing facility (SNF) utilization (6.7%) and higher rates of home health (HH) utilization (55.3%). However, variation in PO member HH utilization rates ranged from approximately 10% to 90%.

If you have feedback on your new PO joint replacement report or would like to request an additional custom analysis to better fit your needs, contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

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MVC Coordinating Center Looking Back at 2022 and Forward to 2023

On behalf of the MVC Coordinating Center, I’d like to start by wishing you all a very happy and healthy new year! MVC had a stellar 2022 with a wide range of successful activities, all while continuing to support hospitals, physician organizations, and CQI partners.

Over the course of 2022, MVC welcomed three new members to the collaborative, distributed 21 push reports, grew its analytic offerings by adding pharmacy administrative claims as well as race and equity-related data sets, delivered 23 custom analytic requests, hosted 33 virtual workgroups across six focus areas, advanced both of its value coalition campaigns, and returned to in-person events for the first time since 2019. Additionally, a number of exciting improvements were made to the MVC registry: the creation of three new conditions (endocarditis, small bowel obstruction, and nephrectomy), new filters for patients with a diagnosis of chronic kidney disease or venous thromboembolism, and new comparison groups allowing member hospitals to compare their data to other general acute care hospitals or Critical Access Hospitals.

Additionally, a key MVC accomplishment in 2022 was achieving accreditation as a Qualified Entity (QE) through the Qualified Entity Certification Program (QECP), also known as the Medicare Data Sharing for Performance Measurement Program. As a QE, MVC was able to launch 20 new QE reports on the MVC registry, which give authorized users the ability to drill down into patient-level Medicare data, and recently released its first Qualified Entity Public Report following the completion of MVC’s QECP phase three application.

The Coordinating Center is excited for what’s to come in the new year, with MVC celebrating 10 tremendous years advancing its vision of more sustainable, high-value healthcare in Michigan. MVC looks forward to continuing this work and growth into 2023. There are a number of plans for the coming year that I am excited to share with you.

New Push Reports

A number of new reports will be added to MVC’s suite of reporting in 2023, focusing on topics such as transitions of care, health equity, and the revised Program Year (PY) 2024-2025 metrics of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. The Coordinating Center will work closely with members, the wider CQI community, and other stakeholders to ensure the continued distribution of novel and valuable reporting.

New and Returning MVC Workgroups

The Coordinating Center’s suite of peer-to-peer virtual workgroups will continue to provide a highly accessible online platform for hospital and PO leaders to come together, collaborate, and share practices. MVC will continue offering regular sessions focused on chronic disease management, diabetes, health equity, and health in action. In addition, MVC is looking to host collaborative learning communities for the PY 2024-2025 P4P value metric cohorts, such as the sites that selected cardiac rehabilitation.

Collaborative-Wide Meetings & Reimagined Engagement Events

The MVC team will continue to hold two flagship semi-annual collaborative-wide meetings. These will take place on Friday, May 19 at the VistaTech Center in Livonia and on Friday, Oct. 20 at the Radisson Hotel in Lansing. The MVC team also plans to test new approaches for peer networking to better support practice sharing, such as bringing together sites with similar patient populations and partnering with members to develop impact stories about their quality improvement efforts. Stay tuned for additional details.

Return-on-Investment Analyses

The MVC Coordinating Center made an active effort in 2022 to help its partners measure the impact of their initiatives from an investment and value perspective. MVC’s expertise in this area and its strong relationships throughout the CQI portfolio led to the commission and completion of four ROI exercises last year with additional ROIs in progress in 2023. Similarly, MVC continues to offer its members the ability to request custom analyses using metrics, payers, and date ranges that they specify in order to better understand areas of opportunity. If you are interested in learning more, please submit a Custom Analytics Request and a member of the MVC team will follow up.

As we kick off 2023, I’d like to thank our hospital members, PO members, and CQI partners for their continued collaboration and support. We look forward to working with you throughout the coming year!

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MVC Q4 Newsletter Highlights EOY Success Stories

MVC Q4 Newsletter Highlights EOY Success Stories

The Michigan Value Collaborative's quarterly newsletter provides in-depth synopses of MVC events, updates, and spotlights on members and partners. The final newsletter of 2022 was released this week (Figure 1), summarizing the activities and accomplishments that took place in Q4 of this year. First and foremost, the Coordinating Center thanked its members for their partnership in what turned out to be a very active year and highlighted new additions to the collaborative, including new hospital member Bronson Lakeview Paw Paw and new MVC Site Engagement Coordinator Kristy Degener.

Figure 1. Page 1 of MVC December Newsletter for Q4 of 2022

This edition included a full synopsis of MVC's 2022 Fall Semi-Annual Meeting, outlining the unblinded data session and the topics covered by the many talented and inspiring guest speakers. It also called attention to important updates that will impact Program Years 2024-2025 of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program, outlining some aspects of the program structure that are changing and some that are staying the same as previous program cycles. Finally, the December newsletter highlighted the large portfolio of work that was taken on by MVC staff in partnership with its peer Collaborative Quality Initiatives (CQIs), highlighting in particular four completed return-on-investment analyses and several spotlights on the MVC blog.

The publication of MVC's final newsletter in Q4 coincides with MVC's submission of its end-of-year progress report to funder BCBSM. In developing this impressive summary document, MVC developed an infographic that highlights key statistics and accomplishments from the past six months (Figure 2). MVC plans to distribute a public version of this summary report, MVC's Annual Report, in January 2023. In the meantime, read the full MVC Q4 December Newsletter here.

Figure 2. Summary Infographic of MVC Activity, 7/1/22-12/31/22

The MVC Coordinating Center looks forward to continuing its work in 2023 and wishes everyone a happy holiday season and new year!

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MVC Team Welcomes a New Site Engagement Coordinator

MVC Team Welcomes a New Site Engagement Coordinator

I am excited to join the Michigan Value Collaborative (MVC) in the role of Site Engagement Coordinator. Through my experiences, I have developed a passion for quality improvement in the delivery of healthcare. I have engaged in the collaborative nature needed to improve health outcomes firsthand, and I am excited to foster this environment as a Site Engagement Coordinator with MVC.

Having lived in New York my entire life, I enjoyed exploring what Michigan has to offer in my first few months here. I love being outdoors and finding new hobbies for all seasons of the year. I enjoy participating in triathlons during the summer months and skiing in the winter. I love spending time with family and friends, and my dog, Sable.

I received my undergraduate degree from the State University of New York at Geneseo, where I majored in biology and minored in Spanish. After completing my bachelor’s degree, I earned my Master of Public Health (MPH) from the State University of New York at Albany with a concentration in social behavior and community health.

While completing my MPH, I had the opportunity to work as a Graduate Student Assistant at the New York State Department of Health within the Division of Family Health and the Office of Quality and Patient Safety. Within the Division of Family Health, I provided programmatic assistance to the intervention projects of the New York State Perinatal Quality Collaborative, an initiative that aims to provide the best, safest, and most equitable care to birthing people and infants across New York State.

Within the Office of Quality and Patient Safety, as a part of an evidence-based intervention to increase colorectal cancer screening rates in the Medicaid Managed Care (MMC) population, I worked directly with MMC enrollees to provide them with necessary screening information and connections to appropriate screening resources.

In my most recent role, I served as a Community Support Specialist Team Supervisor for the New York State COVID-19 Contact Tracing Initiative. This position allowed me to be at the forefront of New York State’s efforts to control the spread of COVID-19 and support those who were in isolation and quarantine due to the pandemic.

As Site Engagement Coordinator, I look forward to developing and strengthening partnerships between MVC members and working together to improve the health of Michigan through sustainable, high-value healthcare. If you have any questions, please contact me at kdegener@med.umich.edu.

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New MI Mind CQI Connects Body and Mind to Health in Michigan

New MI Mind CQI Connects Body and Mind to Health in Michigan

Suicide is a leading cause of death in the United States. It claimed nearly 46,000 lives in 2020—a rate 30% higher than two decades ago. More recent data has even shown an increase in the rate of suicide after two years of declining rates. In the state of Michigan, the suicide mortality rate was 14 per 100,000 people.

There are significant opportunities for suicide prevention in primary care and other healthcare settings. Research suggests that patients seek care from primary care physicians within 30 days of establishing a suicide plan or attempting suicide. Furthermore, for every suicide death, there are four hospitalizations and eight emergency department visits (Figure 1).

Figure 1.

In response to this significant health need in Michigan, Blue Cross Blue Shield of Michigan partnered with Henry Ford Health to launch a new Collaborative Quality Initiative (CQI) called the Michigan Mental Innovation Network and Program Design (MI Mind). The MI Mind Coordinating Center team brings providers, health systems, and suicide prevention experts together to reach shared goals of improving suicide prevention, care, and access to key behavioral health services in Michigan. Its mission is to engage psychiatrists, psychologists, and primary care physicians in the use of care pathways to reduce suicides in Michigan significantly.

The core program is a collaboration with provider organizations that aims to determine and implement system-specific suicide prevention elements and use data to implement rapid cycle quality improvement processes. MI Mind hopes to assess what levels and characterizations of risk are most urgent and can be addressed by clinicians to inform recommendations for suicide prevention and quality improvement. The MI Mind program will help facilitate enhanced collaboration and referrals among behavioral health and primary care clinicians and promote purposeful screening for suicidal risk. The MI Mind team aims to train clinical staff using the well-established Zero Suicide protocol and anticipates the program will improve patient support, enable more effective and efficient healthcare, and reduce suicide rates.

The MI Mind collaborative is co-led by Program Director Brian Ahmedani, PhD, LCSW, who is internationally recognized for his work in suicide prevention and the Director for the Center for Health Policy and Health Services Research at Henry Ford Health; and Program Director Cathrine Frank, MD, a practicing and board certified psychiatrist widely regarded as the original clinical architect of the Zero Suicide program and Chair of the Department of Psychiatry and Behavioral Health Services at Henry Ford Health.

For more information on MI Mind, visit their website, where a variety of easy-to-use, organized tools and materials or available for the benefit of primary care providers, behavioral health professionals, patients, and their loved ones. Providers may also contact the MI Mind Coordinating Center at MiMIND@hfhs.org. In addition, the 988 Suicide and Crisis Lifeline (previously the Suicide Prevention Lifeline) is available to provide equitable and accessible suicide prevention support across the United States.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is mindful that many other CQIs also partner with hospitals and providers throughout Michigan. MVC posts recurring feature blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with any suggestions or questions.

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Understanding MVC Episode Creation and the Meaning of Data

Understanding MVC Episode Creation and the Meaning of Data

The Michigan Value Collaborative (MVC) houses a wealth of administrative claims data for Blue Cross Blue Shield of Michigan, Blue Care Network, and Medicare Fee-For-Service beneficiaries in Michigan. These data provide valuable insights about health services utilization, patient outcomes, and the value of care received at facilities across Michigan. To gain meaningful insight from large sets of unprocessed claims data, MVC transforms these claims into 30- and 90-day episodes of care for over 40 different medical conditions and surgical procedures. These episodes are the core of MVC analytics and result in the data available to MVC members through the online data registry and push reports. In order to best understand the meaning of MVC analytic outputs, it’s important to know what an MVC episode actually includes and how it is created.

One of the ways that MVC provides insights into episodes of care is with data on payments for professional and facility healthcare services. A foundational aspect of MVC data is that payments are price standardized and risk adjusted. In other words, the payments that MVC shares in its reports and on the registry are not representative of actual dollars; they represent utilization of healthcare services that account for patient, provider, and payer differences for fairer comparisons between members and over time. Price standardization removes variation due to various factors that impact insurer payments, such as the payer, contractual agreements, geographic location, and time (see example scenario in Figure 1).

Figure 1.

On the other hand, risk adjustment accounts for differences between patients, because some patients have more healthcare needs than others and may experience a worse outcome or require greater amounts of care than another patient. Risk adjustment helps with fair comparisons between hospitals that see more complex patients compared to those with fewer complex patients. MVC’s risk adjustment always accounts for patient age, gender, payer, history of high healthcare expenditures, and comorbidities such as end-stage renal disease. It also sometimes accounts for condition-specific factors. Together, price standardization and risk adjustment allow for patients and hospitals to be compared more accurately and fairly in MVC reporting.

How are MVC episodes created?

Episodes are initiated by one of three types of index events: inpatient admission to a hospital, an emergency department visit resulting in an inpatient admission to a hospital, or an outpatient procedure at a hospital. To become an MVC episode, these initiating events must have corresponding billed and paid insurance claims that fit into the episode definition of an MVC condition. These definitions are typically comprised of inclusion and exclusion codes for ICD-9-CM and ICD-10-CM diagnosis codes, ICD-9-PCS and ICD-10-PCS codes, and/or CPT codes. Generally speaking, episodes of medical conditions have an initiating facility or professional inpatient claim with a qualifying diagnosis code in the primary diagnosis code position. For example, a patient admitted to an inpatient hospital with a primary diagnosis code of R65.20 (severe sepsis without septic shock) may have a sepsis episode in MVC data. The criteria for initiating surgical episodes are more varied and depend on the procedure. For more details about condition-specific episode definitions and rules, please refer to the MVC Episode Definitions document available on the resources page of the MVC registry.

Once an episode is initiated, the claims that follow are attached to that episode and categorized into payment components (Figure 2). The span of the initiation of an episode through initial discharge is called the index event, for which MVC aggregates facility claims and associated price-standardized facility payments for the base payment as well as outlier and transfer payments, if applicable. The claim categories after index discharge make up the bulk of an episode. This post-discharge aspect of MVC episodes allows hospitals to follow their patients after they leave the hospital's four walls. For the 30 or 90 days after discharge, facility claims for that patient’s episode are price-standardized and categorized into post-acute care and inpatient readmission components. Post-acute care is further sub-categorized into the following categories: emergency department (ED), home health care (HH), skilled nursing facility (SNF), rehab (inpatient and outpatient), and outpatient facility-based services. For greater detail about MVC episode creation, see the MVC Data Guide on the resources page of the MVC website.

Figure 2.

While facility claims and their respective price-standardized payments are grouped into various categories, the price-standardized professional payment spans the entirety of the episode. Since claims for facility and professional-based services are billed separately, they can be brought together by service dates for a more comprehensive summary of care. The resources page on the MVC website contains a more detailed breakdown of episode payment components.

How are episodes used?

Once episodes are created, the MVC Coordinating Center analyzes these data to answer a variety of questions about health services utilization. For example, what proportion of a hospital’s joint replacement patients are going to a SNF after their procedure? How does that compare to the statewide average? How long is the average length of stay for a hospital’s sepsis patients? What proportion of sepsis patients are admitted to the ICU/CCU during their hospitalization? There are many questions surrounding utilization and outcomes that MVC utilizes its data to help answer. MVC episodes can help inform a wide variety of quality improvement initiatives for numerous conditions.

In addition to some of the measures mentioned above, MVC frequently includes comparison groups in reporting as a point of reference, which allows hospital and physician organization (PO) members to compare their performance, utilization, or outcomes with the collaborative average, regional average, or other individual hospitals or POs. MVC comparison groups are sometimes further tailored by size or type, such as by critical access hospital status or by PO size. See Figure 3 for a sample caterpillar plot from a recent chronic obstructive pulmonary disease (COPD) report for POs.

Figure 3.

While claims-based analytics can provide insights into health services utilization, it doesn’t always reveal the full picture. MVC encourages members to use its push reports and custom reports in conjunction with electronic medical record data and as conversation starters with staff and clinicians working on particular conditions or service lines. Additionally, many MVC conditions align with other collaborative quality initiatives (CQIs). As the MVC team collaborates with other CQIs to combine clinical and claims data, MVC encourages cross-collaboration of site champions to foster partnerships and information sharing.

The MVC Coordinating Center is always open to comments and suggestions to help improve its portfolio of analytic offerings. If you or your team has any feedback on existing reports, suggestions for new reports, or interest in new MVC conditions, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.