0
View Post
MVC Fall Semi-Annual Summary: Prescribing Health in Michigan

MVC Fall Semi-Annual Summary: Prescribing Health in Michigan

The Michigan Value Collaborative (MVC) held its second semi-annual meeting of 2022 last Friday, marking MVC’s first in-person collaborative-wide meeting since 2019. A total of 90 leaders registered for the meeting, representing 25 different hospitals, seven physician organizations (POs), and five stakeholder organizations from across the state of Michigan. This meeting’s theme of “Prescribing Health in Michigan” showcased strategies to drive evidence-based medication utilization and support patient access to medications through the implementation and evaluation of quality improvement projects.

MVC Director Hari Nathan, MD, kicked off Friday’s meeting with an update from the MVC Coordinating Center. He welcomed one new collaborative member, Bronson Lakeview (Paw Paw), as well as MVC’s newest team members, Associate Program Manager Erin Conklin and Statistician Lead Usha Nuliyula. Dr. Nathan also highlighted the successes delivered by the Coordinating Center since May’s Semi-Annual Meeting. For instance, MVC launched its Qualified Entity registry pages to provide authorized users with more granular data than is available in the Medicare FFS reports, incorporated Distressed Community Index data into push reports as part of MVC’s commitment to emphasizing equity in healthcare, and distributed three new push reports (chronic obstructive pulmonary disease for POs, emergency department and post-acute care utilization for acute and critical access hospitals, and a hysterectomy report for hospital members).

Dr. Nathan also provided an update on the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, noting that final scorecards for Program Year 2022 will be distributed in quarter one of 2023. Attendees also learned about P4P changes coming with Program Years 2024 and 2025 (see Figure 1).

Figure 1.

Based on member feedback, MVC will be rolling out an updated methodology to improve the actionability of the program. Along with the existing 30-day episode of care component, MVC is introducing new value metrics and engagement metrics for PYs 2024 and 2025. The value metrics will incentivize evidence-based and actionable high-quality services, such as increasing cardiac rehabilitation utilization after percutaneous coronary intervention (PCI), increasing follow-up rates after hospitalizations for pneumonia, or decreasing preoperative testing prior to low-risk procedures. The engagement metric will award points to hospitals for attending and contributing to MVC engagement activities, such as attending both semi-annual meetings or presenting at a workgroup. Stay tuned for additional details on PYs 2024 and 2025; informational webinars on the program changes are coming soon.

Showcasing MVC’s new pharmacy claims data from BCBSM and Blue Care Network was a focal point for the meeting. MVC Senior Analyst Monica Yost led attendees through an overview of MVC’s current pharmacy claims data along with an unblinded data session focused on opioid overprescribing after joint surgery (see Figure 2 for a blinded version of utilization across the collaborative). Leveraging opioid prescribing recommendations from the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), the data session allowed hospitals and POs to see their opioid prescribing rates in the 30 days following hip and knee replacements compared to their peers. Hospitals and POs performing well were invited to offer insights as to how this was achieved and what mechanisms other members could adopt to improve performance levels.

Figure 2.

With the scene set, MVC welcomed keynote speaker Lindsey Kelley, Associate Chief of Pharmacy at Michigan Medicine. Dr. Kelley provided attendees with an overview of the challenges patients face accessing high-cost, complex medications as well as opportunities to improve access and patient experience through integrated health system specialty pharmacy. Walking through Michigan Medicine’s model, Dr. Kelley noted that simplifying the workflow for specialty pharmacies reduces strain on clinic staff (i.e., physicians, nurses, medical assistants) and eliminates the instances of prescriptions being sent that cannot be filled, thereby reducing gaps in therapy starts. Sharing the model’s evaluation strategy, Dr. Kelley highlighted the project’s collaboration with MVC, which led to a larger proportion of all target specialty medication prescription fill data being tracked and extended the evaluation’s reach.

Following Dr. Kelley’s presentation, Troy Shirley, PharmD, MBA, System Director of Pharmacy for Bronson Healthcare, presented Bronson’s efforts to improve health equity through pharmacy-supported discharge initiatives. One initiative focused on medication reconciliation at discharge, which leveraged unit-based pharmacists to complete medication reconciliation for patients hospitalized with chronic obstructive pulmonary disease, pneumonia, heart failure, and acute myocardial infarction. Additionally, Bronson’s “Meds to Beds” program engaged a multi-disciplinary team that included a retail pharmacist, pharmacy, technician, unit nurse, and care manager to hand-deliver patients’ medications at the bedside and provide medication counseling prior to discharge.

Next on the agenda was a presentation from Tiffany Jenkins, PharmD, BCACP, Director of Population Health Pharmacy at Trinity Health Alliance of Michigan, who shared insights about population health pharmacy initiatives within a physician organization, including a diabetes medication management initiative focused on evidence-based diabetes management to improve quality of care, reduce inappropriate use of pharmaceuticals, and lower cost of care; a pharmacy tech-led medication adherence monitoring strategy to engage patients, providers, and care teams in appropriate medication use; an obesity medication management initiative focused on evidence-based utilization of chronic weight management medications to lower cost of care; and a comprehensive medication management project that leverages pharmacist-care team collaboration to support medication management.

Closing out the morning session, Mark Bicket, MD, PhD, Co-Director of the Opioid Prescribing Engagement Network (OPEN) and Assistant Professor with the Division of Pain Research, Department of Anesthesiology at the University of Michigan, presented information on shifts to prescribing recommendations after surgery to decrease opioid use, techniques to promote the adherence of non-opioid medications and non-pharmacological approaches to pain management, and strategies to maximize safe storage and disposal of controlled substances.

In the afternoon following a networking lunch, the presenters participated in a panel discussion moderated by MVC Co-Director Michael Thompson, PhD, MPH. The group discussed strategies to change provider behavior and navigate the challenges of pharmacy-related improvement initiatives. The meeting concluded with a summary of the day and upcoming MVC activities, led by MVC Associate Program Manager Erin Conklin. The slides from Friday’s meeting have been posted to the MVC website. If you have questions about any of the topics discussed at the fall 2022 semi-annual meeting or are interested in finding out more, please reach out to the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu. MVC’s next semi-annual meeting will be in person on Friday, May 19, 2023, at the Vistatech Center in Livonia.

0
View Post
MVC Releases Its Fall Semi-Annual Agenda, Speaker Topics

MVC Releases Its Fall Semi-Annual Agenda, Speaker Topics

The MVC Coordinating Center recently released the full agenda for its forthcoming Fall 2022 Semi-Annual Meeting, which takes place in Lansing at the Radisson Hotel on Friday, October 28, 2022, from 9 a.m. to 2:30 p.m. MVC holds collaborative-wide meetings twice each year to bring together quality leaders and clinicians from across the state. This meeting’s theme of “Prescribing Health in Michigan” will support attendees in learning strategies to drive evidence-based medication utilization and support patient access to medications through the implementation and evaluation of quality improvement projects.

Speakers at semi-annual events are often members who share their successes, challenges, barriers, and solutions in pursuing a higher value and quality of care. The speakers this fall represent a variety of stakeholder groups, including member hospitals and physician organizations (POs), pharmacy experts, pain management experts, and of course MVC Coordinating Center leadership.

The keynote presentation will be given by Dr. Lindsey Kelley, Associate Chief of Pharmacy at Michigan Medicine. She also serves as Program Director for the PGY1 Community Pharmacy Residency and adjunct faculty at the University of Michigan College of Pharmacy. Dr. Kelley earned her Doctor of Pharmacy degree from the University of Arizona in Tucson. She completed a pharmacy practice residency at Abbott Northwestern Hospital in Minneapolis, MN, and received her MS from the University of Minnesota College of Pharmacy while completing a two-year Health-System Pharmacy Administration and Leadership residency at the University of Minnesota Health. Dr. Kelley has been an active member of national pharmacy associations, state affiliates, and advisory councils. She was also honored with the ASHP New Practitioners Forum Distinguished Service Award in 2010 and recognized as a fellow in 2019. Her presentation will focus on improving patient care through better access to high-cost and complex medications.

MVC members will also hear presentations from their peer hospitals and POs about pharmacy initiatives implemented at other sites. Dr. Troy Shirley, System Director of Pharmacy at Bronson Healthcare, will present on improving health equity through pharmacy-based initiatives. Dr. Tiffany Jenkins, Director of Population Health Pharmacy at Trinity Health Alliance of Michigan, will present on population health pharmacy initiatives within a PO.

The Opioid Prescribing Engagement Network (OPEN) will touch on pain management best practices and resources. They are represented by Dr. Mark Bicket, Co-Director of OPEN and Assistant Professor in the Division of Pain Research in the Department of Anesthesiology at the University of Michigan. His presentation will focus on improving medication adherence for surgical pain management.

Attendees can also expect to hear from MVC Coordinating Center leadership and staff about the MVC Component of the BCBSM Pay-for-Performance (P4P) Program, unblinded data on prescribing practices across the collaborative, new conditions and data sources that are available to members on the registry and in push reports, MVC’s new Qualified Entity status and resulting patient-level Medicare data, and updates about other upcoming MVC events. The guest presentations will be followed by a panel discussion about medication adherence facilitated by MVC leadership.

At the conclusion of the meeting, attendees will have learned approaches to improving medication access and utilization, patient experience, treatment adherence, care transitions, post-discharge support, patient education, reduced readmissions, and health equity. The full agenda can be accessed online here.

These presentations would be informative and applicable for any of the following stakeholders who are invited to attend:

  • MVC hospital site coordinators
  • MVC PO site coordinators
  • Quality leadership
  • Physicians
  • Nurse practitioners
  • Pharmacists
  • Community-based organizations or social workers
  • CQI staff

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 4.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Those interested in attending this informative and collaborative meeting should register here. The MVC Coordinating Center looks forward to a fantastic meeting. See you there!

Activity Planners

Hari Nathan, MD, PhD; Deborah Evans, RN; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH

0
View Post
The Behavior Change Puzzle of Medication Non-Adherence

The Behavior Change Puzzle of Medication Non-Adherence

Non-adherence to a prescribed medication regime for chronic disease management is known to lead to poor health outcomes and higher healthcare costs. A number of studies have shown that adherence is usually around 50% or less, even when medications are provided free of charge. What seems to be less clear is how best to address poor adherence; one study points out that most of the current interventions meant to improve adherence rates are too complex or ineffective, and that the research in this field is rife with weaknesses and bias.

But as with most quality improvement initiatives, understanding the source of the problem is an important first step. In this case, identifying the reasons for non-adherence is an important starting point for reducing barriers and improving patient outcomes. Many factors may affect whether a person takes their medications, including the patient themselves, the disease being treated, the health system and team, and the type of therapy involved. One study’s survey of 10,000 patients found that the most cited barrier to taking one’s medications was simply forgetfulness (24%). This was followed by perceived side effects (20%), high drug costs (17%), and a perception that their prescribed medication will have very little effect on their disease (14%).

The same study illustrated the various patient, provider, and external factors that can play a role in medication adherence using the figure below (Figure 1). If any one of these factors were to present a challenge for the patient, then they are at risk of not taking their prescribed medications on time and any related medical issues.

Figure 1.

While some interventions such as pill box aids and electronic reminders have helped patients when forgetfulness is the issue, these do not address factors such as concerns about side effects and medication-related harm, or uncertainty about the importance of taking long-term prescribed medications. These issues have the potential to be addressed through shared decision-making and education from clinical experts such as pharmacists and nurses.

One review analyzed the impact that social determinants of health has on medication adherence. Disadvantageous circumstances in social and living conditions are associated with an increase in chronic disease, and it is believed that these same challenges impact a person’s ability to manage their health. When an individual is facing food insecurity, unemployment, and unstable living conditions, they are sometimes unable to address their health concerns emotionally or financially. The review found that medication adherence was negatively impacted by food insecurity and housing instability, although few studies identified other specific social determinants that influence non-adherence to medications beyond these two. In fact, education, income, and employment status did not significantly correlate with adherence to a medication regime.

The Michigan Value Collaborative (MVC) would like to hear how your institution is addressing medication non-adherence, especially in the chronic disease patient population. This will be an upcoming topic at a chronic disease management workgroup. Please contact MVC at michiganvaluecollaborative@gmail.com for information about attending.