09 Jul 2025
0
View Post
June Workgroups Highlight Organizational Structure Impacts on Cardiac Rehab and Measuring System Quality

June Workgroups Highlight Organizational Structure Impacts on Cardiac Rehab and Measuring System Quality

July 9, 2025 | 0 Comments | , , ,

In June, MVC hosted two virtual workgroup presentations – the first, a cardiac rehab workgroup focused on how healthcare organizational structures impact the effectiveness of cardiac rehab operations. The second workgroup, health in action, was a continuation of the recent MVC spring collaborative-wide meeting (CWM) presentation and discussion on How Should We Measure System Quality? The MVC Coordinating Center hosts workgroup presentations twice per month, covering a variety of topics including post-discharge follow-up, sepsis, cardiac rehab, rural health, preoperative testing and health in action.

Cardiac Rehab Workgroup June 10, 2025

MVC hosted a cardiac rehab workgroup with a presentation by Gregory Scharf, BS, ACSM-CEP, AACVPR-CCRP from MyMichigan Health System. Scharf is the Cardiopulmonary Rehab System Manager for nine cardiac rehab and eight pulmonary rehab programs that serve 25 counties in Michigan. In addition to his role with MyMichigan, Scharf is also the vice president of the northern region of the Michigan Society for Cardiovascular and Pulmonary Rehabilitation (MSCVPR). With his experience and knowledge, Scharf shared detailed insight into how healthcare organizational structure impacts the effectiveness of cardiac rehabilitation operations.

Organizational Structures & Impact

Many cardiac and pulmonary rehabilitation programs experience disjointed connections within healthcare organization structures.  According to a recent MSCVPR state poll, up to 20% of the state’s cardiac rehab (CR) programs were structured under a non-cardiovascular related service. Scharf polled the MVC workgroup audience to see where their cardiac rehab programs fell within their organizational structure and found that out of the 21 responses, 11 sites had their CR program under Cardiology/Cardiovascular service, three under respiratory service, four under cardiopulmonary service, one under diagnostic imaging, one under cardiovascular/neurology, and one did not have an onsite CR program.

Scharf noted that in his experience, many of the structures and managerial roles of cardiac rehab programs varied across sites. Cardiac rehab managers included an obstetrics/emergency room nurse manager, physical therapy manager, respiratory services supervisor, and a cardiovascular services manager who was also the echocardiogram technician. The lack of consistency in who should manage a cardiac rehabilitation program adds to the challenges within the healthcare organizational structure.

Supporting Cardiac & Pulmonary Rehab Programs

How can cardiac rehab be strategically aligned within a system? Main organizational connections for CR programs can be successful if placed under the umbrella of cardiovascular services (testing, heart failure clinic, open heart surgery, structural heart surgery, electrophysiology, and vascular), and rehabilitation services (occupational/physical therapy, etc.). Misalignment may occur if the organization’s strategies and objectives are disconnected between service areas, for example:

  1. Communication breaking down across the system
  2. Advocates for the CR service lack authority for change
  3. There are conflicts between service resources and access to space based on organizational leadership structure (OT/PT/CR)

A challenge for smaller sites may be that their organization is not large enough to support the typical structure of large health systems. At MyMichigan the CR program functions with 30 clinical staff for all sites whereas PT has more than 1,000 clinicians. These kinds of discrepancies may cause programs like cardiac rehab to be placed under misaligned service structures due to convenience (staff availability, resource availability) versus a more appropriate setting.

Important questions to ask about your site’s cardiac rehab program structure:

  1. Who is responsible for your cardiac rehab operations?
  2. Are they responsible for non-cardiac rehab departments as well?
  3. Who are the cardiac rehab subject matter experts (SME) and do they have authority to make changes?

SMEs may vary in experience and knowledge, especially when looking at smaller healthcare sites. These SMEs may only have secondary or limited experience with cardiac rehab services, which can impact how successful the program is. One way to help support staff in these positions is to encourage continuing education programs and certifications related to cardiac rehabilitation.

Understanding the Anatomy of the Referral

Over the past 10 years, MyMichigan has seen a significant increase in referral rates for cardiac rehab. Unfortunately, an increase in referrals does not always equate to an increase in patient participation. Some examples of why this may happen include referral delays, missing referral information (no qualifying diagnosis, or no co-signing MD/DO), or a referral being sent with the patient information but no signed order (inactionable).

Figure 1. Common Referral Delay Examples

When referrals are completed incorrectly, CR program staff must do the leg work to reconnect with the referring provider and make sure they receive a complete referral for their patient. MyMichigan faxes a Cardiac Rehabilitation (CR) Referral & Evaluation Order back to the referring provider to complete and return before the patient can be seen for cardiac rehab. This extra step can impact patient recovery and create added strain on the workforce for multiple healthcare sites.

MVC Data Analytics Resources & Support

Wanting to take a deeper look at cardiac rehab claims data, MyMichigan Health System collaborated with the MVC team including Emily Bair, Site Engagement Coordinator, Julia Mantey, Sr. Data Analyst, and Jiaying Zhang, Data Analyst. The MVC analysts created custom reports that helped visualize where MyMichigan’s CR patients were being referred to and which patients were being referred to their CR program from external sites.

Looking at MyMichigan sites they found that approximately 94% of the patients that discharged from the MyMichigan Midland Medical Center for any of the Michigan Cardiac Rehab Network (MiCR) Main five Conditions (AMI, PCI, CABG, SAVR, TAVR) ended up staying within the MyMichigan system cardiac rehab program. Additionally, they looked at what locations MyMichigan cardiac rehab patients come from across the state. Approximately 58% of CR patients are internal referrals and 41% are from external referrals, almost doubling patient population in MyMichigan’s cardiac rehab program. This also put a spotlight on how much this system’s cardiac rehab program impacted patient populations of external healthcare sites/systems in the state.

Key Take Aways

  • What internal barriers exist due to your organizational structure?
  • Is communication getting to those that impact change?
  • Understand what steps need to be completed between referral and scheduling the patient appointment
  • Understand the process for referrals that leave the system/site

Health in Action Workgroup 6.26.25

In late June MVC Director Hari Nathan, MD, PhD presented on how quality could be measured at a system level. This was a continuation from his interactive presentation at our spring CWM earlier this year, How Should We Measure System Quality? This “Part 2” workgroup included breakout groups and focused topics for discussion.

Advantages of Health Systems

Dr. Nathan shared several advantages that health systems have in the world of quality improvement that could be utilized, such as being able to right-size care and services at sites, having internal selective referrals as an option, avoiding low-volume surgeries, creating “focused factories,” disseminating best practices, and being able to have a big impact on attributed populations.

Health systems have the ability to address barriers to care on a larger scale, for example improving electronic health record integration between sites and being able to integrate telehealth across the system. Or by collecting data on various patient populations, a system has the potential to develop and expand its population health program. Utilizing the strengths of a system can benefit individual healthcare sites and improve patient care.

It is important to begin challenging systems to become more than just a sum of their parts – rather, to function as a cohesive unit. How do we create the right incentives for hospital systems to improve quality and costs? What metrics should be measured? These are just a few of the questions posed by Dr. Nathan as the workgroup audience prepared to go into breakout session discussions.

At MVC’s spring CWM in May of this year, audience members were asked “What is your organization doing at a system-level that you would want to be measured on and/or receive credit for improving?”. The most popular responses included: CMS 5 Star Measures, balancing length of stay (LOS) and readmissions, infection prevention, and sepsis outcomes (LOS, readmissions, mortality/end of life care).

Based on the CWM responses, four breakout session topics were chosen (readmissions & balancing LOS, safety, infection prevention, sepsis outcomes), and participants were asked to think about and discuss “What is YOUR organization working on at a system level that you would want to be measured on and/or receive credit for improving?”. Based on their poll responses, participants were sent into breakout groups to discuss their topic more in depth.

Readmissions & Balancing LOS

Members expressed great interest in identifying opportunities to incentivize process measures. Currently tracked metrics that were shared included order set utilization, care coordination, evaluating daily readmission risk reports, and transitions to home care. It was noted however, that these metrics may be difficult to track via claims data. Another system-wide metric discussed was the percentage of patients being seen by their primary care physician one week post discharge. The measure of success could be either achievement (outperform MVC All) or improvement (improve on system metric compared to previous measure).

Some barriers to implementing these processes as a system would be system-wide financial support for care coordination and nurse navigators. These positions are typically site specific and funded through the site’s individual budget.

Safety

During this breakout session members discussed some of the interests their sites/systems had around tracking safety metrics across the system. Sometimes a system can be different than just multiple hospitals under the same umbrella. Oaklawn Hospital, for example, is a single hospital site, but their goal is to align better with their primary care offices which requires a systems approach.

When looking at safety measures, Henry Ford Health shared ideas on how measuring or tracking a patient’s nutritional status might be valuable, as well as physical or occupational therapy consults for falls. Patients with a hip fracture from a fall tend to have longer hospital stays, this could be tracked by LOS codes such as weakness or loss of balance.

Infection Prevention

Members discussed some of the successful methods they have been implementing so far with their infection prevention initiatives. ProMedica Charles & Virginia Hickman shared they use a hub and spoke model where the sites have a system level clinical risk department that helps oversee essential hospital acquired infection data (using PowerBI, a data visualization program). This program enables a drill down for the different hospital leaders to design and implement quality improvement initiatives at their site.

At the system level leaders review data to identify opportunities and coordinate with hospital quality leads to implement improvement strategies, maintaining an upstream and downstream approach. In the UP Health system, they use a collaborative model involving regular reporting and discussion of quality markers among hospitals under the LifePoint organization, with resource sharing and active discussion facilitated by calls that include Duke University Health System partners.

Sepsis Outcomes

Members shared that their health systems have hospital level sepsis committees that meet once per month to review sepsis cases, as well as system level sepsis committees that include a representative from each site that meet monthly or quarterly to review sepsis cases. One of the ways that members are tracking their sepsis cases across the system is by tracking when sepsis patients go from “door to initial antibiotic received,” since research has shown this to be the biggest impact on reducing sepsis related mortality.

Sepsis compliance is also an important metric that systems are tracking to meet CMS standards. Sites within a system track sepsis compliance metrics and review them monthly both site by site and system wide. Through the group discussion, the idea of tracking the associated order sets for sepsis cases through MVC claims data may be interesting to view at a system level (though singling out order sets in claims data may be difficult).

Wrap Up

The breakout sessions not only helped to highlight what health systems are currently doing to track quality across their sites but also gave some insight into what metrics could be utilized as performance-based incentives in the future.

MVC welcomes workgroup presenters from across Michigan to share their expertise, success stories, initiatives, and solution-focused ideas with MVC members. Please reach out to us by email if you are interested in being a workgroup presenter or submit a presentation proposal here.

18 Jun 2025
0
View Post
CQI Spotlight: Michigan Surgical Quality Collaborative (MSQC)

CQI Spotlight: Michigan Surgical Quality Collaborative (MSQC)

June 18, 2025 | 0 Comments | ,

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 disparities, 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.

Figure 1. MSQC Hernia Care Pathways

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.

Figure 2. RITE-Size Resources

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.”

MVC is proud to partner with MSQC in advancing surgical quality improvement 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. Please reach out to us by email if you are interested in learning more about MVC data and collaboration offerings.

11 Jun 2025
0
View Post
May Workgroups Highlight Sepsis Predictive Models and Post-Surgical Early Ambulation

May Workgroups Highlight Sepsis Predictive Models and Post-Surgical Early Ambulation

June 11, 2025 | 0 Comments | , , ,

In May, MVC hosted two virtual workgroup presentations – the first, a sepsis workgroup focused on Covenant Health’s strategies and successes in improving sepsis bundle compliance under Centers for Medicare and Medicaid Services (CMS) reporting standards. The second, a health in action workgroup, focused on Michigan Medicine’s efforts to advance post-surgical recovery through early ambulation with the help of care path and command center supported real-time notifications. The MVC Coordinating Center hosts workgroup presentations twice per month covering a variety of topics including post-discharge follow-up, sepsis, cardiac rehab, rural health, preoperative testing, and health in action.

Sepsis Workgroup 5/13/25

Improving CMS sepsis compliance is a national priority; hospitals that succeed not only avoid penalties but – more importantly – save patient lives. In her presentation, Amy Lorenz, RN, BAS, MPA, Lead QI Specialist and Sepsis Team Leader for Covenant Healthcare pointed out that a CMS compliance score review in January 2021 of just 64% predicated their site’s interest in pursuing methods to improve sepsis compliance.

To start, Covenant Healthcare reviewed the number of sepsis Best Practices Advisory (BPA) alerts (or OurPractice Advisory or OPAs) firing in the background of their Electronic Medical Records (EMR) based on Modified Systemic Inflammatory Response Syndrome (SIRS) Criteria. The numerous alerts lead to interruptions in workflow, alert fatigue, and frustration.

With the help of their EMR and IT teams, Covenant Health decided to research and validate the use of a predictive model available through EPIC called BPA Level 8. The predictive model is a ruled based, logical scoring system that relies on various criteria such as patient medication orders, lab values, age, and comorbidities to assess the risk of sepsis development for any patient. The predictive model also incorporates non-specific SIRS criteria and additional exclusion criteria (Figure 1).

Figure 1. Covenant Healthcare Base Sepsis Care Path Level 8 Criterion for Exclusion

With the replacement of the SIRS Criteria with the Predictive Model in Q3 of 2023, Covenant Health saw the number of interruptive alerts drop from 90-100,000 to just 30,000 per month in 2024. Lorenz notes that this reduction in interruptive alerts alone was a relief to staff. However, they have additionally seen other positive outcomes including:

  • A climbing RN action rate (10% to 24.5%),
  • An increase in accuracy in sepsis diagnosis (9-18% to 50-60%), and
  • A reduction in the number of sepsis flags missed by the model (only 1-2 per month)

These outcomes together suggest that in addition to reducing inefficient alerts, patients are increasingly receiving optimal and appropriate care. Additional outcomes of this initiative highlighted in the presentation included the development of a linked automatic blood culture and/or lactate level order set within the EMR. Additionally, with support from medical leadership, this order set can now be approved by RNs eliminating a common stopgap in care.

A multidisciplinary approach with regular staff feedback, education, and leadership support further drove engagement and compliance of staff. Another Covenant Healthcare team member on the call, Beth Turnbull, Lead Senior EMR Applications Analyst pointed out that nursing leadership was involved in the implementation of this predictive model from the beginning. Nursing also engaged in evaluating data dashboards, routine compliance audits, and collaborative huddles to monitor sepsis bundle adherence and maintain accountability.

While Covenant Healthcare’s predictive model is specific to their EMR program EPIC, attendees noted that there are other predictive model options available. Ultimately, the key takeaways from this presentation used to improve sepsis bundle compliance include:

  1. Identify and analyze fall outs: to prioritize and target education
  2. Deploy an easy-to-access knowledge base to support clinical decision-making: by creating a one-page resource or visual dashboards
  3. Promote transparency: by increasing access to real-time data and routine collaborative huddles to help keep teams accountable
  4. Secure leadership backing: but also empower front-line workers to make quality efforts stick
  5. Measure and validate interventions: based on data and compliance trends

Health in Action Workgroup 5/29/25

The health in action workgroup featured a joint presentation by Heidi O’Neill, MS, Project Manager Lead; Mary Nowlin, PA-C; and Niki Farquhar, MSE, Project Management Lead from Michigan Medicine. Their presentation centered on the power of interdisciplinary collaboration, data-driven processes, and scalable strategies to embed post-surgical real-time notifications for delayed post-operative ambulation into Michigan Medicine’s post-surgical clinical pathways.

In 2019, Michigan Medicine started a multidisciplinary quality initiative supporting teams across the site to improve outcomes called Advancing Care, Treatment Efficiency, Innovation, Value and Teamwork for Surgical Episodes (or ACTIVATE). O’Neill explained that ACTIVATE places emphasis on teamwork, innovation, and communication to drive patient experience and outcomes. By focusing on units/ services with high observed/expected (O/E) length of stay (LOS >1.0), high surgical volume, and positive leadership engagement; the ACTIVATE team ensured that each unit they invested in had room to improve and support to achieve their goals.

Post-surgical early ambulation, or getting patients up and walking as soon as possible after surgery, has been shown to decrease the length of hospital stay. Common ACTIVATE interventions to promote early ambulation include patient education videos, transport triggers for ambulation from stretcher to bed, documentation of ambulation within four hours, and the development of detailed clinical pathways (see Figure 2).

Figure 2. Common ACTIVATE Interventions to Promote Post-Surgical Early Ambulation

Additionally, Nowlin explained that as the ACTIVATE team spread their interventions across various services, from colorectal to spine then to more general surgical units (4B and the 5th floor) they noticed that there wasn’t a consistent order set for early or sustained ambulation. To ensure consistent documentation, the ACTIVATE team developed an early ambulation order set to be used across all units and started tracking their impact.

ACTIVATE’s efforts to outline post-surgical clinical pathways and optimization of documentation of ambulation eventually led to their collaboration with Michigan Medicine’s Capacity Operations Real Time Engagement Center (or M2C2), launched in November 2022. M2C2 is a state-of-the-art command center designed to act as the hub for Michigan Medicine operations and innovation by leveraging real-time visualization of patient milestone achievement based on EPIC data. Their goal is to not only improve LOS but to ultimately increase the percentage of patients who achieve post-surgical milestones (e.g., early ambulation) in a timely manner. Farquhar explained, M2C2’s integration of care paths and responsive actions when patients deviate from their expected progression are paving the way to reduced LOS, safe discharge, and increased bed capacity.

Figure 3. M2C2 Post-Surgical Procedure Care Path Framework

To develop the post-surgical care path framework (Figure 3), Nowlin and Farquhar met with other key stakeholders to ensure that ACTIVATE and M2C2 efforts to optimally progress patients through the early ambulation node of the post-surgical path were synced. Understanding the goal ACTIVATE had previously set for ambulation within four hours of exiting the OR, M2C2 set alerts for patients that had no documented ambulation by three hours post-surgery to allow for a one-hour intervention window. During this period, M2C2 clinical expeditors (CEs) conduct a patient chart review and then contact the nurse and medical provider to discuss barriers to ambulation.

Within the first quarter of the new M2C2 alert for ambulation going live, nearly 1280 alerts were logged: 559 resulting in contact with the care team to assess barriers to ambulation. When compared to baseline data, a 23.1% decrease in median time to first ambulation was observed for ICU post op patients. For non-ICU post-op patients, a 7.1% decrease was observed. Additionally, a 0.34 day decrease in average LOS was observed. These results indicate opportunities for enhanced patient recovery, shorter LOS, and better overall patient outcomes.

Lastly, Farquhar outlined opportunities to continue to progress with early ambulation including:

  1. Refine exclusions for patients that are not appropriate for early ambulation
  2. Improve visibility of ambulation status and timeline in EPIC
  3. Explore improved capture of ambulation in clinical notes
  4. Enhance alert communication to support nursing
  5. Continue to work on nurse-to-nurse APS consult orders for pain management control

MVC’s May workgroups exemplify efforts from two different sites to place value on interdisciplinary teams, the importance of data visibility, and alignment across clinical, operational, and administrative units to ensure optimal quality improvement.

If you are interested in pursuing a healthcare improvement program, MVC has data specialists available to help navigate and create custom analytics reports. Please reach out to us by email if you would like to learn more about MVC data or engagement offerings!

04 Jun 2025
0
View Post
MVC Welcomes Its New Project Manager, Emily Woltmann, PhD, MSW

MVC Welcomes Its New Project Manager, Emily Woltmann, PhD, MSW

June 4, 2025 | 0 Comments |

I'm thrilled to join the Michigan Value Collaborative (MVC) as a project manager, supporting MVC’s value-based initiatives in cardiac rehabilitation and pre-operative testing, and more. The enthusiasm, thoughtfulness, and dedication of the team has impressed me, and I look forward to contributing my experiences to our efforts.

My interest in the gap between accessible, high-quality healthcare and patient and provider experiences was sparked during my early career as a community mental health worker. The lack of effective psychosocial treatment options often left me feeling ill-equipped to assist my clients. This motivated me to pursue a Master’s Degree in Social Work (MSW) at the University of Michigan, with a focus on policy analysis and program evaluation in the mental health setting. I was surprised to discover that many evidence-based treatments existed but were unavailable outside academic settings. This realization led me to dedicate my career to understanding and bridging this disconnect.

After working as a research associate at the VA Ann Arbor Veterans Administration Medical Center, I pursued a PhD at the Dartmouth Institute for Health Policy and Clinical Practice. While there I worked on the first national demonstration project implementing evidence-based practices in community mental health settings in the United States. My research focused on the role of workforce instability in implementing evidence-based practices and the development of an electronic decision support system to aid shared decision-making between care managers and patients.

Following this, I continued my implementation science research at the Ann Arbor VA, University of Michigan, and as an assistant professor at the Brown School at Washington University in St. Louis. I then took a career break to focus on family responsibilities.

In 2022, I re-entered the workforce, joining the Department of Learning Health Sciences at the University of Michigan Medical School. I worked on a study examining strategies for implementing a cardiovascular risk reduction intervention for patients in community mental health settings. Later, I transitioned to the Division of General Medicine at UM, managing quality improvement projects in primary care clinics. This role solidified my desire to focus my efforts more fully on the quality improvement field.

I look forward to contributing further to enhancing healthcare quality and value in Michigan through my role at MVC. Please feel free to contact me with any questions at ewoltman@med.umich.edu.

28 May 2025
0
View Post
Refreshed Hospital-Level, ED-Based Episode Push Reports Released April 2025

Refreshed Hospital-Level, ED-Based Episode Push Reports Released April 2025

May 28, 2025 | 0 Comments | , ,

The MVC Coordinating Center distributed refreshed hospital-level versions of its push report utilizing emergency department-based episodes (“ED-based episodes”) in April, preparing versions for acute care hospitals and Critical Access Hospitals to include different comparison groups. The report leverages data focused specifically on patient episodes first initiated by a visit to the emergency department and follows those episodes to determine common metrics such as episode payments, post-ED care utilization, and outpatient service rates.

In addition to reflecting more recent data across all included payers, these refreshed hospital-level reports provide additional social risk data than was offered previously with the addition of several metrics based on patient Zip code to the patient population snapshot table. This allows hospitals to better understand the patients represented in various service line cohorts presented within the ED-based episodes report and the types of social risk factors that may be present, such as low median household income, SNAP usage, vehicle ownership, and homeownership.

Each page of the report is dedicated to a specific condition with mostly the same metrics throughout, such as risk-adjusted, price-standardized 30-day total episode spending, inpatient admission rates, and rates of post-ED utilization. Reports feature each hospital’s own attributed ED-based episode data for eight high-volume ED conditions: abdominal pain, cellulitis, chest pain (nonspecific), congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes with long-term complications (including renal, eye, neurological, or circulatory), diabetes with short-term complications (including ketoacidosis, hyperosmolarity, or coma), and urinary tract infection (UTI).

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payment (Figure 1) for the reported conditions is highest for diabetes with long-term complications ($21,031), followed by CHF ($18,363), diabetes with short-term complications ($12,571), and COPD ($11,145). The collaborative-wide average total episode payment is lowest for chest pain ($3,327) and abdominal pain ($3,405). These rankings are consistent with the 2024 ED-based episode reports.

Figure 1.

A key goal of these reports is to provide insights into healthcare utilization following index ED events; therefore, the latest reports continue to include a dot plot (Figure 2) comparing patient post-ED utilization at a member hospital against their peer comparison group. Dot plots provide information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and the percent of patients who had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Rates of subsequent ED visits, outpatient services, home health, skilled nursing facility care, and inpatient or outpatient rehab are also provided.

Figure 2.

MVC uses its most recent medical insurance claims data from Medicare FFS, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, Blue Care Network HMO Commercial and Medicare Advantage plans, and Michigan Medicaid to build these ED-based episodes reports.

MVC recently presented data on the incidence of behavioral health co-diagnoses on ED-based episodes at its May collaborative-wide meeting. This presentation highlighted the presence of behavioral health ICD-10 codes on index ED visits for patients with a primary diagnosis code matching one of MVC’s ED conditions. MVC reported 13% of ED index events statewide contained a behavioral health code. The most common codes observed were for anxiety disorder (36.7%), major depressive disorder (10.6%), and dementia (8.7%). The recent ED-based episode reports include a row for “most frequent comorbidities” by condition, which will help members determine service lines where psychological disorders or substance abuse disorders are a common consideration for specific service lines at their hospital.

MVC’s ED-based episode structure was developed in collaboration with the Michigan Emergency Department Improvement Collaborative (MEDIC), a BCBSM-funded Collaborative Quality Initiative with the goal of improving care and patient outcomes in Michigan emergency departments. MVC and MEDIC team members worked closely to develop 30-day episodes of care initialized by a patient’s visit to the ED and including all claims-documented care received in the 30 days following a patient’s index ED visit.

Please share your feedback with the MVC team if certain report measures are helpful or if you wish to see additional ED-based episode reporting for certain conditions and metrics. MVC is now also accepting custom report requests using its ED-based data. Contact MVC to learn more.

21 May 2025
0
View Post
April Workgroups Highlight Preoperative Testing and MVC’s Process Measures Report & Registry Review

April Workgroups Highlight Preoperative Testing and MVC’s Process Measures Report & Registry Review

May 21, 2025 | 0 Comments | , , ,

In April, MVC hosted two virtual workgroup presentations – the first, a preoperative testing workgroup focused on the CQI collaboration with the Michigan Surgical Quality Collaborative (MSQC) to reduce preoperative testing rates for low-risk surgeries, supplemented by a brief overview of the RITE-Size Initiative and how MVC sites can benefit from participating. The second workgroup, health in action, focused on the recent MVC Process Measure Report and included an overview of how to utilize the MVC registry. The MVC Coordinating Center hosts workgroup presentations twice per month covering a variety of topics including post-discharge follow-up, sepsis, cardiac rehab, rural health, preoperative testing and health in action.

Preoperative Testing Workgroup 4/8/2025

Jennifer Bennett, MBA, BSN, RN, Lead Quality and Patient Safety Coordinator for Henry Ford Health (HFH) Madison Heights – Warren, shared that in 2017 the estimated cost for unnecessary preoperative testing and treatment was $200 billion nationwide (Healthcare Finance News, 2017). Additionally, in 2014, PerryUndem and the Choosing Wisely Campaign completed a phone survey of over 600 different physicians (primary care and specialists) across the country. This survey inquired whether providers believed unnecessary tests and procedures in the healthcare system were a serious problem and who or what entity should be responsible for leading improvement efforts.

Results showed that the top reasons providers ordered the unnecessary tests were because of malpractice concerns, belief that it should be done “just to be safe,” patients insisting on having the test, or they were trying to keep patients happy (Figure 1). Providers also believed they were the best suited to address overuse of unnecessary tests and procedures in the healthcare system.

Figure 1. Reasons Why Physicians Order Unnecessary Tests

Physicians surveyed selected several solutions to try and address the issue including malpractice reform, having specific evidence-based recommendations in a format that would be easy to discuss with the patient, having more time to discuss alternatives with patients, and changing the system of financial rewards for preoperative testing metrics (Figure 2).

Figure 2. Possible Preoperative Testing Reduction Strategies Poll

In collaboration with MSQC, Henry Ford Health Madison Heights-Warren launched a pilot program in 2023 to implement appropriate preoperative screening for low-risk surgeries, including breast lumpectomy – partial mastectomy, minor hernia, and laparoscopic cholecystectomy. Initial data used for setting a baseline understanding showed that preoperative testing rates for these procedures across the state had a wide range of 8% - 85%, and testing before low-risk surgeries was noted to be common for greater than 50% of patients undergoing at least one test.

Using testing recommendations from several notable academic medical societies, Henry Ford and MSQC were able to build an outline of recommendations for blood work (labs), electrocardiogram (ECG) tests, cardiac stress tests, and chest x-rays. A decision tree was developed to aid providers in choosing a test that was appropriate for a patient prior to their procedure (Figure 3).

Figure 3. Suggested Pre-op Testing Decision Aid for Low-Risk Surgeries

This decision tree took into consideration what American Society of Anesthesiologist (ASA) class the patient fell under. The ASA classes (ASA 1 – 5) are determined by physical status of the patient (Do they have comorbidities, age related issues, life expectancy if they don’t have the procedure, etc.?) The higher the ASA class level the more likely the patient will require additional testing due to chronic disease processes being present. Recommendations for preoperative testing on patients that are an ASA class 3 or above were combined into a guidance chart (Figure 4) to aid in test order decision making.

Henry Ford Health Madison Heights-Warren reported several successes during their pilot program. These include:

  1. Engaging stakeholders: They successfully engaged various stakeholders—including patients, providers, office staff, CQIs, and IT—in meaningful conversations and collaborative problem-solving.
  2. Acknowledging work: The team emphasized the critical importance of the work being done and its alignment with the best interests of patients.
  3. Cost savings: They highlighted the potential for significant overall cost savings resulting from the program's implementation.
  4. Revising protocols: Protocols were revised to incorporate new best practices for preoperative testing, ensuring enhanced care quality.

Some of the barriers that arose included communication breakdowns, a lack of education or understanding, trying to engage and include providers that were contracted private practice and may not have the same electronic medical record (EMR) access, and not having a complete set of data due to claims data delays (Medicare/Medicaid).

Results

Prior to the pilot program launching (March 2022 - March 2023), HFH Madison Heights-Warren's preoperative testing rates were at 37.8% and after implementation (March 2023 – September 2024) their preoperative testing rate reduced to 31%. Their next steps include partnering with the RITE-Size initiative to develop future preoperative testing goals and re-engaging with stakeholders at other Henry Ford Health sites.

RITE-Size Initiative Overview

MVC Program Director Hari Nathan, MD, PhD, gave a brief overview of the RITE-Size initiative. The goal for right-sizing testing before elective surgery is to identify patient risk-level, match patient risk-level to pre-op testing, and perform a safe and successful low-risk surgery. This initiative is a grant funded collaborative partnership between Michigan Surgical Quality Collaborative (MSQC), Michigan Value Collaborative (MVC), and the Michigan Program on Value Enhancement (MPrOVE) (Figure 5). The plan is to learn from the clinical and claims data, consider clinician input, and to recommend high-value tests based on this information.

Figure 5. RITE-Size Offerings

If your site is interested in participating in the RITE-size preoperative testing program, please reach out by email to the MVC Coordinating Center.

Health in Action Workgroup – MVC Process Measures Report & Registry Review 4/24/25

The health in action workgroup featured a presentation by MVC’s Site Engagement Coordinator Emily Bair, MS, MPH, RDN, CSP. The presentation focused on the recent MVC Process Measure Report and included an overview of how to utilize the MVC registry.

Traditionally, MVC push reports have focused on just one condition, surgery, or metric at a time. The process measures push report was developed to pull together information on multiple conditions to provide individualized, comprehensive, and actionable insights for MVC members (Figure 6). This report was provided to sites that are participating in the MVC portion of the BCBSM P4P program as well as non-P4P sites. This allows sites to evaluate their progress on all eligible measures, not just the metrics selected for the P4P program year.

Figure 6. MVC Conditions

This process measures report includes 90-day inpatient or surgical episodes created from index admissions between January 2022 – December 2023. Exclusions included patients who had an inpatient hospital transfer, died in the hospital during their index hospitalization, or were discharged to hospice. Payors included Blue Care Network HMO, commercial and Medicare Advantage, Blue Cross Blue Shield of Michigan PPO commercial, and Medicare Advantage, Medicare, and Michigan Medicaid.

Within the report each site has an individualized sociodemographic overview table that displays the patient population for each process measure cohort (Figure 7). This table illustrates the distribution pattern of the population within each process measure but is not necessarily indicative of the distribution of patient demographics for the outcome of interest. One detail to note is that the race/ethnicity denominator includes all patients but may not add up to 100% due to the exclusion of other race/ethnicity categories.

Figure 7. MVC Process Measure Report for Hospital A (blinded data)

In addition to race/ethnicity categories, MVC is populating data on patient zip codes (categorized as prosperous, comfortable, mid-tier, at-risk, or distressed according to the Economic Innovation Group’s Distressed Communities Index (DCI) 2015-19. The DCI incorporates economic indicators such as education, employment, and income as well as patient age and gender. These are some of the first steps being taken to incorporate sociodemographic information into our analyses, deepening our understanding of the patient community's needs and awareness to support further health equity efforts.

Registry Review

How can we use the MVC registry to investigate certain metrics or patient demographics?

  1. Search for specific metrics such as preoperative testing rates at your site. Are they higher or lower than the MVC All average?
  2. Investigate certain procedures for which tests are being ordered more frequently than others
  3. Drill down to see if certain patient age categories are accumulating a higher testing rate than others

For example, when looking at the multi-payer preop testing reports, helpful filters to utilize would be the following:

  1. Episode start dates – selecting an exact date range
  2. Payers – choosing the appropriate payers for the date range you are looking at (noting that Medicare and Medicaid data may be 6 months to 1 year behind BCBSM)
  3. Procedures – choose the desired procedure(s) you want to investigate
  4. Tests – choose the desired tests you want to investigate in relation to the procedure
  5. Patient characteristics – choose what age(s), gender, race/ethnicity, and comorbidities you want to include/exclude

Interested in joining the MVC registry?

Once you send a registry request the MVC team will confirm your request with your specified site’s MVC Site Coordinator (primary contact). Once confirmed you will be sent the MVC website confidentiality agreement (WCA), and upon receiving the completed WCA, MVC will provide a username and directions to login in via email.

If you are interested in pursuing a healthcare improvement program, MVC has data specialists available to help navigate and create custom analytics reports. Please reach out to us by email if you would like to learn more about MVC data or engagement offerings!

14 May 2025
0
View Post
MVC 2025 Spring Collaborative-Wide Meeting Summary

MVC 2025 Spring Collaborative-Wide Meeting Summary

May 14, 2025 | 0 Comments | , , , ,

Collaboration in Action: Shaping the Future of Healthcare Across Michigan

The Michigan Value Collaborative (MVC) held its spring 2025 collaborative-wide meeting on Friday, May 9, in Midland. A total of 106 attendees representing 62 hospitals, 6 physician organizations, 6 Collaborative Quality Initiatives (CQIs), and 11 healthcare systems from across the state of Michigan came together to build partnerships and collaborate on approaches to healthcare delivery that will have a long-lasting impact.

MVC Director Dr. Hari Nathan kicked off Friday’s meeting with updates on the MVC Coordinating Center [. He introduced MVC’s newest team members, senior analysts Steven Ellinger and Tanima Basu, and Program Assistant Dinah Pollard. Dr. Nathan also announced the promotion of Jana Stewart to Associate Program Manager and welcomed Dr. Jessica Golbus as the new Co-Director of the Michigan Cardiac Rehab network (MiCR). He provided an update on recruitment progress for Phase II of the RITE-Size pilot and encouraged sites interested in participating to reach out to the MVC Coordinating Center. Dr. Nathan concluded the welcome presentation by highlighting MVC reporting updates. These included new multi-payer preoperative testing dashboard reports added to MVC’s data registry in Q4 of 2024, and five hospital-level push reports with data reflecting P4P Program Year (PY) 2026-2027 selections, statewide health equity, process measures, P4P PY 2024 final scorecards, and ED-based episodes.

Managing Director Mark Bradshaw, MSc, presented a summary of PY 2024 scoring and PY 2026-2027 selections for the MVC Component of the BCBSM P4P Program [SEE SLIDES]. In his summary of PY 2024 scoring, Bradshaw highlighted opportunities for members to leverage MVC resources to optimize P4P scores via MVC’s engagement point menu options and highlighted some of the value metrics that have seen success after their first year of scoring.

The overview of MVC members’ P4P selections included a comparison of the value metric selections that were made for the PY 2024-2025 vs. the PY 2026-2027 program cycles (Figure 1). Bradshaw also reviewed MVC’s new health equity measure and index of disparity before closing with a reminder about upcoming dates relevant to participating P4P hospitals (Figure 2).

Figure 1.

Figure 2.

The meeting then featured MVC’s first Engagement Awards, presented by MVC Engagement Manager Jessica Souva, MSN, RN, C-ONQS. MVC presented the awards to members who went above and beyond in their engagement with MVC to the benefit of the entire MVC membership. Scheurer Health received the award for the most engaged peer group 5 hospital, MyMichigan Collaborative Care organization for the most engaged physician organization (PO), Chelsea Hospital for the most engaged hospital, and Corewell Health for the most engaged health system.

Souva remained at the podium for a presentation on MVC’s 2024 Quality Improvement (QI) survey, sharing details about the survey’s purpose, completion rate, results, and applications [SEE SLIDES]. The four most widely reported QI initiatives included sepsis, health equity, readmissions, and emergency department care, and also aligned with the initiatives reported as highest priority for some of the largest health systems in Michigan (Figure 3). Souva provided specific examples of MVC engagement activities that were developed to specifically support the initiatives reported in the QI survey and address common barriers members reported facing. She urged MVC’s PO members to participate in the 2025 QI survey so that MVC will be better equipped to provide support for PO QI initiatives in the future.

Figure 3.

Before sending meeting attendees to participate in the poster session, Souva shared the responses from the opening virtual ice-breaker question: “What keeps you motivated to continue working in healthcare?” Members credited their teams and making a difference in the lives of patients and families as their motivation to persevere during challenging times. Posters were then presented by partner CQIs such as MEDIC, MOQC, MSHIELD, and MI Mind. Electronic copies of the posters are available on the spring meeting website [LINK]. The MVC Coordinating Center would like to thank all poster presenters for sharing their work.

After the poster session, MVC Associate Program Manager Jana Stewart, MPH, provided a presentation highlight the ways in which MVC collaboratives with other CQIs to help drive local quality improvement efforts in hospitals across Michigan. This included two case studies and unblinded data presentations for MVC’s two value-based initiatives: cardiac rehabilitation utilization and preoperative testing de-implementation. She also presented a use case for a new area MVC is exploring within its ED-based episodes of care focused on behavioral health care and outcomes, also with aggregate and hospital-level unblinded data.

Since the launch of MVC's cardiac rehabilitation initiative in 2020, the work has been incorporated into all aspects of MVC’s portfolio, from dedicated workgroup topics to reporting and related P4P metrics, and it also led to the 2022 launch of MiCR in partnership with BMC2 and the NewBeat program in partnership with HBOM. Cardiac rehabilitation enrollment for patients discharged from a “Main 5” condition (e.g., AMI, CABG, PCI, SAVR, and TAVR), has increased across the collaborative from 24% in 2020 to 34% in 2023, amounting to an estimated 145 lives saved and 243 readmissions avoided. Stewart also shared that the mean days to a patient’s first cardiac rehabilitation visit has decreased from 59 days in 2020 to 46 days in 2024.

Highlights from MVC’s preoperative testing efforts included updates on the RITE-Size pilot—a collaboration largely between MVC, MPrOVE, and MSQC—that supported three MVC member hospitals in reducing their low-value preoperative testing rates in 2024 through a variety of strategies. Stewart called out that members interested in participating in Phase II of the pilot in 2025 or 2026 will be well positioned to both reduce their testing rates significantly and also achieve the full two engagement points for 2025. She encouraged anyone interested to reach out to the MVC Coordinating Center for additional information.

Stewart concluded by sharing aggregate and unblinded data on the prevalence of behavioral health as a co-diagnosis in MVC ED-based episodes, where behavioral health ICD-10 codes such as anxiety disorder, major depressive disorder, and dementia appear as co-diagnoses (Figure 4) in approximately 13% of index ED events. She also shared how those behavioral health rates differ by payer as well as condition and noted that 1 in 3 of ED patients who have a resulting inpatient admission have a behavioral health code noted as a comorbidity.

Figure 4.

After a networking lunch, attendees spent the afternoon participating in roundtable discussions and small group activities on two to three topics [SEE ROUNDTABLE MATERIALS]. During the session, attendees could either join three roundtable discussions or join one roundtable and one small group activity on system approaches to QI. At each table attendees learned about the work of the roundtable facilitator, asked questions, and discussed similar initiatives at their own organizations. In the system activity, MVC members were asked a series of questions about measuring system-level QI, and their responses will help inform MVC’s future work to support health systems across Michigan.

The meeting closed with a reflection of the day spent together, reminders about upcoming meetings, and opportunities for best practice sharing with other MVC members.

If you have questions about any of the topics discussed at MVC’s spring collaborative-wide meeting or are interested in following up for more details, contact the MVC Coordinating Center. MVC’s next collaborative-wide meeting will be in person on Fri., Oct. 10, 2025, in Livonia.

 

30 Apr 2025
0
View Post
MVC Virtual Networking Event: Collaborative Learning in Post-Discharge Follow-up for Sepsis Patients

MVC Virtual Networking Event: Collaborative Learning in Post-Discharge Follow-up for Sepsis Patients

April 30, 2025 | 0 Comments | , , ,

On April 16, 2025, MVC hosted a virtual networking event providing members with an opportunity to make professional connections and discuss strategies for improving post-discharge follow-up for sepsis patients. Forty-six MVC members from thirty-three hospitals and seven health systems participated in the ninety-minute event. 

The event kicked off with an ice breaker activity (Figure 1) and an interactive quiz on common sepsis patient demographics, symptoms, and discharge care best practices.  

Figure 1

Prior to starting the breakout discussion groups, MVC’s Engagement Manager, Jessica Souva, MSN, RN, C-ONQS presented unblinded hospital-level 14-day follow-up after sepsis rates for 30-day inpatient episodes from July 1, 2023, to June 30, 2024. 

The breakout discussions were structured to engage attendees in conversations about challenges and strategies to addressing barriers in patient follow-up after sepsis. This goal was accomplished by providing groups with specific scenarios and types of approaches to improve follow-up after discharge for sepsis patients (Figure 2)

Figure 2

What challenges are MVC members facing related to follow-up after discharge for sepsis patients? 

MVC members reported that sepsis patients often face challenges in scheduling follow-up appointments, not knowing when to contact their provider for early warning signs and being readmitted before their scheduled post-discharge follow-up appointments. Contributing factors include lack of provider ability, incomplete patient or family education, and sub-optimal discharge dispositions.  

What are MVC members doing to improve their rates of follow-up after discharge for sepsis patients?  

During the breakout discussions, attendees shared that they are addressing the identified challenges through a multifaceted approach focusing on patient education, communication, resource access, team collaboration, and data evaluation. 

Patient Education and Empowerment 

  1. Discharge Paperwork: Include a phone number for patients to call with questions or concerns and to schedule follow-up appointments. This allows patients to seek follow-up care sooner. 
  2. Family Involvement: Educate and involve family members to facilitate follow-up care by ensuring they understand the importance. 
  3. Empowering Survivor Stories: Share stories from patient survivors through interviews, surveys, or patient advisory councils. These stories can be used to educate current patients, their families, and providers. 

Communication and Coordination 

  1. Care Coordinator/Nurse Navigator: Assign a care coordinator or nurse navigator as the point of contact post-discharge. Care Coordinators and Nurse Navigators can help patients understand factors influencing readmission and how to mitigate these factors. 
  2. Continuous Communication: Maintain open communication between inpatient and outpatient case managers regarding transitions of care. 
  3. “Call Back Crew”: Build a team to follow up with patients, reinforce education, and use call centers to identify trends and improve follow-up processes. 

Resource Access 

  1. Scheduling Follow-Up Appointments: When possible, schedule follow-up appointments before discharge. 
  2. Discharge Clinics: Block time for a dedicated provider to staff a clinic for patients who do not have or are unable to get an appointment with their PCP. This type of clinic can reduce return ED visits and readmissions by providing support, education, and resources. 
  3. Educate Staff About Under-utilized Resources: Local Area Agencies on Aging can facilitate access to free or low-cost services to improve the home setting for patients aged 65+. Many insurance providers, like Medicare Advantage/BCBSM provide additional support post-discharge with designated case managers.  

Team Collaboration and Internal Processes 

  1. Multi-Disciplinary Approach: Include care management and various therapies to support patient recovery. Ensure all patients receive a physical and occupational therapy evaluation to screen basic functional needs before discharge and determine the best future care setting. 
  2. Unified Team Message: Ensure therapy, physician, and care management teams provide a unified message to patients. 
  3. Improve Team Reliability and Training: Build internal trust and, consequently, patient trust. Provide physicians with training on how to conduct difficult discussions with patients and their families, ensuring patients understand their situation and the benefits of alternative approaches when recommended by medical professionals. 

Data and Evaluation 

  1. Patient Interviews and Surveys: Include a readmission nurse on the patient care team to interview readmitted patients and learn from their experiences.  The readmission nurse can act as a liaison between quality and hospital care teams, highlighting patients needing special attention and collecting feedback. 
  2. Retrospective Review: Complete a retrospective review of the patient’s journey to identify improvements needed in education and communication upon readmission for the same reason. 
  3. Care Transition Programs: Add sepsis patients to Care Transition Programs to trigger alerts for retrospective review of readmission cases and to identify improvement areas. 

What are members saying about the MVC April Virtual Networking Event? 

  • “Very fun and informational event. I like the smaller break out sessions to foster meaningful conversation and then bringing the ideas of the smaller groups to the entire group.” 
  • “Very well organized. I loved the interactive piece.” 
  • “I enjoyed the pre-break out group survey/quiz questions to help with engagement…it is less intimidating to speak up in the smaller groups than when everyone is in on large group.” 
  • “I enjoyed the networking aspect of this event and look forward to others in the near future. MVC Site Engagement Coordinators did a wonderful job facilitating this event and engaging the participants.” 
  • “It was reassuring to hear that many of the hospitals across the state are having the same issues and working on similar projects. It gave me a sense that my own hospital is on the right path.” 

MVC looks forward to hosting more virtual networking events throughout the year to increase collaboration and connection with MVC’s members. If your hospital or organization has a networking topic they would like to share, please email us. We would love to hear from you.   

23 Apr 2025
0
View Post
MVC Announces Agenda, Speakers for Spring Collaborative-Wide Meeting

MVC Announces Agenda, Speakers for Spring Collaborative-Wide Meeting

April 23, 2025 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce the agenda for its spring collaborative-wide meeting on Fri., May 9, 2025, from 10 a.m. – 3 p.m., at the H Hotel in Midland, MI. This meeting’s theme of “collaboration in action” reflects a focus on partnerships, collaborating to overcome barriers, and leveraging data to shape improvement projects. Those interested in attending MVC's spring collaborative-wide meeting can learn more and register here.

MVC Director Hari Nathan, MD, PhD, and Managing Director Mark Bradshaw, MSc, will kick off the day with Coordinating Center updates as well as announcements about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This will be followed by a new engagement awards ceremony and a presentation about statewide trends in quality improvement efforts, both presented by MVC Engagement Manager Jessica Souva, MSN, RN, C-ONQS.

The meeting includes a mid-morning poster session with 11 presenters highlighting success stories and research across the broader CQI portfolio. This is one of several opportunities to network with peers.

MVC Associate Program Manager Jana Stewart, MS, MPH, will present on recent MVC partnerships with other CQIs that drove site-level quality improvement initiatives. In addition to providing updates on these partnerships and their respective progress, Stewart will also share new priorities related to cardiac rehabilitation, preoperative testing, and ED-based episodes of care. This presentation will include unblinded data on key measures for all three topics, including new data on mental health comorbidities among patients treated in the emergency department. Attendees will be able to benchmark their site’s performance on a variety of metrics and come away with ideas for site-level interventions to implement.

After lunch and open networking, the afternoon features 10 concurrent interactive roundtables covering a wide variety of topics. From collaboration across academic and system units, behavioral health, and data reporting topics to a variety of patient-centered initiatives and more, the roundtables offer something for everyone. Attendees will join between two and three 15-minute discussions as they rotate to different roundtable speaker presentations. One of these options includes a longer 30-minute fireside chat with Hari Nathan, MD, PhD, on system-level approaches to quality improvement.

New this year is an innovation station that will be available throughout the day. It will feature a variety of stations where attendees can interact, leave suggestions, and connect with peers. The day will conclude with closing remarks and next steps with Jana Stewart, MS, MPH.

The deadline to register for MVC’s spring collaborative-wide meeting is April 28. We look forward to seeing you there!

 

16 Apr 2025
0
View Post
State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

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

April 16, 2025 | 0 Comments | , , , ,

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

Data Collection and Utilization

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

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

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

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

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

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

Efforts to Improve Healthcare Access

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

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

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

Looking Ahead

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

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

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