16 Nov 2023
0
View Post
MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

November 16, 2023 | 0 Comments | , , ,

Today is National Rural Health Day. Since 2010, the National Organization of State Offices of Rural Health set aside the third Thursday of every November to highlight the unique healthcare challenges facing residents within rural communities and celebrate providers who deliver innovative, affordable, and coordinated rural healthcare. MVC’s current membership includes 44 hospitals based in rural communities, 22 of which are designated as Critical Access Hospitals (CAHs). In tribute to National Rural Health Day and the needs of its growing rural membership, MVC hosted a special rural health workgroup yesterday.

The workgroup featured a guest presentation by Stephanie Pins, MSA, CPHQ. Pins is the Director of Quality, Risk, and Compliance for MyMichigan Medical Center Sault, formerly War Memorial Hospital, and is co-leading the Health Equity Council for MyMichigan Health. She led the creation of a transportation program for War Memorial Hospital by working with local transportation companies and applying for grants to cover the cost of the program.

This guest presentation focused on how MyMichigan is supporting rural communities through their Non-Emergency Medical Transportation (NEMT) Project, and the steps their team took to develop this program. Beginning in 2024, CMS will require that hospitals screen admitted patients for five social determinants of health (SDOH) domains. One of those five required domains is transportation needs since access to transportation and distance to care have a significant impact on healthcare outcomes.

MyMichigan Medical Center Sault primarily services the very rural communities of Chippewa, Luce, and Mackinac counties, located in the eastern Upper Peninsula of Michigan. A resident of Drummond Island—part of Chippewa County—may have to drive as many as 70 miles each way to get to an appointment at MyMichigan Medical Center Sault. Limited vehicle access in this part of the state was highlighted recently at MVC’s fall collaborative-wide meeting; the eastern Upper Peninsula had some of the highest rates in the state for housing units with no vehicle (Figure 1).

Figure 1.

While presenting, Pins emphasized that once MyMichigan identifies a need through screening, the next step is to find a way to connect those patients with the assistance they need to access medical care. One transportation solution utilized by MyMichigan Medical Center Sault is the Road-to-Recovery program, offered in partnership with McLaren Northern Michigan in Petoskey. The MyMichigan Medical Center Sault location offers some oncology cancer treatment services, but not radiation, so patients may need to travel to Petoskey—a distance of over 90 miles—to receive radiation therapy as part of their cancer treatment. The fully funded Road-to-Recovery program is available five days a week free of charge to anyone in the eastern Upper Peninsula. A hospital-owned van is driven by a volunteer driver from the MyMichigan Medical Center Sault location to scheduled pick-up locations along the I-75 corridor to Petoskey. Service times are coordinated with McLaren Northern Michigan’s oncology group so all the patients using this service have aligned appointment times. Pins shared that one noteworthy ancillary benefit of this program has been the peer support and relationship building that resulted from patients traveling together for extended periods while going through a similar treatment experience.

A second transportation solution utilized by MyMichigan Medical Center Sault is the Rides-to-Wellness Program, a partnership effort with local transportation companies and Connect UP. Patients can use this service to travel to other appointments or patient care services and serves as a critical stopgap in ensuring patients have somewhere to turn for time-sensitive transportation needs. Pins shared that the patient testimonials from those utilizing the service are helpful evidence of its value to the eastern Upper Peninsula (Figure 2).

Figure 2.

MyMichigan Medical Center Sault identified several lessons learned from delivering its Rides-to-Recovery Program over the last 10 years and applied many of those lessons to the development of its more recent Rides-to-Wellness Program. Pins also shared several tips for starting similar hospital-based transportation support programs at other locations throughout the state (Figure 3).

Figure 3.

Those who missed the workgroup and would like to learn more about these two programs, how they are managed, and how they were developed can review the full recording here. MVC is excited to offer a new rural health workgroup series quarterly in 2024. Contact MVC if you are interested in receiving invitations to those workgroups.

14 Sep 2023
0
View Post
MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

September 14, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce open registration for its upcoming Fall Collaborative-Wide Meeting on Friday, Oct. 20, 2023, from 10 a.m. – 3 p.m., in Lansing, MI. This meeting’s theme is “High-Value Care for All: Collaborative Approaches to Equitable Healthcare,” and will focus on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

This meeting will include presentations on health equity frameworks for quality improvement, insights from claims-based data, and inter-organizational partnerships to improve patient outcomes. MVC is thrilled to be joined by Renée Branch Canady, PhD, MPA, CEO of the Michigan Public Health Institute (MPHI), as its keynote speaker. Dr. Canady has extensive experience in diversity, equity, and inclusion (DEI) efforts, and was recognized as Crain’s 2021 Notable Executives in DEI. She received this honor for her work implementing incremental changes in health equity and social justice at MPHI. Under her leadership, MPHI established the Staff of Color Affinity Group, the Center for Health Equity Practice (CHEP), and the Center for Culturally Responsive Engagement (CCRE). She also recently published a new book titled Room at the Table: A Leader’s Guide to Advancing Health Equity and Justice.

The MVC Coordinating Center will also present MVC data linked with supplemental social determinants of health data sets, updates about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and other Coordinating Center updates.

MVC’s fall collaborative-wide meeting will also feature a new roundtable format with insights from a wide variety of guest speakers, including Nora Becker, Michigan Medicine; Diane Hamilton, Corewell Health Trenton; Matthias Kirch, Michigan Social Health Interventions to Eliminate Disparities (MSHIELD); Laura Mispelon, Michigan Center for Rural Health; Amanda Sweetman, the Farm at Trinity Health; Larrea Young and Noa Kim, Healthy Behavior Optimization for Michigan (HBOM); and Thomas West, U-M Health West. Attendees will rotate through several mini-presentations and discussions about specific health equity topics, such as demographic data collection and patient screening practices, developing and funding community benefit programs, addressing transportation access barriers, support programs within rural communities, tobacco cessation interventions, financial toxicity risks for patients, and more.

Attendees will have multiple opportunities to network and learn from their peers. The meeting includes a mid-day poster session to highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions through 10/5/2023 that feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to health equity or MVC conditions/data, authored by clinicians and non-clinicians alike, or presentations already shared at a recent conference or event. Instructions for submitting a poster are available on MVC’s events page. The meeting also includes breakout sessions in the afternoon focused on regional trends and opportunities using MVC data and member insights, as well as an optional networking reception at the conclusion of the event, from 3-4 p.m.

Those able to attend MVC's fall collaborative-wide meeting may register here. MVC hosts two collaborative-wide meetings each year to bring together healthcare quality leaders and clinicians from across the state.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

Hari Nathan, MD, PhD; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH; Kristy Degener, MPH

29 Aug 2023
0
View Post
MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

August 29, 2023 | 0 Comments | , , ,

After childbirth, all individuals should have access to patient-centered counseling about birth spacing, and, if desired, contraceptive methods to help fulfill their personal reproductive goals. Promoting patient-centered contraceptive care and equitable access to contraceptive methods for those who desire them may improve population health outcomes.

Researchers and medical professionals are increasingly recognizing the impact of social determinants of health (SDOH) on individuals’ access to care and overall health outcomes. Unmet social needs may affect contraceptive initiation after childbirth by influencing individuals’ preferences for future childbearing, as well as individuals’ access to high-quality contraceptive care. To better understand this relationship, a group of clinician investigators used MVC data in a paper published in the American Journal of Obstetrics and Gynecology to evaluate the association between living in a neighborhood with high social vulnerability and the use of long-acting reversible contraception (LARC) and sterilization methods during the postpartum period.

Lead author Michelle H. Moniz, MD, MSc, Program Director of the Obstetric Initiative (OBI), and her colleagues utilized MVC administrative claims data to identify childbirth episodes from Jan. 2016 to Dec. 2019 with outcomes including LARC and sterilization use by 60 days into the postpartum period. Social vulnerability was determined using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). The SVI measures a community’s economic and social resilience by integrating 15 U.S. Census variables to generate composite scores across 4 themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.

In 140,345 delivery episodes at 79 hospitals, 8% of patients initiated LARC devices, and 8.3% initiated sterilization by 60 days postpartum. Dr. Moniz and colleagues observed independent associations between social vulnerability and postpartum contraceptive use. It appeared that different SVI themes such as socioeconomic status, minority status and language, household composition and disability, and housing type and transportation aligned with varying use of LARCs or sterilization (Figure 1). Individuals living in neighborhoods with the highest socioeconomic vulnerability and minority status/language vulnerability were more likely to utilize LARC methods. Individuals living in neighborhoods with the highest household composition vulnerability were less likely to initiate LARC methods.

Figure 1. Adjusted LARC and Sterilization Use by 60 Days Postpartum (Using SVI Theme)

Conversely, sterilization was more likely among populations living in neighborhoods with highest housing/transportation vulnerability and less likely among those living in neighborhoods with highest socioeconomic vulnerability and minority status/language vulnerability.

Dr. Moniz and colleagues suggest that “structural factors—such as distance to clinic, fees for parking and transportation, clinic hours, childcare access, ability to miss work to seek healthcare, and out-of-pocket costs for healthcare—may affect postpartum contraceptive use.” They also note that more research is needed to fully understand the means by which SDOHs influence an individual’s healthcare preferences and choices. Additional investigations could shed light on the mechanisms by which unmet social needs influence reproductive wishes and access to patient-centered contraceptive counseling and methods after childbirth.

In all sectors of healthcare and medical research, but especially in maternal health where inequities in health outcomes have worsened in recent years, further studies must be done to better understand the impact of SDOHs. While medical advancements and the pursuit of best practices are critical to ensuring improvement in healthcare delivery, these innovations cannot impact outcomes for all patient populations until we understand the structural factors affecting patient access and goals.

MVC is committed to using data to improve the health of Michigan through sustainable, high-value healthcare. Therefore, one of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. MVC shares its data with clinical, administrative, and CQI experts for investigative analyses to help identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Michelle H. Moniz, MD, MSc; Alex F. Peahl, MD, MSc; Dawn Zinsser, BA; Giselle E. Kolenic, MA; Molly J. Stout, MD, MS; Daniel M. Morgan, MD

Full Citation

Moniz, M. H., Peahl, A. F., Zinsser, D., Kolenic, G. E., Stout, M. J., & Morgan, D. M. (2022). Social vulnerability and use of postpartum long-acting reversible contraception and sterilization. American Journal of Obstetrics and Gynecology, 227(1). https://doi.org/10.1016/j.ajog.2022.03.031

30 Mar 2023
0
View Post
MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

March 30, 2023 | 0 Comments | , , , ,

MVC staff stepped out of their daily routines recently when they volunteered as a team at a local nonprofit organization. Eager to make this service opportunity as meaningful to their work as possible, MVC staff selected an organization with ties to health and well-being. Last month they were hosted by Food Gatherers, the food bank and food rescue program serving Michigan residents in Washtenaw County. MVC teammates worked together to sort rescued produce in the Food Gatherers warehouse, saving and packing 1,312 pounds of produce for the community.

Though MVC teammates were excited and impressed by that number, it pales in comparison to the amount of food processed by food banks like Food Gatherers, which last year distributed 7.3 million pounds of food — the equivalent of 6 million meals — through its network of partner programs. In order to collect and distribute all those meals, Food Gatherers maintains a working warehouse where an average of nine tons of food are processed each day, and a busy community kitchen prepares and serves hot meals seven days a week. Volunteers play a significant role in these operations.

Produce boxes and other foods that are processed by volunteers eventually find their way into the hands of over 170 community partners, such as food pantries or emergency groceries. In addition to distributing food, Food Gatherers also works to connect beneficiaries to SNAP and other federal food programs and provide innovative food distribution initiatives at area schools and clinics. A new area of focus is the cultivation of partnerships with healthcare providers to further identify and address food insecurity in the community.

Food Gatherers established its Health Care and Food Bank Partnership Initiative to create a connection between local healthcare institutions and Food Gatherers’ network of partner pantries. It was designed to increase access to food for community members in partnership with healthcare providers. Key activities of the initiative include establishing food insecurity screening and referral programs within primary care locations, training medical professionals such as residents and allied health professionals on the role of food security as a key social determinant of health, and drawing attention to the issue of hunger and healthy food access with healthcare providers.

This is a growing area of interest for food banks across the country since food insecurity is closely linked to poor health outcomes and increased risk of chronic disease. According to one study, in fact, the rate of Type 2 diabetes is 25% higher in adults who are food insecure. In addition, as many as one-third of patients with a chronic illness are unable to afford food, medications, or both. A recent publication using MVC data also found strong associations between chronic disease burden and financial outcomes.

Several components of the Food Gatherers Health Care and Food Bank Partnership Initiative were initially supported through a Michigan Medicine grant. Food Gatherers has worked with Michigan Medicine, Trinity Health St. Joseph Mercy Ann Arbor, and IHA as well as with community-based clinics such as the Hope Clinic, Packard Health, and the Corner Health Center. Though the grant ended in 2021, the larger concept of partnership between healthcare providers and community food banks is still an area of interest and opportunity.

"Food Gatherers has been working with our local health care partners to support and encourage the use of food insecurity screening in primary care settings,” said Markell Miller, MPH, Director of Community Food Programs at Food Gatherers. “When providers can identify food insecurity in a patient, they can help connect the individual to resources - specifically SNAP, or if it's an urgent need, a local food pantry. Hunger is a health issue, and when providers talk about food security, they reinforce the connection between nutrition and health, and also destigmatize the experience for individuals facing food insecurity. Our Hunger and Health Training program provides baseline information for physicians on food security as a social determinant of health, and how to support individuals facing food insecurity. We've focused on training medical residents going into careers in primary care, but there is an opportunity to train other providers to increase knowledge and comfort with food insecurity screening and referrals. We look forward to future opportunities to expand our partnership with health care providers, and also continue to seek sustainable funding solutions to support the network of healthy pantries that are available in our community."

Similar programs are also underway at other food banks across Michigan, such as Gleaners Community Food Bank of Southeastern Michigan. In 2015, Gleaners was one of three participating food banks in a two-year randomized controlled research study on the impact of food bank interventions on outcomes for patients with Type 2 diabetes. They have partnerships with the CHASS Center, Covenant Community Care, Henry Ford Health System, the Michigan Health Endowment Fund, the National Kidney Foundation of Michigan, and Trinity Health St. Joseph Mercy Livingston, and have thus far connected more than 500 patients with healthy food.

MVC recently invited Jessica Ramsay, MPH, Director of Wellness and Nutrition Education at Gleaners, to present at MVC’s upcoming chronic disease management workgroup on Thurs., April 20, from 2 - 3 p.m. The presentation will focus on partnerships between healthcare providers and community organizations, highlighting pilot programs and initiatives at Gleaners that improved both patient outcomes and healthcare utilization through reduced food insecurity. Registration for this workgroup presentation is open now.

To learn more about the food banks mentioned, please visit the websites of Food Gatherers and Gleaners Community Food Bank of Southeastern Michigan. Reach out to MVC if your hospital or PO has a similar partnership in place with a community-based organization – MVC would love to highlight this work.

To learn more about the ways in which food insecurity impacts health, check out the video below from Feeding America.

Illuminating Intersections: Hunger and Health (Feeding America)

09 Feb 2023
0
View Post
MVC to Honor Medical Pioneers for February’s Black History Month

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

February 9, 2023 | 0 Comments | ,

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

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

Figure 1.

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

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

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

Figure 2.

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

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

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

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

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

02 Feb 2023
0
View Post
MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

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

February 2, 2023 | 0 Comments | , , , ,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

10 Nov 2022
0
View Post
Distressed Community Index Data Supplements MVC Equity Work

Distressed Community Index Data Supplements MVC Equity Work

November 10, 2022 | 0 Comments | , , , ,

Emphasizing health equity in Michigan is a key strategic initiative for the Michigan Value Collaborative. MVC kicked off this strategic initiative at its October 2021 semi-annual meeting with the theme of “The Social Risk and Health Equity Dilemma.” Since then, MVC has expanded its access to data sets related to health equity, developed hospital health equity reports, and regularly convened stakeholders from around the state via a health equity workgroup series that launched in January 2022. MVC is eager to find new and exciting ways to utilize data and collaborate with members on health equity topics in Michigan.

One of the more recent enhancements to MVC’s capacity was the addition of more granular data on social determinants of health. MVC secured access to Distressed Community Index (DCI) data, a tool for measuring the comparative economic well-being of US communities. DCI data was first integrated into MVC reporting in August with the distribution of a new push report on emergency department and post-acute care use. It was also incorporated in MVC’s newest physician organization report on chronic obstructive pulmonary disease, which was distributed to PO members last month.

The DCI data are developed by the Economic Innovation Group and derived from the US Census Bureau’s Business Patterns and American Community Survey Five-Year Estimates (2016-2020). The DCI is a composite measure of ZIP-code level socioeconomic distress comprised of seven key indicators, including education, housing, unemployment, poverty, income, employment changes, and business (see Figure 1).

Figure 1.

The resulting DCI composite measure assigns individual five-digit ZIP codes a number from 0 to 100 with 0 representing the least distressed communities and 100 representing the most distressed communities. The DCI is then grouped into five ordered categories for ease of comparison: distressed, at risk, mid-tier, comfortable, and prosperous. The data include details on 874 ZIP codes in Michigan that have at least 500 residents, of which 192 (22%) are prosperous communities and 120 (14%) are distressed communities. The map below (see Figure 2) highlights the distribution of community-level distress categories across the state of Michigan, with the blue areas representing more prosperous communities and the red areas representing more distressed communities.

Figure 2.

The data also reveal staggering racial/ethnic disparities in Michigan. As seen in Figure 3 below, Black/African American Michiganders are far more likely to live in distressed communities relative to non-Hispanic whites. This information is further evidence of the need for broad efforts to reduce disparities according to race/ethnicity and local community distress.

Figure 3.

Incorporating the DCI into MVC data analytics will offer new opportunities to better understand health equity challenges in Michigan. The MVC Coordinating Center looks forward to using these data in collaboration with its members and is eager to discuss how best to leverage such data sets to identify inequity in Michigan healthcare. Please contact MVC to learn more or request custom analytics.

25 Aug 2022
0
View Post
BCBSM Initiative Incentivizes Data Collection on Social Factors

BCBSM Initiative Incentivizes Data Collection on Social Factors

August 25, 2022 | 0 Comments | , , ,

Health equity is a top priority for providers across the country, who are keenly aware of the prevalence and exacerbation of existing health inequities. The state of Michigan in particular ranks poorly in measures of population health and social determinants of health (SDOH), which represent a huge opportunity to improve equity and health outcomes for patients. Health equity is currently a key strategic focus of the Michigan Value Collaborative (MVC) Coordinating Center in the years ahead, as well as for Blue Cross Blue Shield of Michigan (BCBSM). As work in this area grows, some suggest that better data collection is the next critical step to improving health equity.

Data collection is the focus of BCBSM’s latest initiative - the SDOH Standardized Data Collection and Aggregation Initiative - which offers incentives to physician organizations (POs) for collecting and submitting SDOH screening data. Its goal is to increase SDOH screening by primary care physicians during annual wellness visits as well as enhance SDOH data submitted to the Michigan Health Information Network (MiHIN), Michigan's nonprofit statewide health information network.

This data will be used in the short term to improve data conformance and SDOH definitions within the Michigan provider community. Ideally, this initiative will help BCBSM to improve care coordination between providers, identify gaps in resources and community-level social need trends, and provide analytics and reporting to the provider community. The long-term goal is to reduce disparities and improve health outcomes.

There are multiple pathways for POs to participate, primarily by either submitting screening data through MiHIN’s SDOH use case, or by developing infrastructure to enable participation in MiHIN’s SDOH use case. BCBSM sees this incentive program as an important step toward ensuring all patients receive the care they need.

“The SDOH initiative is valuable for both patients and providers because it encourages providers to screen for SDOH needs in patients and also encourages that the data from these screenings is exchanged in an interoperable way,” said Karolina Skrzypek, MD, Medical Director of Clinical Partnerships at BCBSM. “It is very important that providers across the state of Michigan have the ability to access SDOH screening data regardless of where the screening took place. Screening for SDOH needs by providers is the first step in helping to address these needs in our patients.”

These points were echoed by Martha M. Walsh, MD, MHSA, FACOG, Medical Director of Clinical Partnerships and Engagement at BCBSM, who said, “We know that when patients have SDOH needs, that it is more difficult for them to have their healthcare needs met and for patients to care for their chronic conditions. Our initial goal in having providers screen for SDOH needs is for patients to have their needs addressed at the point of care.”

Some POs are already actively submitting this data to MiHIN and can receive incentive payments for continuing to do so. The other pathways are focused on those who have capacity to store and extract SDOH data but are not submitting it to MiHIN, or those POs who don’t yet have the digital infrastructure in place. Helping all POs to achieve a similar capacity and submit their data to the same vendor will allow for a broader understanding of the gaps and communities in need of further funding.

“By aggregating this data, we hope to learn more about specific domains of need and geographic areas with the most needs so that we can start to address these more broadly,” said Dr. Walsh. “We hope that by screening for and addressing SDOH needs, we will start to be able to decrease disparities in care for our most vulnerable patients.”

Incentives for the MiHIN SDOH use case pathways are paid out of the BCBSM Physician Group Incentive Program (PGIP) reward pool. Therefore, any deadlines related to participation are based on PGIP payment cycles. Those POs wishing to participate in the October 2022 cycle should submit their opt-in form and any other required materials by the end of August.

A separate value-based reimbursement (VBR) reward was created specifically for patient-centered medical home (PCMH) designated primary care physicians for completing SDOH screenings using Z codes. This VBR payment was available when the SDOH initiative launched in January. Provider offices had six months to work towards meeting the criteria to receive VBR effective 9/1/2022. Criteria for the 2023 cycle was previously announced and updates to the criteria will be provided during the upcoming BCBSM September PGIP quarterly meeting.

Any POs or providers interested in learning more about this initiative and the pathways for participating can read the full brochure here and submit questions directly to BCBSM at POPrograms@bcbsm.com. In addition, if your PO or hospital has success stories or insights that have resulted from collecting SDOH screening data, please consider sharing your story and insights with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

Support for MVC is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships program. Although BCBSM and MVC work collaboratively, the opinions, beliefs, and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs, and viewpoints of BCBSM or any of its employees. To learn more about the Value Partnerships program, visit www.valuepartnerships.com.

24 Mar 2022
0
View Post
Unique Food Assistance Program Bridges Medical and Food Sectors

Unique Food Assistance Program Bridges Medical and Food Sectors

March 24, 2022 | 0 Comments | , ,

MVC hosted another successful session of its new health equity workgroup last week with a guest presentation by Ariane Donnelly, MPH, RD, Health Promotion Coordinator at the Washtenaw County Health Department. The new health equity workgroup was established in response to a greater strategic focus on health equity within the MVC Coordinating Center as well as widespread interest in this topic within the healthcare field.

The March 16 workgroup focused on the Prescription for Health program, which takes a unique approach to chronic disease management by connecting the medical system with the food sector. It operates by having participating healthcare providers assign “prescriptions” to their patients to eat more fruits and vegetables. These prescriptions can then be “filled” at local participating farmers markets, where patients receive $100 in tokens to spend on fresh fruits and vegetables as well as nutrition education and support. Participants also work with Community Health Workers to set health goals. The program leverages the fact that Michigan is the second most agriculturally diverse state in the country, and its abundant farmers markets can be an asset in supporting healthy lifestyles for patients.

Evaluation of the program’s effectiveness has been fruitful. For every year of the program, the health department found a statistically significant increase in self-reported fruit and vegetable intake, often by one cup or serving per day (see Figure 1).

Figure 1.

The program was first created in 2008 in response to high levels of food insecurity within communities in Washtenaw County combined with generally low consumption of fruits and vegetables, both of which are associated with an increased risk of chronic disease. Ms. Donnelly pointed out that while many clinics provide nutrition advice, patients face multiple barriers to equitably accessing healthy foods and need additional support. Since its first pilot, the program has continued to grow in total enrollees and economic impact, and it maintained its participation levels throughout the pandemic with a modified version of the program.

Similar programs are in operation in other parts of the state and country as well, such as Food Rx in Chicago and Fresh Prescription in Detroit. Washtenaw County’s Prescription for Health program launched an implementation toolkit in 2016 to help others with starting a similar program in their area.

To learn more about the Prescription for Health program’s operations, impact, and lessons learned, watch the full recording of the workgroup here: https://bit.ly/3IyIsnS. You can also visit the program website for more information: www.washtenaw.org/prescriptionforhealth.

MVC will continue to invite guest speakers with valuable insights on a more equitable health system. The next MVC health equity workgroup will take place on Tuesday, May 10, from 1-2 p.m. If you would like to suggest a topic or speaker for a future workgroup, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

Prescription for Health is funded by Saint Joseph Mercy Health System with additional financial support from multiple partners.

10 Mar 2022
0

Health Equity Report Refreshed with New Data and Demographics

March 10, 2022 | 0 Comments |

With an enhanced strategic focus on health equity, the MVC Coordinating Center was excited to share refreshed versions of its health equity push report this week. The health equity report was first launched in August 2021 in response to growing interest from members as well as widening gaps in health outcomes for patients with a lower socioeconomic status. The purpose of the report is to help members better understand their patient population, and the newest version re-examines some of the original findings. It also adds data to help providers identify the most impacted patients and understand how their care differs from patients with a higher socioeconomic status.

The report distributed this week provided a comparison of Medicaid patients to Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) patients, whereas the first iteration compared outcomes of dual-eligible versus non-dual-eligible Medicare patients. Therefore, one change from the previous report is that the patients included are much younger on average. This report incorporated index admissions from 1/1/2018 – 9/30/2021 for BCBSM PPO Commercial and BCN HMO Commercial and from 1/1/2018 – 12/31/2020 for Medicaid. Members who received reports will see comparisons between these two groups for total episode payments, length of stay, 30-day readmission rates, 30-day post-discharge emergency department utilization, and 30-day post-discharge office visit rates.

Despite utilizing different payer data, insurance type was still a good predictor of health outcomes in the report. The Coordinating Center continued to see poorer outcomes across the board for those patients who were publicly rather than privately insured – a finding that is consistent in the research literature as well. These disparities were most pronounced among medical conditions than surgical procedures.

This report continued to look at post-acute care trends but narrowed its focus to office visits specifically. This is because there were significant differences in office visit rates by insurance type in the previous report and skilled nursing facility use was much less relevant within this report's younger patient population. When looking at office visit utilization, the rates were significantly different between BCBSM/BCN and Medicaid patients for both medical conditions (see Figure 1) and surgical procedures. However, the disparity was more pronounced in medical conditions. MVC saw a decrease in office visits in early 2020 across the state that is believed to be related to the pandemic, but visits returned to pre-pandemic rates in the latter half of the year. Furthermore, episodes were excluded from this report if they contained a confirmed diagnosis code of COVID-19 in the first three diagnosis code positions of any inpatient facility claim.

Figure 1. Office Visit Trend Graph from Blinded Report

Another key change to the report was the addition of a patient population demographics table (see Figure 2), which provides the hospital with age, race, zip code, and comorbidity information for Medicaid versus BCBSM/BCN patients. Overall, the most common comorbidity across the state was diabetes, and the Medicaid population was younger on average.

Figure 2. Demographics Table from Blinded Report

Like the first version of the report, there was a conscious decision to exclude comparison groups. This is because the socioeconomic factors of a hospital’s patient population cannot be changed, and there is great diversity between hospitals throughout the state and within geographic regions. For those reasons, benchmarking was not the intention of this report. However, it is important to note that across the state, the data analyzed by the MVC Coordinating Center consistently indicates that Medicaid patients have poorer outcomes than privately insured patients, including longer lengths of stay, higher readmission rates, higher post-discharge emergency department utilization, and lower rates of office visits post-discharge.

The MVC Coordinating Center is eager to support members in improving health equity. Please consider sharing feedback on this report with the Coordinating Center, as well as attending MVC’s newest workgroup on health equity to learn and share with peers. If you have any questions, comments, or suggestions, please contact the Coordinating Center at michiganvaluecollabortative@gmail.com.