09 Apr 2025
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CQI Spotlight: Michigan Collaborative for Type 2 Diabetes

CQI Spotlight: Michigan Collaborative for Type 2 Diabetes

April 9, 2025 | 0 Comments | , , , ,

Type 2 Diabetes (T2D) affects over 1 in 9 adults in Michigan and increases the risk of kidney and cardiovascular disease, hypertension, nerve and eye damage. Although newer interventions have demonstrated effectiveness in treating and preventing T2D, barriers to equitable, widespread dissemination and implementation remain a challenge. Delivering evidence-based diabetes care to all T2D patients in Michigan is essential for creating a future where diabetes is no longer a chronic progressive disease.

With this vision in mind, the Michigan Collaborative for Type 2 Diabetes (MCT2D) launched in 2021 and aims to accelerate implementation of and eliminate barriers to guideline-concordant care, through supporting its participating practices with quality improvement efforts. MTC2D is currently focused on three evidence-based strategies: dietary and lifestyle changes based on the use of continuous glucose monitors (CGMs), guideline-directed antihyperglycemic medications, and low-carbohydrate eating patterns. MCT2D recognizes the importance of utilizing these strategies to reduce T2D incidence and to slow disease progression to improve health in Michigan and lower health care costs.

In three short years, MCT2D’s quality improvement efforts have already resulted in major achievements. As MCT2D Program Director and Associate Professor of Family Medicine at the University of Michigan Lauren Oshman, MD, MPH, stated,

So far, MCT2D has recruited more than 400 primary care, endocrinology, and nephrology practices across the state. Their efforts have resulted in a 12% relative reduction in patients with an A1c greater than 8% from 2021 to 2023, as well as an increase in CGM prescribing from 17% to 31% for patients who were on insulin (2021-2023).

MCT2D’s recent successes stem from its commitment to placing patients at the heart of their efforts. The MCT2D patient advisory board meets six times a year to guide the activities of the collaborative, including reviewing medication handouts, low-carbohydrate meal plans and grocery lists, instructional videos on injectable medications, and guides for using continuous glucose monitoring devices (Figure 1). This ensures materials are accessible and patient friendly. Patients are also invited to attend collaborative-wide and regional meetings to share their stories alongside healthcare professionals, further emphasizing the central role of the patient in MCT2D’s quality improvement initiatives.

Figure 1.

In addition to supporting patients, MCT2D addresses the needs of clinicians by offering guidance on clinical best practices, as well as insurance coverage and cost-related issues. MCT2D also hosts regional meetings twice a year and monthly educational webinars where guest speakers deliver presentations on topics requested by collaborative members. Sessions have covered topics such as “Mental Health and Diabetes,” “Working with Specialists,” and “Metabolic Surgery for Type 2 Diabetes.”

Achieving health equity is essential in all aspects of healthcare, but it is particularly crucial in the prevention and management of chronic diseases. All of MCT2D’s initiatives aim to advance health equity in communities across Michigan, ensuring that everyone—regardless of race, ethnicity, socio-economic status, insurance coverage, or geographic location—has access to high-quality care for T2D. MCT2D has established six health equity goals aimed at reducing the prevalence and complications of T2D, while enhancing the quality of life for all patients (Figure 2). To achieve these goals, MCT2D has launched several equity-focused initiatives, including a collaboration with Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) to complete one-on-one consultations with practices on their social determinants of health screening processes.

Figure 2.

MCT2D’s impact on the quality of T2D care is dependent on strong collaborative partnerships with its 23 participating physician organizations.  While MCT2D brings together physician participants from primary care, endocrinology, and nephrology, it centers the crucial role of other members of the care team, including pharmacists, nurse practitioners and physician assistants, care managers, nurses, and dietitians. As Dr. Oshman explains, "Taking care of people with T2D is a team sport. The strength of our collaborative comes from our diversity."

Over the past year, MCT2D and MVC have collaborated in several ways. MVC provides claims-based data and analytic consultation to support MCT2D in establishing quality improvement benchmarks. MVC also collaborated with MCT2D in 2024 to develop a statewide report on T2D in Michigan. This report provided a comprehensive overview of the demographics, healthcare visits, and prescription utilization patterns of patients with T2D in Michigan. The report highlighted key trends in healthcare utilization within this patient population, including emergency department visits, hospitalizations, and consultations with primary care providers (PCPs) and specialists.

MVC is currently partnering with MCT2D on a value exercise to compare the use of guideline concordant medications and change in cost and outcomes among T2D patients in MCT2D practices compared to non-participating practices. This work significantly enhanced the MVC team's understanding of pharmacy claims data from BCBSM and BCN and provided valuable insights that will inform future projects and analyses using pharmacy claims data.

MVC is proud to partner with MCT2D in advancing T2D care across Michigan. The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement, and MVC is excited to continue showcasing the innovative contributions of individual CQIs and the ways in which MVC’s data analytics are supporting high-value care initiatives across the portfolio.

24 Sep 2024
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MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

September 24, 2024 | 0 Comments | , , , , ,

Chronic disease management was a key driver of healthcare utilization over the last decade and has been cited as the most expensive chronic disease in the U.S. In response, MVC recently partnered with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to develop a statewide report on Type 2 Diabetes (T2D), a chronic illness that impacts over 1 million adults in Michigan. This new report was recently shared by both MVC and MCT2D at the Michigan Obesity Summit and will be distributed to MVC member hospitals later this week.

The report summarized demographics, healthcare utilization, and prescription patterns among those patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. To create this report, MVC first used its claims data to identify beneficiaries aged 18 and older with a qualifying T2D diagnosis in the past year. After identifying annual cohorts of beneficiaries with T2D for each year, 2017-2023, MVC assessed annual utilization of T2D prescription medications, emergency department (ED) visits, inpatient hospitalizations, and provider visits.

MVC assessed filled prescriptions among T2D beneficiaries with corresponding prescription coverage using its pharmacy claims. This was the first time MVC included prescription claims data in a member push report and the first time that prescription claims from all MVC payer sources were utilized in a single MVC analysis. Medicare beneficiaries were excluded from 2022 and 2023 prescription utilization rates because Medicare pharmacy claims were only available through 12/31/2021. Diabetes-related drug classes were identified in pharmacy claims based on National Drug Code (NDC) as well as standardized prescription names and classes.

Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are frequently prescribed to improve glucose control, reduce mortality, slow kidney disease progression, and aid in weight loss. The American Diabetes Association now recommends the use of these medications for patients with cardiovascular disease, kidney disease, and obesity. In keeping with these guidelines, MVC’s analyses indicated a large increase in utilization of GLP-1 receptor agonists (3.1% to 18.6%) and SGLT2 inhibitors (2.3% to 14.2%) between 2017 and 2023 (Figure 1). In the same period, prescriptions decreased from 2017 to 2023 for insulins (20.9% to 16.5%) and sulfonylureas (17% to 10.9%).

Figure 1.

Demographic characteristics including age, sex, race (Figure 2), and insurance provider (payer) were described within the report for all beneficiaries with T2D across all payers 2017-2023 and compared to the characteristics of all beneficiaries reflected in MVC data during those years. Compared to all beneficiaries, those with T2D were older, with an average age of 66 years versus the average of 43 years among all beneficiaries. T2D beneficiaries were also more likely to be male (50% vs 43%), Black (20% vs 15%), and more often covered by non-commercial insurance plans (45% vs 28%).

Figure 2.

From 2017 to 2023, rates of diabetes-related ED visits and hospital admissions remained relatively infrequent among T2D beneficiaries. Around two percent of T2D beneficiaries visited an ED for a reason related to diabetes each year, and one percent were hospitalized in relation to diabetes. ED utilization unrelated to diabetes decreased from 37.4% in 2017 to 33.1% in 2023 among T2D beneficiaries (Figure 3). Hospital admissions unrelated to diabetes decreased from 21.3% to 16.4% (Figure 4).

Figure 3.

Figure 4.

In contrast, T2D beneficiaries saw primary care physicians, nephrologists, and endocrinologists more frequently between 2017 and 2023, with observed increases for all three provider types (Figure 5). Most notably, visit utilization with primary care providers increased from 18.3% to 32.9%. Nephrologist visit utilization increased from 1.2% to 2.2%, and endocrinologist visit utilization increased from 1.9% to 3.6%.

Figure 5.

This new report created in partnership with MCT2D provided a high-level overview of healthcare utilization among T2D beneficiaries within Michigan. Since the analyses utilized data derived from medical insurance claims, one key limitation was the exclusion of uninsured individuals as well as key indicators of T2D outcomes that are not accurately captured in claims data, such as HbA1C levels, blood pressure, continuous glucose monitor utilization, and retinopathy screening. Despite these gaps, the data revealed promising trends in diabetes care, including increased primary care visits, greater use of guideline-directed medications proven to show significant benefit, and reduced emergency department visits. MVC’s analyses also underscored areas for improvement, such as the need to address health equity gaps and continued promotion of guideline-directed medical therapy.

MVC will share copies of the completed report directly with members later this week, and a copy is also available on the MVC website [PDF]. If you are interested in pursuing a custom analysis for any of these measures or a different tailored custom analysis, please reach out to MVC.

18 Aug 2023
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MEDIC Helps EDs in Michigan Improve Care for Adults, Children

MEDIC Helps EDs in Michigan Improve Care for Adults, Children

August 18, 2023 | 0 Comments |

Serving a spectrum of functions, emergency departments (EDs) provide essential care and services, operating in the critical space between outpatient and inpatient care. EDs also serve as a safety net within the US healthcare landscape by performing necessary clinical services for populations who may not otherwise have access. Patients visiting the ED may undergo a wide range of rapid diagnostic and treatment options, ranging from unscheduled procedures, laboratory testing, utilization of basic and advanced imaging studies, and admission of patients to the hospital. Despite the ED’s critical role and services, there are few coordinated, scalable efforts to improve care quality in the ED. These realities within emergency medicine made it a prime opportunity for quality improvement (Kocher et al., 2019), which was the impetus for adding an emergency medicine-focused Collaborative Quality Initiative (CQI) to the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio.

The Michigan Emergency Department Improvement Collaborative (MEDIC) was founded in 2015 to address the critical gap in coordinated quality improvement in the ED, including intervention design through implementation and evaluation, at scale, across health systems. Michigan Value Collaborative (MVC) members recently heard about MEDIC and its work as part of the launch of MVC’s new ED-based episodes and reporting; MEDIC and MVC collaborated on the development of this new episode of care data structure.

MEDIC’s quality improvement efforts to date have included initiatives such as improved appropriateness of head CT imaging utilization for children and adults with minor head injuries, greater CT diagnostic yield for adults with suspected pulmonary embolism, decreased use of chest x-rays in children with respiratory illness (i.e., asthma, croup, bronchiolitis), higher rates of ED discharge for children with asthma and adults with low-risk chest pain, and increased distribution of take-home naloxone to patients with opioid use disorder (OUD) or who experience opioid overdose or withdrawal.

MEDIC Success Stories

Since 2017, MEDIC participating sites have significantly improved collaborative-wide performance on all MEDIC quality measures. By reducing unnecessary imaging utilization and decreasing unwarranted hospitalization rates from the ED, MEDIC positively impacted the emergency care experience for thousands of patients in Michigan who received more evidence-based care and fewer low-value services. These improvements also contributed to an estimated total reduction in the ED cost burden in the millions of dollars (Figure 1).

Figure 1.

Zach Sawaya, MD, an emergency physician at MyMichigan Medical Center, reflected positively on the benefits of partnering with MEDIC on specific quality improvement initiatives. "MEDIC has pushed our group to be more cognizant of our imaging use, in particular in the pediatric population,” he said. “We've seen significant improvements in our rates of pediatric head CTs and chest X-rays that have been driven by MEDIC-provided data and decision-making resources.  In particular, we've seen wait times on pediatric head injuries go down as parents have been very open to discussion of PECARN rules and foregoing head imaging.”

The fact that MEDIC’s efforts support patients of all ages within its participating sites is unique; MEDIC is one of only a few CQIs with initiatives focused on pediatric patients. The MEDIC 2023 pay-for-performance incentive program, for example, focused on performance improvement on its pediatric-specific metrics. A key goal of this work was to ensure that children receiving emergency care in community hospital EDs received the same high-quality evidence-based care delivered in a pediatric emergency center. Since there are only three Michigan pediatric centers—all members of MEDIC—most children receive emergency care in community hospital EDs, and MEDIC observed disparities in the quality of emergency care delivered to children treated in community EDs. Children seen in community EDs were less likely to receive evidence-based care, as measured by our quality initiatives, than those seen in pediatric centers. In an emergency, patients can’t often choose which ED to go to, rather they need to go to the closest option. Over time and with participation in MEDIC, the data indicate MEDIC community hospitals improved their collective performance on MEDIC pediatric measures to be nearly on par with that of pediatric specialty hospitals.

The COVID-19 pandemic and its resulting impact on EDs also put MEDIC in a unique position. Within days of the pandemic being declared in the US, the MEDIC team pivoted from its standard work to support the COVID-19 response by leveraging its collaborative-wide learning network to support frontline efforts. MEDIC rapidly assembled a platform for informal and formal discussion between member EDs, which manifested as a series of virtual town halls and Grand Rounds focused on information exchanges among colleagues to rapidly innovate and meet challenges as the situation evolved.

This series began with lessons learned from the experience of its southeast Michigan EDs where the pandemic first unfolded in Michigan. This allowed sites in other areas of Michigan to understand what they would likely experience in the coming weeks or months, giving them valuable preparation time. Over several weeks, these well-attended sessions focused on the following topics: conservation of PPE, management of COVID-19 respiratory failure, special considerations for the pediatric population, and supporting the wellness of the ED workforce.

MEDIC – ED Partnerships

EDs partner with MEDIC in two primary ways: data collection and collaborative engagement in quality improvement. To participate in MEDIC, a partner ED must establish a flow of electronic health data for all ED visits to the MEDIC data registry as well as provide additional abstracted data, facilitated by a data abstractor hired with support from BCBSM. This then allows MEDIC to provide detailed evaluation and performance reporting on all measured quality initiatives, which in turn helps facilitate and inform site quality improvement interventions. MEDIC provides member hospitals with a level of insight into their ED practice patterns that would not be possible without participating in the collaborative.

In addition to being able to understand their data, participating in MEDIC allows hospitals to learn from one another, which significantly shortens the learning curve for improvement. Each site’s emergency medicine physician champion and abstractor(s) lead local intervention design and implementation, participate in MEDIC tri-annual collaborative-wide meetings, and share experiences and lessons learned with collaborative peers. MEDIC provides quality improvement evidence, guidelines, standardized performance measurement, data visualization, evaluation, and support for local intervention efforts.

MEDIC currently partners with hospital EDs across the state. Any sites not currently partnered with MEDIC are encouraged to visit their recruitment page for more information on becoming a member and contacting the team.

As MVC continues to build its offerings for members, the coordinating center is cognizant that hospitals and providers partner with multiple CQIs. MVC posts regular 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 questions.

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.

16 Feb 2023
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HMS CQI Receives Endorsements from National Quality Forum

HMS CQI Receives Endorsements from National Quality Forum

February 16, 2023 | 0 Comments | , ,

Michigan healthcare systems and professionals have the unique opportunity to leverage a portfolio of Collaborative Quality Initiatives (CQIs), all working diligently to support collaboration and data sharing. Together with their partners, these CQIs improve the quality and value of healthcare in Michigan and beyond. One such CQI achieved a momentous distinction in January 2023 when the National Quality Forum (NQF) recognized the Michigan Hospital Medicine Safety Consortium (HMS) with two prestigious endorsements for measures that can reduce unnecessary antibiotic use.

“We are incredibly proud of the work our collaborative has accomplished to date,” said Dr. Scott Flanders, MD, HMS Program Director. “Having two of our quality measures validated by the National Quality Forum reinforces the value of our work in Michigan and across the nation.”

The focus of these measures relates to two common and costly hospital incidents: inappropriate diagnosis of community-acquired pneumonia (CAP) in hospitalized medical patients, and inappropriate diagnosis of urinary tract infection (UTI) in hospitalized medical patients. HMS’s work in this space began in 2017 when the Joint Commission launched required standards for hospital antimicrobial stewardship. The HMS team, led by infectious disease physician Dr. Tejal Gandhi, partnered with experts from the Centers for Disease Control and Prevention (CDC) to develop and validate related quality measures across a diverse set of hospitals. The primary aim of this work was to prevent the use of unnecessary antibiotics, which can lead to adverse events, antibiotic resistance, and delays in diagnosing underlying conditions. Since antimicrobial use is broad within the hospital setting, HMS first narrowed its scope to CAP and UTIs, which accounted for up to 50% of antibiotic use in general hospitalized patients. The HMS team collected hospital data on the appropriate duration of treatment for patients with uncomplicated CAP as well as testing and treatment of asymptomatic patients with a UTI. The CDC already uses HMS collaborative-wide improvement rates to set national targets.

In the early years of the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnership program, several CQIs were actively partnering with hospitals on various aspects and types of surgery. However, this failed to account for the care of hospitalized medical patients, who are at risk for adverse events and account for over 50% of healthcare costs. In response, HMS was established with the aim to help Michigan hospitals improve patient safety and care quality for hospitalized medical patients (i.e., general medicine, emergency medicine, infectious diseases, pharmacy, vascular access, etc.). HMS supports hospitals via rigorous data collection and analysis, as well as collaboration on best practice implementation.

Since its formation, the HMS team has achieved many substantial successes throughout its tenure. Long before its antibiotic stewardship initiative, HMS had significant success working on venous thromboembolism (VTE). The collaborative helped hospitals make significant gains by increasing rates of VTE risk assessment, increasing pharmacologic prophylaxis in at-risk patients, and increasing the use of mechanical prophylaxis in patients with contraindications for pharmaceutical prophylaxis. The HMS VTE initiative has since been retired, though resources are still available here.

In 2014, HMS pivoted into other areas of patient safety when members voted to focus on the appropriate use of peripherally inserted central catheters (PICC) and measuring complication rates associated with these devices, led by hospitalist Dr. Vineet Chopra. At the time, the use of these devices was growing and there were few evidence-based best practices to support indications for use and management of complications. Together with national experts and collaborative members, HMS developed guidelines for the use of devices in different scenarios, a resource known as the Michigan Appropriate Guide to Intravenous Catheters (MAGIC) that was published in the Annals of Internal Medicine. This toolkit is used across the world to determine appropriate catheter device use and is offered in conjunction with other PICC quality improvement resources on the HMS website here.

In conjunction with its PICC initiative, HMS later adopted a focus on the appropriate use and complication rates for midlines. While doing quality work related to PICCs, a number of HMS member hospitals noticed significant use of midlines at their hospitals. HMS leveraged its unique ability to collect data on midline use across its membership to understand complication rates, which resulted in the development of the HMS Midline Toolkit available here.

More recently in 2021, HMS launched a new sepsis initiative at 12 volunteer pilot sites, collecting data to assess the care of patients diagnosed with sepsis, led by intensivist Dr. Hallie Prescott. The initiative was introduced to the remaining HMS-member hospitals in January 2023. The sepsis initiative focuses on the care of sepsis patients during the entire continuum of care, including on admission/early diagnosis, inpatient hospitalization, discharge, and 90 days post-hospitalization.

The Michigan Value Collaborative (MVC) and HMS teams have partnered several times over the years, especially on recent sepsis-related initiatives. Developed in partnership with HMS, MVC developed and shared a sepsis report with MVC and HMS member hospitals in 2021 and 2022, providing insights on measures such as 90-day price-standardized total episode payments, inpatient length of stay, ICU/CCU utilization, 90-day post-acute care utilization, and 90-day readmission rates. Both CQIs hoped to facilitate cross-collaboration between clinical and quality personnel on the identification of patterns, opportunities, and strategies related to care for sepsis patients. MVC and HMS have also partnered on various matching exercises designed to bring MVC’s robust administrative claims data together with HMS’s clinically rich abstracted data to further inform quality improvement efforts.

Projects focused on such a large, diverse patient population inherently come with complex challenges. One challenge is the need for HMS to engage all areas of the hospital, generating buy-in among those individuals treating hospitalized medical patients. At the outset, HMS primarily engaged with member hospitals and hospitalists. However, over the last several years the collaborative has increasingly engaged muti-disciplinary stakeholders, such as infectious disease physicians, critical care physicians, emergency medicine, infection preventionists, pharmacists, vascular access experts, interventional radiologists, nursing, and hospital leadership.

As evidenced by its recent endorsement and focus areas to date, the work of the HMS team impacts the majority of patients treated at Michigan hospitals and beyond. With a focus on improving care for hospitalized patients, there are also many other possible focus areas for quality improvement on the horizon. For more information on HMS, visit their website.

As MVC continues to build its offerings for members, the MVC Coordinating Center is cognizant that hospitals and providers partner with multiple CQIs. Throughout 2023, MVC will post quarterly 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 questions.

15 Dec 2022
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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

December 15, 2022 | 0 Comments | , ,

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.

12 May 2022
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HBOM Resources Help CQIs, Providers Reduce Smoking

HBOM Resources Help CQIs, Providers Reduce Smoking

May 12, 2022 | 0 Comments | , ,

Today, the leading preventable cause of death, disease, and disability in the United States is tobacco use. National studies show that 70% of smokers want to quit, but in Michigan only about 15% receive treatment. This critical gap is the current focus of one of the newest population health Collaborative Quality Initiatives (CQIs) in the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio. The Healthy Behavior Optimization for Michigan (HBOM) CQI aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful.

HBOM’s mission is to make “the healthy choice the easy choice,” which is accomplished in this case by providing tobacco cessation support throughout the state of Michigan through value-based reimbursement (VBR). In 2022, nine CQIs committed to working with HBOM to provide targeted, just-in-time tobacco cessation support to seize on their “teachable moment.” This approach draws on evidence-based behavior change strategies that leverage unique shifts in patient motivation around major health events, when they may find new motivation to commit to positive health behaviors like smoking cessation.

HBOM works with hospitals, clinics, and care teams across the state of Michigan through its partner CQIs to promote healthy behaviors among patients. They also provide partner CQIs and their respective members with the infrastructure and metrics to measure the impact of these changes. Although HBOM is primarily concerned with three health behaviors (smoking cessation, healthy eating, and physical activity), smoking cessation is their current focal point.

HBOM’s smoking cessation tools and resources are available in both paper and electronic formats to ensure equitable access, and are being shared widely at the patient, physician, and organization levels. Clinicians can share these materials with patients to increase access, awareness, and utilization of smoking cessation opportunities. One example includes a “Tap for Support” near-field communication (NFC) badge (see Figure 1) that clinicians and healthcare staff can wear for patients to scan with their phone, providing them with instantaneous online smoking cessation tools and resources.

Figure 1.

Another example is the Tobacco Cessation Box that HBOM tailored to meet the needs of those wishing to quit smoking. In addition to the badges, it includes HBOM’s Quit Smoking Resource Guide Tear Off Pad (see Figure 2), which providers can use as a discussion tool for Nicotine Replacement Therapy options. The box also includes a reference guide containing a high-level overview of tobacco cessation prescription medication options and HBOM’s VBR toolkit.

Figure 2.

When CQIs and their members wish to learn more or provide support beyond the resources mentioned above, they can connect with HBOM to discuss state-wide smoking cessation metrics, best practices, challenges, and collaboration opportunities. The HBOM collaborative meets regularly with participants and partnering CQIs to address challenges and improve population health. The team is also closely connected with the Michigan Tobacco Quitline and resource recommendations delivered by text message for anyone who wishes to quit smoking.

The MVC and HBOM teams have discussed plans to include HBOM resources in future relevant MVC report communications, such as those chronic conditions that are related to tobacco use. In the meantime, hospitals and physicians can request their own tobacco cessation boxes (see Figure 3).

Figure 3.

For more information on HBOM, visit their website.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is cognizant that many other CQIs also partner with hospitals and providers throughout Michigan. Throughout 2022, MVC will post a series of 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.

28 Jan 2022
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New Health Equity Workgroup Has Successful Launch

New Health Equity Workgroup Has Successful Launch

January 28, 2022 | 0 Comments | ,

Health equity has captured the attention of healthcare. It was a top trend for healthcare providers in 2021, and surveys indicate it will be one of the main priorities for large healthcare employers in 2022. It is also a key strategic focus of the MVC Coordinating Center in the years ahead. As such, MVC is building out offerings for its members in this space, which began with the launch of its new health equity report and was followed by a semi-annual meeting dedicated to the topic in October 2021. Most recently, MVC launched a new health equity workgroup, which will continue to meet on a bimonthly basis in 2022.

The first health equity workgroup took place this week featuring speakers from the MSHIELD (Michigan Social Health Interventions to Eliminate Disparities) collaborative—one of the newer teams in the Blue Cross Blue Shield of Michigan Collaborative Quality Initiative (CQI) portfolio. MSHIELD Co-Director Dr. John Scott co-presented with MSHIELD Program Manager Carol Gray. They were joined by 72 attendees representing hospital teams, physician organizations, fellow CQIs, and other areas. The presentation focused on the role of MSHIELD in addressing social risk factors in healthcare as well as members’ approaches to health needs screening, referral, and linkage.

The social determinants of health (SDOH) have a tremendous impact on patient health outcomes, resulting in Healthy People 2030 naming it one of its five priorities. With thousands of journal articles confirming the impact of the SDOH, there is now a shared understanding across healthcare providers that this area is a priority. In fact, it affects patient health outcomes significantly more than clinical care (see Figure 1). MSHIELD’s presenters highlighted this fact and used it as an opportunity to define a common language for the discussion. They said health equity is achieved when every person can attain their full health potential and no one is disadvantaged from achieving this because of socially determined circumstances.

MSHIELD will serve as a link between the healthcare system, the community resources that can reliably serve patients’ social needs, and the communities that are home to those patients. To that end, MSHIELD will help establish partnerships with key healthcare and community entities and promote the exchange of data and services in a way that helps achieve health equity.

Unlike some of the “legacy” CQIs that are clinically focused, MSHIELD will fill a consulting role with other CQIs to help them set and meet goals related to health behaviors and social needs. Since health equity is a multi-faceted issue affecting all areas of health, MSHIELD also has an unlimited population and practice focus. For the time being, however, the speakers identified that MSHIELD is particularly interested in food access, housing instability, and transportation since those are areas with the strongest evidence for impact in a clinical setting.

MSHIELD’s presenters also summarized their findings from an environmental scan of the larger CQI portfolio. Last year they surveyed the other CQIs in the BCBSM Value Partnerships portfolio to identify what types of SDOH data they may collect and how. Of the 16 SDOH domains (see Figure 2), MSHIELD found that almost all CQIs collect data on demographics, insurance status, and health-related behaviors. However, only three CQIs currently collect data related to material hardship (e.g., food insecurity, housing insecurity, transportation, medication affordability, access to technology, childcare, etc.). MSHIELD hopes to help build on what has been collected so far and assist providers and CQIs alike in their pursuit of health equity initiatives.

Figure 2. Domains of the Social Determinants of Health from MSHIELD Presentation

The workgroup concluded with an active discussion about current practices and challenges experienced by providers in identifying, referring, linking, and following up with patients. Representatives from physician organizations and hospitals alike shared examples about how they integrate screening and capture this data, which led to conversations about the technologies used to assist with this process and the value of universal versus targeted screening strategies. Most of the participants who shared their experience expressed that whichever strategy they adopted, there were efforts to make the screening questions accessible for those with language or literacy barriers. Examples of this that were provided by members included translating materials to common languages from their local community and utilizing the professional abilities of social workers on site. There were also discussions about how to best identify resources within a given community for the purposes of referrals, with some thoughtful suggestions about partnering with community health needs assessment teams and social workers from within hospitals.

To hear the full discussion and learn more details about MSHIELD, the full recorded workgroup can be viewed here. MVC looks forward to continuing this health equity conversation on March 16. Register for the next MVC health equity workgroup here. If you would like to receive future MVC workgroup invitations or you have an idea for a future speaker, please contact the Coordinating Center at michiganvaluecollaborative@gmail.com.

Speaker Biographies:

Dr. Scott is an Assistant Professor of Surgery in the Division of Acute Care Surgery at the University of Michigan. His health policy and health services research interests are focused on improving access to timely, affordable, high-quality surgical care for the acutely ill and injured.

Carol Gray leads the overall management, performance, and coordination of the MSHIELD program and team. She has extensive experience managing public health research teams, communicating across and coordinating with multiple partnerships, and linking and engaging with community-based organizations.