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State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

Hospitals across Michigan are increasingly focused on using their available data to assess care delivery gaps, inefficiencies, and areas for improvement. The Michigan Value Collaborative (MVC) developed its 2024 Statewide Health Equity Report to provide a detailed summary of how hospitals across Michigan are approaching this process with a health equity lens. By analyzing MVC claims data along with survey responses from 52 hospitals and 11 health systems, the full report captures how hospitals are leveraging data to evaluate patient care, identify disparities in outcomes, and develop interventions that improve the overall value of care delivery.

Data Collection and Utilization

One of the key highlights of the report was the varied approach and capacity for collecting, measuring, and utilizing data on health equity. Many hospitals utilize readmission rates, clinical quality indicators, and demographic information to identify variations in care. However, the extent to which this data informs hospital-level decisions varies. While some hospitals remain in the early stages of collecting and organizing health equity data, others are beginning to analyze and apply these insights to shape their initiatives. Nearly a third of respondents indicated they were using data to guide funding and program priorities, while a smaller percentage integrated equity metrics into quality improvement strategies.

To further support hospitals in taking action, MVC used its robust medical insurance claims-based data to highlight established disparities for specific service lines. A notable finding was the difference in rates of birth complications by race (Figure 1). Women who identify as Asian and/or Pacific Islander had higher rates of postpartum hemorrhage than other race categories, and patients identified as Black had higher rates of hypertension and severe maternal morbidity (SMM) than the overall population.

Figure 1. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity During Index Hospitalization, Overall and by Patient Race/Ethnicity, 2021-2024

Another notable finding was sex differences in cardiac rehabilitation enrollment (Figure 2). Women are significantly less likely to enroll in cardiac rehab within 90 days of discharge for eligible cardiac procedures, take longer to enroll in their first session, and attend fewer sessions on average than male patients. These patterns point to differences in how patients access and engage with follow-up care, and these gaps are present even among hospitals with strong cardiac rehabilitation enrollment rates.

Figure 2. Rates of Cardiac Rehabilitation Utilization within 90 Days of Discharge from a Qualifying Event by Sex, 2015-2023

These MVC claims-based investigations into healthcare outcomes across populations can assist hospitals in setting or enhancing their health equity goals.

Efforts to Improve Healthcare Access

Beyond data collection and analyses, the report summarized a range of efforts to improve healthcare access. Most hospitals have expanded telemedicine services, increased clinic hours, deployed mobile health units, support non-emergency medical transportation programs, and offer rideshare assistance to reach a variety of patient populations who struggle to access care in their community. Language accessibility has also been a focus, with nearly 90% of hospitals offering translated materials and on-site interpretation services. Financial barriers remain a concern, with 79% of hospitals reporting efforts to support patients dealing with medical debt or lacking insurance coverage.

There were also several hospitals implementing community-based programming and solutions in response to gaps for specific disease impacted communities or underserved groups. The most common types of solutions currently supported by hospitals across the state included:

  • Food Security Initiatives: Many hospitals are addressing food insecurity by screening patients for social needs, partnering with community food programs, and even launching hospital-based farms and Healthy Food Rx programs to encourage nutrition-based health interventions.
  • Community Health Workers (CHWs): Increasingly, hospitals are integrating CHWs into their care models to bridge the gap between clinical care and community-based support, particularly in rural and underserved areas.
  • Incorporating Patient Voices: Hospitals are utilizing Community Health Needs Assessments (CHNAs), patient experience surveys, and community advisory boards to ensure that patient perspectives inform quality improvement initiatives.

Looking Ahead

Although most hospitals have taken steps to improve care delivery across all patient populations, they face significant organizational barriers, such as insufficient funding for dedicated staff and programming, lack of staff training or expertise in community-focused challenges, and difficulty communicating the business case or return on investment of such efforts. These barriers and new ones will likely grow in the coming months and years as the field’s federal funding streams shift.

Amid that uncertainty, MVC hopes to play the role of facilitator by supporting hospitals with actionable equity data, facilitating peer learning opportunities through dedicated meetings and sharing of success stories, and financial incentives through the MVC Component of the BCBSM P4P Program. In addition, the MVC Coordinating Center regularly consults with the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) team on best practices for data collection and equity-centered quality improvement. MVC will demonstrate this commitment via its quarterly MVC member spotlight blog—which will highlight successful initiatives across MVC’s membership—and via dedicated learning sessions at MVC’s Oct. 10 collaborative-wide meeting in Livonia.

If you are interested in pursuing a health equity initiative, MVC has a robust registry of claims data that can be utilized, as well as site specialists who can help facilitate connections with peers doing similar work. Please reach out to us by email if you have a success story to share or want to learn more about related MVC data.

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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.