CQIs -

25 Mar 2026

CQI Spotlight: Michigan Oncology Quality Consortium

March 25, 2026 | 0 Comments | CQIs, MOQC, non-medical drivers of health, non-medical needs, oncology, quality improvement

Cancer care is not defined by treatments alone—it is measured by the experiences, quality of life, and outcomes of the people navigating the disease. Across Michigan, patients with cancer face complex clinical decisions alongside challenges that extend beyond the clinic, from treatment side effects to barriers in accessing supportive services. Through statewide collaboration, shared data, and a commitment to improving care delivery, the Michigan Oncology Quality Consortium (MOQC) is working to ensure that patients and their caregivers receive more consistent, compassionate, and high-value cancer care.

Established in 2009, MOQC was tasked with addressing oncology data that showcased significant variation in care outcomes as well as significantly higher costs compared to other areas of healthcare. One of 21 Collaborative Quality Initiatives (CQIs) sponsored by the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships Program, MOQC’s aim is to improve access, value, and quality of care for all invasive cancers.

In addition to establishing cross-cutting measures that apply to all disease groups within oncology, MOQC’s work expanded to acknowledge and address the impact of non-medical drivers of health on patient outcomes, intentionally creating space for more patient, caregiver, and frontline voices to shape meaningful change and guide the evolution of cancer care in Michigan.

Services and Benefits for MOQC Members

MOQC provides access to resources and tools, quality improvement initiatives, partnerships, funding, and support that its membership of 54 oncology practices would not otherwise have available. Through collaborative-wide and regional meetings, MOQC fosters member networking, ongoing education on best practices and emerging topics, new publications, and collaboration opportunities. MOQC also meets with oncology practices individually to review their performance measures. For those needing additional support in any area, MOQC conducts root cause analyses in collaboration with the healthcare team and provides resources and consultation on their processes and progress.

Members also benefit from access to the Patient and Caregiver Oncology Quality Council (POQC), a robust and highly engaged patient advocacy group currently comprised of 30 members (Figure 1). POQC gives teams the opportunity to learn directly from the lived experiences of patients and caregivers and brings forward barriers to care that may not be visible in data alone. POQC also contributes to decision-making about quality measures and initiatives through their work on MOQC’s Measures and Steering Committees. Their voices help member practices stay connected to the heart of what they do as they work to help guide MOQC’s efforts toward fair, effective, and compassionate health outcomes across the state (Figure 2).

MOQC members also have the opportunity to establish integrated clinical pharmacist positions providing direct patient care through the Pharmacists Oncology Excellence Program in Michigan (POEM). This program, which has been in place for five years, encompasses 12 pharmacists who support 113 physicians across 28 practices. POEM has been associated with a variety of positive patient care outcomes and clinic time savings relating to clinical care activities.

MOQC’s Key Initiatives and Achievements

Through MOQC’s targeted initiatives, oncology care and outcomes are improving across Michigan. The Palliative Care and Hospice initiative aims to increase time enrolled in hospice to maximize benefits and quality of life for patients and caregivers. By creating tools for how and when to talk to cancer patients about palliative and hospice care (Figure 3), MOQC practices have seen hospice care enrollment improve from 44% in 2017 to 66% in 2024. In the words of a member physician,

“There is so much to help us do better at survival in cancer, and so many more new treatments out there, but the one thing that is often overlooked is – is it the right thing to do for the patient? So I was thrilled to see that MOQC is focusing on hospice. It’s so under looked in oncology these days.”

A complimentary initiative, expanding palliative care access through a partnership with the Center to Advance Palliative Care (CAPC), provides training curriculum to advance practice providers (APPs) regarding primary palliative care, with intentional recruitment in areas of the state that have little-to-no palliative care currently. Those who complete the curriculum attain a certificate from CAPC and integrate primary palliative care into their ongoing care of patients and caregivers.

Patient quality of life is an important consideration in cancer care. To address nausea, a common side effect of chemotherapy that significantly impacts patients’ quality of life, MOQC launched a Chemotherapy-Induced Nausea and Vomiting (CINV) – Antiemetics initiative in 2020. The initiative works to increase prescribing of olanzapine to manage treatment-related nausea. Since the initiative began, prescribing of olanzapine has increased from 10% to the notable achievement of 60% in 2024, helping more patients have better treatment experiences. To help evaluate the impact of this effort, MOQC reached out to the Michigan Value Collaborative (MVC) to leverage its robust claims-based data. Together, MVC and MOQC evaluated the impact and value of this initiative in a 2023 impact and value assessment, and the two teams are in the process of refreshing that analysis with newer years of claims data.

Other initiatives include implementing a statewide gynecologic oncology virtual tumor board to support multidisciplinary learning, standardize care recommendations across practices, expand access to clinical trials, and expand perspectives for clinicians caring for patients throughout Michigan. MOQC helps optimize statewide treatment of advanced non-small cell lung cancer via an oncology stewardship initiative focused on improving biomarker testing across the state and increasing education around targeted therapies.

In addition to centering patient voices through POQC and many other MOQC accomplishments, a major achievement of MOQC is the development of a comprehensive Excellence in Quality Certification program that recognizes oncology practices providing high-quality and high-value care. Eligibility criteria include a site visit to ensure safe practices regarding anticancer therapy, measure performance, medical record review, and policy review. All criteria measure policy and practice to validate that oncology care is guideline-concordant and recognizes substantial decreases in variations in care and in costs of care (Figure 4). A key component of the certification is creating an action plan to close non-medical gaps in healthcare, ensuring all cancer patients in Michigan have the same access to high quality care. Fourteen out of MOQC’s 54 practices were certified in 2024, and 23 practices pursued certification in 2025.

MOQC is proud of its commitment to addressing the non-medical needs of patients and caregivers through the POQC and the Excellence in Quality Certification program. Additional ways MOQC centers this aspect of patient care is by endeavoring to provide patients with increased access to supportive services and resources, including standardizing screening for non-medical needs, integrating referrals to Michigan 2-1-1 into electronic medical records (EMR), providing meals to patients who are currently food insecure and receiving anticancer therapy (plus up to one caregiver per patient), and facilitating financial navigation training for interprofessional members of oncology care teams. Non-medical patient needs and gaps in care are also being addressed through MOQC’s stewardship initiative, which aims to improve the use of systemic anticancer therapy with the goal of enhancing patient health outcomes while reducing financial strain on patients. In addition, MOQC conducts multivariate analyses of its measures annually to find gaps in care based on demographic categories. These analyses allow MOQC to review variation among practices and collaborate individually with them as needed to close gaps.

Looking Ahead: Continuing to Drive Whole Team Collaboration

MOQC’s work offers a reminder that improving oncology care often requires thinking beyond traditional approaches. By weaving patient and caregiver experiences into the fabric of their work, MOQC is able to look for gaps in care, prompt new questions, and reshape how they understand quality. MOQC’s initiatives and learning opportunities (such as interprofessional development sessions, the statewide tumor board, the palliative care certificate program, and addressing non-medical needs) are shaped with recognition that there is a whole team involved in the patient care related to MOQC’s quality measures. MOQC invites practices to engage with quality improvement in ways that expand perspective and challenge existing healthcare power dynamics. Through this multifaceted approach, MOQC is always striving to look for a deeper partnership with all of the people most affected by the outcomes.

The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement in Michigan. MVC is excited to continue highlighting the innovative contributions of individual CQIs and the ways in which MVC’s data are supporting high-value care initiatives across the portfolio. Please reach out to MVC by email if you are interested in learning more.

21 Jan 2026

CQIs health outcome variation OBI Obstetrics Initiative quality improvement

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CQI Spotlight: Obstetrics Initiative

January 21, 2026 | 0 Comments | CQIs, health outcome variation, OBI, Obstetrics Initiative, quality improvement

In 2018, Michigan was facing a concerning reality: nearly one in three births in the state occurred by cesarean delivery, a rate that exceeded the national average and signaled opportunities to improve the safety, experience, and value of childbirth care. Behind every data point were real families navigating some of the most important moments of their lives and clinicians striving to deliver the best possible care within a complex maternity landscape. The need for change was personal, urgent, and increasingly difficult to ignore.

As such, patients, clinicians, and employers began voicing concerns about rising cesarean rates affecting patients’ recoveries, long-term health, and trust in the healthcare system. Recognizing the scope of the problem and the opportunity to address it, Blue Cross Blue Shield of Michigan (BCBSM) turned to clinician leaders at University of Michigan to help design a statewide response, which leveraged Michigan Value Collaborative (MVC) claims data on childbirth episodes. In 2018, this collaboration laid the groundwork for what would become a dedicated effort to transform maternity care in Michigan.

Formally launched in 2019, the Obstetrics Initiative (OBI) emerged as one of BCBSM’s 21 Collaborative Quality Initiatives (CQIs). At that time more than 70 hospitals joined together under OBI’s vision to support safer deliveries, reduce unnecessary cesarean deliveries, use resources more wisely, and improve the overall culture of care. Today, OBI continues to build on that foundation by ensuring that every birth in Michigan is supported by the best evidence, the best practices, and a shared commitment to healthier beginnings.

Services and Benefits for OBI Members

To support its members in successfully implementing quality improvement (QI) initiatives, OBI supports its members using four primary offerings (Figure 1). One of those offerings is OBI’s robust, real-time benchmarking data that enables actionable insights. OBI’s registry is a best-in-class source of clinically credible data and compelling data stories that inspire change. A second core offering is direct support and expertise on specific QI interventions, including the development of best practice protocols and resources that advance evidence-based care. A third core offering is the transformational learning that occurs at OBI’s collaborative-wide meetings and other activities that are key to networking, partnership building, and collective learning across maternity units in Michigan. Finally, a fourth core offering is the intentional collection and incorporation of patient stories and experiences in all ongoing activities.

OBI Program Director Michelle Moniz, MD, MSc, recognizes how OBI’s tailored approach to QI support helps sites achieve a shared purpose of high-quality perinatal care that improves the lives of current and future generations. In her words:

“Every large-scale QI initiative faces a vexing unsolved problem: how best to support hospitals and clinicians who aren’t responding. Our routine QI support approaches—group meetings, webinars, online toolkits, performance incentives—can fall short for sub-optimally responding sites/clinicians, and leave patients vulnerable to low-quality, low-value healthcare. OBI imagines a future where CQIs deliver the right support, to the right hospital/clinician, at the right time, to achieve highest-quality care across all CQI members. This vision—which we call Precision QI—leverages scarce resources most efficiently to achieve evidence-based healthcare at scale for all patients.”

OBI’s "precision QI” offers personalized QI support for each hospital. Just as precision medicine accounts for individual patient differences in developing a treatment plan, OBI’s precision QI support model (Figure 2) is adaptive, diagnosing and responding to the unique needs of each OBI member and may include:

Performance Measurement: Offering observed, risk-adjusted, and peer-comparative data
Performance Feedback: Incorporating individualized goal setting and data for hospitals and individual providers
Outreach: Offering augmented support when performance deteriorates or is stably poor
Engagement: Offering a suite of resources for key target audiences, including hospital leadership, QI leader, bedside clinicians, and patients

OBI’s Key Initiatives and Achievements

OBI is now a unique asset for quality improvement in Michigan and beyond. Having built a vibrant community of multidisciplinary teams at currently 65+ hospitals across Michigan, OBI generates the evidence base needed for more effective, transformational quality improvement in obstetrics.

Putting that framework into action, OBI achieved noteworthy successes over the years. Since OBI’s inception, their flagship initiative, Safely Averting Cesarean Births, has focused on safely lowering the primary cesarean rate in Michigan. In 2023, OBI launched Patient Voices, a statewide survey to assess childbirth experiences and patient-reported outcomes related to birth. OBI then launched another statewide initiative, Bringing Our Patients COMFORT, in 2024, to promote best practices for managing pain after childbirth.

To reduce first-birth term cesareans – also known as nulliparous term singleton vertex (NTSV) cesareans, OBI’s Safely Averting NTSV Cesarian Births initiative successfully reduced the statewide cesarean rate from a historic high of 28.9% in 2023 to 26.9% as of September 2025. This improvement reflects years of effort to increase compliance with national diagnostic criteria for labor arrest disorders (which increased from 37.9% in 2020 to 77.1% in 2025). Increased compliance was aided using an algorithm to guide fetal management in labor, resulting in significant improvement from 47.3% compliance in 2022 to 93.2% in 2025.

Pain management is another area where OBI has made meaningful progress. Successful promotion of the use of scheduled nonopioid prescribing after cesarean births through OBI’s Bringing Our Patients COMFORT quality initiative boosted a compliance rate of 86.1% in 2024 to 96.8% compliance in 2025. Analyses are ongoing to evaluate corresponding reductions in opioid prescribing rates and amounts.

OBI’s third quality initiative Better Births for All aims to ensure that every OBI member has the tools and support to consistently implement evidence-based obstetric practices while fostering psychological safety and respectful, person-centered care for all during labor and birth. The path to accomplish that is threefold. First, OBI partners with a Patient and Community Action Board (PCAB) to center patient and community experiences in its QI initiatives. The OBI PCAB reviews patient-facing materials and has decision-making power over OBI’s selection of QI initiatives and operationalization of initiative measures in OBI’s incentive packages. OBI further centers patients’ perspectives in its work by measuring and improving collection of patient-reported outcomes and experience data to ensure that patients’ voices are embedded in daily QI work. OBI also educates and trains clinicians on patient-centered approaches and practices they can bring to their own daily work.

OBI is incredibly proud to be a part of the 25+ year history of the Value Partnership portfolio in Michigan, including its long-standing partnership with MVC. OBI and MVC are currently collaborating on several analyses to drive quality improvement, such as evaluating statewide variation in complications and expenditures for different patient groups and modes of delivery, improving the timeliness and quality of prenatal care, evaluating the association between social vulnerability and surgical management of early pregnancy loss. MVC is also working with OBI to estimate the impact and associated cost savings of OBI’s efforts to safely reduce cesarean birth rates in Michigan as well as the impact of OBI’s opioid management work on prescribing rates and costs in Michigan.

19 Nov 2025

BMC2 Cardiac Rehab cardiac rehabilitation CQIs HBOM Michigan Cardiac Rehabilitation Network MVC

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Highlights from the 4th Annual Michigan Cardiac Rehabilitation Network (MiCR) In-Person Meeting in Troy, MI

November 19, 2025 | 0 Comments | BMC2, Cardiac Rehab, cardiac rehabilitation, CQIs, HBOM, Michigan Cardiac Rehabilitation Network, MVC

The Michigan Cardiac Rehab Network (MiCR) held its fourth annual in-person meeting at Corewell Health East in Troy, MI on Nov. 13, 2025. The full slide deck is now available [LINK]. Opening the meeting’s agenda was Mike Thompson, PhD, MPH, co-director of MiCR and senior advisor at MVC. He welcomed attendees to the Corewell Health Beaumont Troy campus, announced the finalization of MiCR’s two-year strategic plan (Figure 1), and shared that Henry Ford Hospital was receiving the final MiCR Cardiac Rehabilitation Utilization Award mini grant to support their QUASAR project, which pilots a hub-and-spoke telehealth model for cardiac rehabilitation (CR) delivery. He also highlighted renewed engagement of the MiCR Advisory Council and ongoing collaboration with the Healthy Behavior Optimization for Michigan (HBOM) team to collect patient stories.

Dr. Thompson described MiCR’s strategic initiatives in two key areas: telehealth and medication management. For telehealth, MiCR is employing a multi-pronged approach that includes surveys, qualitative interviews, and stakeholder outreach to understand the current state, implementation plans, and barriers to telehealth CR implementation in Michigan. This effort will also include an evaluation of the value and utilization of existing resources that support telehealth CR. In the realm of medication management, MiCR is using claims data to assess variability in medication adherence among CR participants and applying surveys, interviews, and outreach to identify gaps and opportunities for improvement. These efforts will lead to actionable plans designed to help stakeholders implement initiatives that elevate CR services across the state.

MiCR/HBOM Heart-to Heart Collaboration Update

Larrea Young, MDes, a human-centered design project manager at HBOM, announced the launch of Heart-to-Heart, a new initiative designed to inspire both patients and providers by collecting and sharing diverse stories of patient experiences with CR. The goal of this effort is to foster broader conversations about the life-changing impact of CR and encourage patient enrollment by providing strong peer endorsements. The HBOM and MiCR teams are gathering first-person accounts in video, audio, and photo formats to create an engaging, free, and reusable story library for CR advocates across Michigan and beyond. Progress so far includes 10 patient interviews at two sites, representing a wide range of demographics and experiences. HBOM previewed a clip from a patient interview at the meeting. Clinicians were also encouraged to contribute to the effort by sharing voice messages about cardiac rehabilitation through Speakpipe.

Leveraging National CR Quality Improvement (QI): Efforts, Updates, and Next Steps

Megan Gross, MPH, CHES, ACSM-CEP, EIM, clinical exercise physiologist at Holland Hospital and board director of the Michigan Society for Cardiovascular and Pulmonary Rehabilitation (MSCVPR), shared a summary of national CR QI efforts and discussed how her organization has leveraged these initiatives to advance local QI projects. She identified tools and resources, advocacy, and QI champions as the core “pillars” of quality improvement, all supported by a foundation of data. Gross highlighted nationally available resources such as the Million Hearts/American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) Cardiac Rehab Change Package and the Agency for Healthcare Research and Quality’s (AHRQ) TAKEheart initiative, as well as ongoing advocacy, research, and publications. Encouraging all CR program staff to view themselves as champions, she transitioned to describe how Holland Hospital has applied these tools in their own QI efforts, concluding with a description of their project to implement an inpatient liaison model aimed at increasing CR participation.

Understanding the Physiologic and Clinical Significance of Metabolic Equivalents (METS)

Barry Franklin, PhD, a director emeritus of preventive cardiology and cardiac rehabilitation at Corewell Health East, gave a presentation explaining the physiological and clinical significance of metabolic equivalents (METs). Dr. Franklin summarized key lessons from his 50-year career in clinical exercise physiology, highlighting topics such as energy systems for exercise, acute cardiorespiratory responses (VO2 max), METs, anaerobic (ventilatory) threshold, fitness and mortality, fitness in relation to surgical outcomes and health care costs, and clinical considerations for prescribing exercise intensity. Dr. Franklin’s key take home message related to his guidelines and recommendations for moving patients from achievement of lower to higher METs through CR participation.

Sustaining Cardiac Rehab Through Health System Integration

Brett Reynolds, MPH, ACSM-CEP, and Cindy Haskin-Popp, MS, ACSM-CEP, of Corewell Health East shared their multi-year journey to build a fully integrated CR service line after the Corewell Health merger. They detailed key phases from planning and collaboration, such as forming committees, aligning workflows, and engaging stakeholders, to implementation, which involved developing communication channels, Epic workflow training, and designating super users for consistency. Post-integration successes included cross-training, improved communication, standardized competencies, and better patient care (Figure 2), while ongoing challenges remain in areas like documentation and order set variation. Looking forward, the team aims to pursue AACVPR accreditation, standardize patient education, and create a centralized referral process to further improve care quality and patient experience.

Medication Management Breakout Session

Following lunch, MVC Project Manager Emily Woltmann, PhD, MSW, led attendees through an interactive breakout session that explored roles, responsibilities, and strategies related to medication management in CR. Participants met in small groups to discuss strategies and barriers to addressing medication management issues with their CR patients (Figure 3). The information gathered will be used by the MiCR team to help drive forward the MiCR medication management strategic initiative.

Data Presentation and Panel Discussion on CR Completion Rates

Dr. Thompson led a session utilizing MVC claims data, which shared aggregate and unblinded data on CR completion rates across Michigan. This included a summary of the proportion of participating patients who finished the widely recommended 36 sessions, as well as those who completed at least 12 or 24 sessions. The findings revealed substantial variability among cardiac rehabilitation programs based on both metrics, with completion rates for the full 36 sessions ranging from 0% to 50% at CR programs across Michigan.

A subsequent panel discussion moderated by Dr. Thompson included Amy Poindexter, BS, CEP, CR manager at Trinity Health Ann Arbor and Livingston Hospitals, Amber Steele, BS, ACSM-CEP, CR lead at McLaren Bay Region Hospital, and David Running, BS, ACSM-CEP, CEPA, supervisor of CR at University of Michigan Health-West. Both the panel and the audience voiced a variety of strategies they use to increase session attendance in CR, such as developing supportive relationships with patients, watching for plateaus in progress, and having completion rituals and celebrations when a patient graduates from CR. The most frequently cited challenges to patients completing an adequate number of sessions were barriers related to the travel distance to CR programs and medical insurance copays.

AACVPR President Stacey Greenway Presents Keynote on AACVPR Strategic Plan

Stacey Greenway, MA, MPH, MAACVPR, ACSM-CEP, the newly elected president of AACVPR, delivered the meeting keynote, highlighting AACVPR’s growing multidisciplinary membership, widely recognized training and certification programs, and enhanced data registry resources for cardiac and pulmonary rehabilitation professionals. She outlined the 2026–2028 strategic plan focused on increasing awareness and engagement, advancing innovative delivery models like telehealth, and strengthening research and outcomes through a national network. Greenway encouraged MiCR members to participate nationally via opportunities such as the AACVPR quality improvement cohort, day on the hill, and legislative advocacy, and she invited involvement in content submission and session proposals for the 2026 Annual Meeting in San Antonio, TX.

Conclusion and Next Steps

Dr. Jessica Golbus, MD, MS, Co-Director of MiCR, wrapped up the meeting with a summary of the day’s key points and next steps. She shared that a follow-up email will be sent in the coming weeks and announced the dates for MVC cardiac rehabilitation virtual workgroups scheduled for 12 p.m. on Feb. 10, June 9, and Oct. 20 in 2026. The date for MiCR’s spring webinar will be announced soon.

MiCR is a partnership between BMC2 and MVC, the purpose of which is to improve access to, utilization of, and delivery of cardiac rehabilitation services across the state of Michigan. MVC is proud to partner with providers, hospitals, and fellow CQIs in advancing quality initiatives that benefit patients in Michigan. If you have questions about any of the topics discussed at the MiCR annual meeting or are interested in following up for more details on other initiatives, email the MiCR leadership team [EMAIL] or the MVC Coordinating Center [EMAIL].

17 Sep 2025

CQIs kidney stone surgery MUSIC MVC Coordinating Center urology

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CQI Spotlight: Michigan Urological Surgery Improvement Collaborative

September 17, 2025 | 0 Comments | CQIs, kidney stone surgery, MUSIC, MVC Coordinating Center, urology

Urological surgery quality improvement is essential for enhancing patient outcomes, ensuring safety, optimizing healthcare costs, and strengthening overall healthcare system performance. To foster patient trust, reduce outcome variation, and drive continuous advancements in urological surgery practices, the Michigan Urological Surgery Improvement Collaborative (MUSIC) was established in 2011.

One of Michigan’s 21 Collaborative Quality Initiatives (CQIs) operating in partnership with Blue Cross Blue Shield of Michigan (BCBSM), MUSIC is a physician-led CQI comprised of a consortium of 44 urology practices (academic, private practice, community) across the state of Michigan, as well as four out-of-state practices. Designed to evaluate and improve the quality and cost efficiency of urologic care, MUSIC aims to improve patients’ lives by inspiring high-quality care through data-driven best practices, education, and innovation.

The initial focus of MUSIC was improving care for patients diagnosed with or at risk of prostate cancer. The earliest quality improvement (QI) initiatives MUSIC undertook focused on decreasing infectious complications following prostate biopsies and decreasing unnecessary imaging for patients with low-risk prostate cancer. Both efforts were very successful with post-biopsy infectious hospitalizations decreasing from 1.1% in 2013 to 0.2% in 2024 and unnecessary bone scans and computed tomography (CT) scans decreasing from 13% and 15% in 2012 to 5% and 4% respectively in 2018. MUSIC has also conducted four randomized clinical trials, two completed and two in-progress, utilizing the MUSIC infrastructure. Since its formation, MUSIC expanded its focus from prostate cancer (MUSIC-Prostate) to a program focused on kidney stones (MUSIC-ROCKS) in 2016 and small kidney tumors (MUSIC-KIDNEY) in 2017, with a plan to begin a new program on benign prostatic hyperplasia (BPH) in the fourth quarter of 2025 (Figure 1).

MUSIC Achievements

Over the last 14 years, MUSIC has made significant strides in urological care and surgical quality, achieving milestones that greatly advanced the field (Figure 2). Through MUSIC’s efforts, active surveillance (AS) for patients with low-risk prostate cancer – which involves monitoring prostate cancer in its localized stage until the doctor feels that further treatment is needed to halt the disease at a curable stage – increased from about 40% in 2018 to about 80% in 2024. Post-ureteroscopy emergency department (ED) visits, another area of focus, decreased from about 10% in 2016 to about 8% in 2024.

MUSIC initiatives also made a significant impact on the use of evidence-based guidelines for prescribing opioids after surgery. Between 2016 and 2024, the use of opioid prescriptions after kidney stone surgery dropped from about 80% to about 15%. The Michigan Value Collaborative (MVC) helped assess the impact and value of MUSIC's opioid initiatives within both the ROCKS and Prostate programs, resulting in a MUSIC-ROCKS value assessment in 2022 and a MUSIC-Prostate value assessment in 2023 (Figure 3). These MUSIC initiatives had a major impact on opioid prescribing in Michigan, helping to reduce the availability of unused opioids in the community and mitigate their potential for misuse. MVC and MUSIC frequently collaborate on analytic projects and exercises that help evaluate ongoing initiatives as well as identify opportunities for QI in the future.

Current MUSIC Initiatives

Active surveillance for prostate cancer patients continues to be a goal with additional focus on ensuring patients on AS receive proper follow-up testing. MUSIC aims to build on the successes of previous initiatives by developing updated recommendations for type and frequency of follow-up testing and conducting urologist and primary care physician (PCP) education and feedback reporting. An area of focus for MUSIC’s ROCKS program includes decreasing post-ureteroscopy infectious complications and ED visits after kidney stone surgery. To achieve these goals, MUSIC is developing more specific recommendations for pre- and post-operative antibiotic use, providing better patient education, using non-opioid post-operative pain management, and decreasing the use of ureteral stents (Figure 4).

Services and Benefits for MUSIC Members

MUSIC hosts multiple collaborative-wide meetings and workshops each year to support its ongoing mission to improve urologic care. Other ways MUSIC supports its initiatives and advances QI is by conducting annual site visits to urologists, other providers, and hospitals to review their performance across various metrics, offer provider education, and discuss opportunities for improvement to ensure all patients in Michigan have access to the same quality of care. MUSIC members also receive support for American Board of Urology maintenance of certification.

For patients, MUSIC provides patient education materials that build trust and help improve outcomes, which are often developed with direct input from patients. When asked to comment on the patient education materials and MUSIC program, MUSIC Patient Advocate James Humphries said,

“Guidance provided by my urologist and the MUSIC materials allowed me to make an informed treatment decision regarding my kidney mass and confidently select active surveillance. I am grateful for the continuing opportunity to participate in MUSIC collaborative meetings and provide commentary on patient educational materials. I sincerely believe other patients will benefit if this document is shared. Ultimately, I attribute my improved health and successful surgical outcome to these collaborative efforts.”

MVC is proud to partner with MUSIC in advancing urological 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 support high-value care initiatives across the portfolio. Please reach out to MVC by email if you are interested in learning more.

18 Jun 2025

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CQI Spotlight: Michigan Surgical Quality Collaborative (MSQC)

June 18, 2025 | 0 Comments | CQIs, MVC Coordinating Center

Surgical quality improvement is essential for enhancing patient outcomes, ensuring safety, optimizing healthcare costs, and strengthening overall healthcare system performance. To build patient trust, reduce outcome variation, and drive continuous advancements in surgical practices, the Michigan Surgical Quality Collaborative (MSQC) was established in 2005. Originally created through a partnership between Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), the American College of Surgeons, and 17 participating hospitals, MSQC aimed to foster collaboration in advancing surgical quality. Today, the collaborative includes 70 Michigan hospitals, all committed to improving care delivery through the promotion of evidence-based, best practices in general surgery.

MSQC Achievements

Over the past two decades, MSQC has made a profound and lasting impact on surgical quality, achieving milestones that have significantly advanced the field. The following are highlights of those success stories.

Postoperative Opioid Prescribing Recommendations

Post-procedural pain management is a crucial component of surgical care, and yet the ongoing opioid epidemic posed a pressing question: How much prescription pain medication should be prescribed after surgery? Recognizing the absence of a standardized, evidence-based approach to opioid prescribing, MSQC partnered with Michigan Overdose Prevention Engagement Network (OPEN) in 2016 to develop and implement new guidelines for general surgery and hysterectomy patients. A range of quantitative measures were employed to inform these recommendations, including the number of pills prescribed, patient-reported outcomes on pill usage, and pain levels post-surgery.

Since the guidelines were introduced, opioid prescriptions across Michigan have dropped by 50% over the course of a few years. Follow-up data showed that patients did not report higher pain levels, reductions in satisfaction with their care, or the need for additional prescriptions. This initiative has had a significant impact on public health in Michigan, helping to reduce the availability of unused opioids in the community and mitigate their potential for misuse.

MSQC Care Pathways

In the surgical field, the absence of standardized procedures often results in variation in practice, as demonstrated by the previously mentioned lack of opioid prescribing guidelines. MSQC is dedicated to fostering consistency by standardizing approaches and ensuring the adoption of evidence-based practices. Through collaboration with multidisciplinary teams across member hospitals statewide, MSQC developed the MSQC Care Pathways (Figure 1). These standardized care pathways, which cover surgeries such as colon surgery, hernia repair, laparoscopic cholecystectomy, hysterectomy, Whipple procedures, and outpatient mastectomies, are helping to improve patient outcomes and reduce care variation across Michigan.

Current Initiatives

Building on its past successes, MSQC is advancing several key initiatives to further enhance surgical care. This includes focuses on surgical quality measures for specific procedures, including colorectal cancer, abdominal hernia, and breast surgery, for which MSQC intends to improve both short- and long-term outcomes. Additionally, MSQC is working to identify patient frailty before surgery and implement targeted interventions to enhance overall surgical experiences and outcomes.

In collaboration with ASPIRE/MPOG, MVC, and MPrOVE, MSQC is also supporting the de-implementation of unnecessary preoperative testing before low-risk surgery. As such, MSQC offered metrics in 2023 and 2024, with 33 MSQC hospitals participating in the initiative and observing a 20% reduction in testing. MSQC continues this partnership via the RIght-Sizing Testing before Elective Surgery (RITE-Size) grant, which aims to support hospitals across Michigan in reducing unnecessary testing via a multi-component intervention first piloted at Michigan Medicine. Several of the resources used in the RITE-Size program (Figure 2) were developed in partnership with MSQC and its hospital abstractors, such as the decision aid, sample testing protocol, and engagement package for primary care physician partners.

A recent survey of surgeons identified postoperative urinary retention as one of the most common challenges in their practices. In response, MSQC has partnered with the Surgical Urinary Catheter Care Enhancement Safety Study (SUCCESS) team to develop a comprehensive toolkit. Created and tested in collaboration with a pilot group of MSQC hospitals, surgeons, and nurses, the toolkit aims to reduce inappropriate perioperative urinary catheter use, prevent complications such as infections and trauma, and improve the management of postoperative urinary retention. By 2024, over 35 MSQC hospitals had implemented these tools, significantly enhancing patient safety, particularly for the most vulnerable populations.

Services and Benefits for MSQC Members

MSQC offers a unique opportunity for hospitals and surgeons to improve surgical care through reliable, real-time, risk- and reliability-adjusted data. By leveraging data collected from trained nurse data abstractors, MSQC helps hospitals statewide with benchmarking, meeting quality standards, and driving continuous improvement in surgical care. In collaboration with surgeon leaders across Michigan, MSQC develops robust variables not captured by other organizations, offering valuable insights into a variety of surgical procedures. Additionally, MSQC provides participating surgeons with personalized reports, empowering them to assess their own performance and identify opportunities for improvement at the individual level. When asked what makes MSQC’s work within the CQI community unique, Dr. Michael Englesbe, MD, FACS, MSQC Program Director explained, “What makes us unique is the quality of clinical data that we have access to. Issues that matter the most to patients such as ‘Did I get the right cancer care’ or ‘Will this hernia repair last me a long time’ are the focus of the MSQC. Again, the high-quality clinical data enables high-quality and impactful efforts to transform care in Michigan.”

09 Apr 2025

Chronic Disease Management CQIs diabetes Michigan Value Collaborative Type 2 diabetes

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CQI Spotlight: Michigan Collaborative for Type 2 Diabetes

April 9, 2025 | 0 Comments | Chronic Disease Management, CQIs, diabetes, Michigan Value Collaborative, Type 2 diabetes

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 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 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.

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.”

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

September 24, 2024 | 0 Comments | CQIs, diabetes, mct2d, michigan, MVC Push Reports, Type 2 diabetes

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%).

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%).

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

August 18, 2023 | 0 Comments | CQIs

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).

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

April 20, 2023 | 0 Comments | cancer, CQIs, MOQC, value assessment

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).

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

February 16, 2023 | 0 Comments | CQIs, HMS, quality improvement

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.

Archive

Figure 1. Patient and Caregiver Oncology Quality Council (POQC)

Figure 2. POQC Member Quote

Figure 3. MOQC Hospice Conversation Guide for Physicians

Figure 4. MOQC Excellence in Quality Certification Criteria

Figure 1: OBI Member Service Offerings

Figure 2. Mechanisms for OBI’s Precision QI Support Model

Figure 3. Pathways for Evidence-Based Induction of Labor

Figure 1. 2025-2027 MiCR Operational and Strategic Framework

Figure 2. Corewell Health System CR Post-Integration Outcomes

Figure 3. MiCR Co-Director Mike Thompson facilitating a medication management breakout discussion

Figure 1: Michigan Urological Surgery Improvement Collaborative Programs

Figure 2: Impact of MUSIC

Figure 3. Page 1 of MVC’s Impact and Value Delivery Assessment for MUSIC-ROCKS

Figure 4: Decreasing Unplanned Healthcare Encounters after Ureteroscopy (URS)

Figure 1. MSQC Hernia Care Pathways

Figure 2. RITE-Size Resources

Figure 1. MCT2D Resources and Education Materials

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Methodology

Limitations

Impact & Next Steps

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)

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