As part of the Michigan Value Collaborative’s commitment to improve the health of Michigan through sustainable high-value healthcare, the Coordinating Center has developed specific focus areas which member hospital and physician organization collaborations are concentrated to drive improvement. These are termed our ‘Value Coalition Campaigns’ (VCCs). MVC’s current VCCs focus on equitably increasing participation in cardiac rehabilitation, reducing the use of unnecessary preoperative testing for surgical procedures, optimizing inpatient post-acute care after major joint replacement, and improving chronic disease management. Further information on each of these VCCs is provided below.
Cardiac rehab (CR) has a Class IA indication, meaning there is high-quality evidence that it is beneficial. Nevertheless, CR is widely underused, with national utilization rates only 20-30% and, in Michigan, a large disparity between CR referral and CR attendance. By using our 90-day episode claims data to provide time-specific hospital-level information on CR enrollment and completed visits, and partnering with the Blue Cross Blue Shield Cardiovascular Consortium (BMC2), the Coordinating Center aims to equitably increase participation in cardiac rehabilitation for all eligible individuals in Michigan. The MVC team is supported by a stakeholder working group made up of hospital and PO representatives, experts in the field, CQI partners, and BCBSM representatives, to provide advisory guidance and ensure the delivery of a collaborative and coherent message when advocating for policy changes that will improve care for patients in Michigan. More information on this VCC can be found in MVC’s Frequently Asked Questions.
The following resources can assist members in their efforts to increase cardiac rehab participation:
- Michigan Cardiac Rehab Network (MiCR) Best Practices Toolkit
- 2021 MVC Cardiac Rehab Progress Report
- Million Hearts Change Package
- CR VCC Blinded Report October 2022 (PDF)
- Introduction to the CR VCC from October 2020 Semi-annual meeting (VIDEO)
- Determinants of Hospital Variation in Cardiac Rehabilitation Enrollment During Coronary Artery Disease Episodes of Care (PUBLICATION)
Preoperative testing, especially in low-risk surgical procedures, often provides no clinical benefits to patients. Despite this, these services continue to be ordered regularly at hospitals across Michigan. Eliminating this unnecessary and, in some cases, potentially harmful preoperative testing represents a clear opportunity to improve value in surgery. The Coordinating Center uses administrative claims data and engagement with MVC members to try and reduce the use of unnecessary preoperative testing for surgical procedures to improve quality, reduce cost, and improve the equity of care delivery in Michigan. As with MVC’s Cardiac Rehab VCC, the Coordinating Center is supported by a stakeholder working group to advise ongoing activity. The expertise of this workgroup is used to provide insight on the best approaches to improve member awareness of preoperative testing practices and increase access to existing guidelines and best practices. More information on this topic can be found in MVC’s Frequently Asked Questions.
The following resources can assist members in their efforts to reduce unnecessary preoperative testing:
- Preoperative Testing Code List
- Waive the Workup - MSQC, MPrOVE, & MVC website to support quality improvement efforts
- Preoperative Testing Flyer (PDF)
- MVC Preoperative Testing Blinded Report (PDF)
- The Conundrum of Unnecessary Preoperative Testing (PUBLICATION)
- Why Do Physicians Order Unnecessary Preoperative Tests? A Qualitative Study (PUBLICATION)
- Choosing Wisely Resource Library
Post-Acute Care after Joint Replacement
As part of this VCC, the MVC Coordinating Center set a target of reducing the average inpatient post-acute care rate to less than 15 percent, or achieving average post-discharge spending of $3,400, in at least 90% of MVC hospitals. With this in mind, the MVC team has facilitated regular joint workgroups in collaboration with the Michigan Arthroplasty Collaborative Quality Initiative (MARCQI) and has disseminated push reports and related data to drive improvement. This has helped drive down the MVC inpatient post-acute care rate to 8.8% and average post-discharge spending to $3,374 for 90% of MVC hospitals. While the initial target set has been reached, the MVC team will continue to support quality improvement efforts in this area. If you are interested in hearing more, please reach out to the MVC Coordinating Center.
Chronic Disease Management
The MVC Coordinating Center also supports members in their efforts to increase post-discharge outpatient follow-up rates after inpatient admissions for chronic diseases. As part of this, the MVC team facilitates regular Chronic Disease Management workgroups with guest speakers from across the state, disseminates push reports focused on chronic disease follow-up and readmissions (e.g. CHF, COPD), and holds quarterly regional networking events for members to come together and share best practice. If you are interested in becoming involved with any of these activities, please reach out to the MVC Coordinating Center.