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MVC Fall 2024 Meeting Summary: Data-Driven Strategies for Success in Quality Improvement

MVC Fall 2024 Meeting Summary: Data-Driven Strategies for Success in Quality Improvement

The Michigan Value Collaborative (MVC) held its fall 2024 collaborative-wide meeting on Fri., Oct. 25, in Livonia. A total of 99 attendees representing 54 hospitals, 6 physician organizations, 2 Collaborative Quality Initiatives (CQIs), and 8 healthcare systems from across the state of Michigan came together to discuss innovative approaches to data-driven quality improvement. The theme of this meeting was to provide MVC members with new data use strategies to support their QI initiatives.

MVC program manager Erin Conklin, MPA, kicked off Friday’s meeting with an update from the MVC Coordinating Center [SEE SLIDES]. She welcomed MVC’s newest team member, site engagement coordinator Rachel Folk, MHA. Conklin also announced phase 2 of recruitment for the RITE-Size preoperative testing initiative, and provided details for the Michigan Cardiac Rehab Network (MiCR) meeting planned for Fri., Nov. 8 in Midland [register here by 10/31]. She concluded by highlighting recent MVC reporting, including refreshed versions of MVC’s common conditions and procedures push reports, a new statewide diabetes report, PY 2024 P4P mid-year scorecards, and MVC’s 3rd annual QECP public report.

Senior Advisor Jim Dupree, MD, MPH, presented on the MVC Component of the BCBSM P4P Program [SEE SLIDES]. He reviewed MVC’s guiding principles, timeline, and historical program structure, announcing four key changes to the PY 2026-2027 cycle (Figure 1). The addition of a health equity measure is one of four key areas that MVC modified for the upcoming cycle.

Figure 1.

The first change that Dr. Dupree discussed in detail is the change to MVC’s payer mix for PYs 2026/2027. Since April 2023, MVC members were given access to rates and spending for their Medicaid patients. Adding this patient population to the MVC P4P payer mix allows the collaborative to score a more comprehensive and diverse patient population. Medicaid data will be reflected in baseline measures provided in MVC participants’ PYs 2026/2027 selection reports.

Dr. Dupree also announced changes to the P4P episode payment condition menu for PYs 2026/2027. MVC will retire colectomy, pneumonia, and joint replacement, and will add percutaneous coronary intervention (PCI). Dr. Dupree summarized MVC’s decision-making and rationale behind each retirement or addition. As a result of these changes, the episode spending metric options for the upcoming cycle include CABG, CHF, COPD, and PCI.

A third change announced on Friday was a revision to the definition of MVC’s sepsis value metric. Dr. Dupree explained that this adjustment was being made to align with the Michigan Hospital Medicine Safety Consortium (HMS) initiative to increase post-discharge care coordination after sepsis. In PYs 2026-2027, MVC’s sepsis value metric will change from 30-day risk-adjusted readmissions after sepsis to 14-day follow-up after sepsis.

To close out the P4P presentation, Dr. Dupree announced the inclusion of a new health equity measure and the methodology behind it. This measure was developed with the goal of addressing common barriers that MVC member hospitals reported in the MVC health equity survey, such as insufficient data, no clear business case, and insufficient financial investments. With the introduction of MVC’s P4P health equity measure (Figure 2), MVC wants to quantify and drive improvement in all-cause readmission rates between payer groups at each hospital using an index of disparity (IOD). Dr. Dupree explained that similar index or composite measures have been utilized by health organizations already, and that this risk-adjusted measure can help identify hospital-level preventable differences in readmissions. Hospitals will earn the health equity point by improving relative to their own baseline IOD or by performing well relative to their peers (i.e., having an IOD at or below the median IOD across the collaborative).

Figure 2.

Before closing the P4P session, Dr. Dupree reviewed the upcoming P4P timeline for various cycles. MVC selection reports for PYs 2026/2027 will be shared with members in early November. Following dissemination of these selection reports, MVC will accept selections until Dec. 13, 2024. Members may attend one of two webinars on Nov. 19 at 1 p.m. [REGISTER for 11/19] or Nov. 21 at 10 a.m. [REGISTER for 11/21] to support their selection process, as well as schedule one-on-one meetings with MVC staff as needed.

After the P4P session, MVC members and stakeholders presented posters highlighting their QI work on a wide variety of conditions and initiatives (Figure 3). The MVC Coordinating Center would like to thank all poster presenters for sharing their work. Electronic copies of the posters are available on the MVC website [LINK].

Figure 3.

The poster session was followed by a presentation from the vice president of care coordination for Corewell Health System, Tricia Baird, MD, FAAFP, MBA. Dr. Baird leads inpatient, transitional, and ambulatory care coordination teams comprised of registered nurses, social workers, and community health workers. The presentation, “Readmission Reduction: Intelligent Targeting to Timely Intervention,” provided an in-depth look at how Dr. Baird’s team identified a subset of their Medicare patients with readmissions that were preventable [SEE SLIDES]. After identifying their complex patients, the Corewell team then designed interventions to target those discharge journeys, essentially providing an example of how to lower a payer-specific readmission rate.

After a networking lunch, attendees spent the afternoon participating in breakout sessions on two topics of their choice. A cardiac rehabilitation breakout session was led by Jodi Perdue, RN-C, BSN, who presented on Munson Medical Center’s multi-phase cardiac rehabilitation program [SEE SLIDES]. Her session was followed by an MVC unblinded data presentation by MVC site engagement coordinator Emily Bair, MS, MPH, RDN.

In the post-discharge follow-up breakout session, MVC project manager Jana Stewart, MS, MPH, guided attendees through a patient journey mapping workshop [SEE SLIDES]. Attendees learned the basics of patient journey mapping approaches and collaborated to draft patient journey maps for key patient populations in Michigan.

In the preoperative testing breakout session, Dana Green, Jr., MPH, a project manager and de-implementation specialist for the Michigan Program on Value Enhancement (MPrOVE), educated attendees on available resources, lessons learned, and upcoming opportunities related to the RITE-Size initiative [SEE SLIDES]. MVC engagement manager Jessica Souva, MSN, RN, C-ONQS, then showed participants their own sites’ performance on MVC’s preoperative testing metric using unblinded data.

The fourth breakout session on sepsis was led by Pat Posa, RN, BSN, MSA, CCRN, FAAN, a quality and patient safety program manager with the Michigan Hospital Medicine Safety Consortium (HMS). She outlined the complex impact of sepsis on patients and the motivations behind launching the HMS Sepsis Initiative, as well as details about HMS sepsis bundles and performance data [SEE SLIDES]. The session was closed out by MVC senior analyst Kim Fox, MPH, with an unblinded data presentation on 14-day follow-up after sepsis, MVC’s newest value metric.

The meeting closed with reminders about upcoming meetings, key dates for the PY 2026-2027 P4P metric selection process, and post-event survey information presented by Jessica Souva (Figure 4).

Figure 4.

If you have questions about any of the topics discussed at MVC’s fall 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., May 9, 2025, in Midland.

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MVC Introduces New Multi-Payer Cardiac Rehab Registry Reports

MVC Introduces New Multi-Payer Cardiac Rehab Registry Reports

The MVC Coordinating Center added four new multi-payer reports to its online registry in April. These new reports evaluate cardiac rehabilitation utilization and encompass all metrics previously provided annually in MVC’s hospital-level cardiac rehab push report for acute myocardial infarction (AMI), percutaneous coronary intervention (PCI), heart valve repair or replacement (SAVR or TAVR), coronary artery bypass graft (CABG), and congestive heart failure (CHF). Each report reflects the most up-to-date available claims data from Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, BCBSM PPO Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial, BCN MA, Medicare Fee-for-Service, and Medicaid insurance plans. Users may select any combination of cardiac conditions and insurance plans to assess in each report.

In addition to allowing dynamic selection of cardiac conditions and payers, the reports allow for customization of report date range (the span of episode start dates), episode length (the time period following each index event), and index place of service (e.g., inpatient, outpatient, emergency department). Users may also filter by patient characteristics including gender, age, and comorbidities (diagnoses prior to the index event). Other patient-level characteristics related to the reflected episode can also be filtered, including whether the patient was transferred during their index event, was diagnosed with COVID-19 during the index event or within 30 days post-discharge, and by certain diagnoses during the index event or within 90 days. Up to four comparison groups are offered for each figure: the collaborative-wide measure, MVC All; the measure among other hospitals in the region, Hospital Region; the measure among only hospitals of the same type, Acute Care/Critical Access Cohort; and the measure among other rural hospitals (if applicable), MHA Rural Hospital Cohort.

Cardiac Rehab Utilization Rates

The first of the four new report provides data on cardiac rehab utilization rates (Figure 1). This report includes a description of cardiac rehab benefits followed by two figures reflecting utilization rates among episodes of the desired condition and payer combinations after all selected filters have been applied. The first figure shows the overall rate of cardiac rehab compared to utilization goals set by the Michigan Cardiac Rehab network (MiCR) and Million Hearts®. The second figure shows utilization trends over time at the user’s hospital(s) and a selected comparison group. This full report and all other reports can be downloaded as a ready-to-print PDF or image file.

Figure 1. Cardiac Rehab Utilization Rates Report

Cardiac Rehab Utilization Rankings

The next report provides data on cardiac rehab utilization rankings, showcasing the ranked order of hospital-level utilization rates for a selected comparison group. For example, in Figure 2 there are data points for cardiac rehab utilization rates during AMI, CABG, PCI, SAVR, and TAVR episodes originating at MVC Hospitals A, B, and C between December 1, 2018, and November 30, 2023 compared to all other MVC general acute care hospitals. The average rate across all comparison hospitals is about 31%, and each point outlined in orange represents the rate at an individual comparison hospital. Again, this report and all others may be downloaded in a ready-to-share format.

Figure 2. Cardiac Rehab Utilization Rankings Report

The remaining new cardiac rehab registry reports provide visual hospital rankings in the same format as the utilization rankings report, but for two other measures: 1) mean days to first cardiac rehab visit, which ranks the average number of days from index discharge to patients’ first cardiac rehab visit (up to 365 days); and 2), mean number of cardiac rehab visits, which ranks the average number of cardiac rehab visits completed within a selected episode length. These reports offer the same dynamic filters and output capabilities.

All MVC registry users will have access to these reports to view the data for their site(s). If you do not have registry access and are interested in using the registry to view these data, you should complete MVC’s user access request form. If you have any questions or feedback about the new registry reports, please contact the Coordinating Center.

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MVC Welcomes Emily Bair, MS, MPH, RDN as Site Engagement Coordinator

MVC Welcomes Emily Bair, MS, MPH, RDN as Site Engagement Coordinator

I’m excited to be joining the Michigan Value Collaborative (MVC) as a Site Engagement Coordinator. As a new member of MVC, I am looking forward to learning and working alongside this talented team of forward-thinking coordinators, administrators and analysts in their efforts to improve the health of Michigan through accessible, high-value healthcare.

Throughout my training I have always been fascinated by the intersection of physical and social sciences. Specifically, how healthcare and medical practices are influenced by social constructs such as race, education and economic stability. I was first introduced to this during my undergraduate education when I pursued a Bachelor of Arts in Anthropology & Biology at Kalamazoo College. I then continued in this vein of study earning a Master of Science in Biomedical Anthropology at SUNY Binghamton University and then a Master of Public Health (MPH) in Nutrition Sciences at the University of Michigan School of Public Health.

Following this portion of my educational journey, I decided to additionally train to become a registered dietitian and was honored in being selected for a Michigan Leadership Education in Neurodevelopmental and Related Disabilities (MI-LEND) fellowship. Through these experiences I developed a greater understanding of the barriers to accessing healthcare for specific populations, namely women, children and the disabled, as well as a passion for educating both patients and providers in these issues.

For the last 5 years I have practiced as a clinical registered dietitian specializing in pediatric gastrointestinal disorders, surgical recovery, and developmental disabilities. I’ve also engaged with projects spanning simulated medical education, hospital volunteer program development, and clinical research writing. This collection of experiences has provided me with a unique lens through which to observe and drive future healthcare efforts.

As Site Engagement Coordinator, I look forward to working with MVC and its members to continue to identify equitable health practices and opportunities for improved health outcomes. If you have any questions or wish to get in touch, please feel free to email me at baire@med.umich.edu.

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MVC Coordinating Center Releases 2023 Annual Report

MVC Coordinating Center Releases 2023 Annual Report

The Coordinating Center published its 2023 annual report to the MVC website recently. It outlines key successes and activities accomplished last year and the new strategy guiding MVC's 2024 efforts. Read the report below or view the PDF Parts A [LINK] and B [LINK]) now.

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MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

MVC Welcomes Its New Engagement Manager, Jessica Souva, MSN, RN, C-ONQS

I feel fortunate to have the opportunity to become a part of the impactful work that MVC began a decade ago. Joining a team that is so committed to improving healthcare quality across Michigan has renewed my passion for driving change to achieve equity in healthcare.

I began my career in healthcare as a nurse over 21 years ago. I have worked as a clinical nurse in the adult and pediatric emergency departments, labor and delivery, and ambulatory care.  In 2018, I earned my Master of Science in Nursing (MSN) from the University of Michigan before transitioning into the quality improvement realm of healthcare in 2019 as a site engagement coordinator for the Obstetrics Initiative (OBI). During my time with OBI, I supported hospital quality improvement teams by applying data analytics to support the implementation and sustainability of health equity initiatives. I believe that healthcare cannot achieve optimal quality without equity in service delivery.

In my time between OBI and MVC, I worked within the care management department at Michigan Medicine, developing workflow processes to launch the University of Michigan Physician Advisor Program, and provided strategic planning support to the nursing and medical directors.

When I am not working, I enjoy cheering on my youngest daughter’s softball team, kayaking, and traveling to new places as much as possible. Please don’t hesitate to reach out to me at jlbishop@med.umich.edu if you have any questions.

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MVC Implements a Variety of Data Updates to Episode Methodology

MVC Implements a Variety of Data Updates to Episode Methodology

Throughout the past few months, the MVC team has made several methodological updates to its claims-based episodes of care data underlying the metrics shared via MVC’s online registry and push reports. Some of these updates were part of regular claims data maintenance, whereas others were improvements identified and implemented by the MVC team.

Long-Term Acute Care Hospital Utilization Added as Post-Acute Care Category

A new category of post-acute care utilization was generated within MVC episodes of care: long-term acute care hospital (LTACH) stays. Previously, facility claims were grouped into seven major categories: inpatient, inpatient rehab, outpatient rehab, emergency department, skilled nursing facility, home health, and outpatient/other. An area of opportunity was identified by the MVC Coordinating Center and MVC members to add LTACH to this list. Formerly in MVC data, claims for stays at LTACH facilities were grouped in with inpatient claims and thus counted towards “inpatient readmissions” in the context of an MVC episode of care. LTACH is now its own category of care within MVC episodes and is assessed separately from inpatient stays at general acute care hospitals and Critical Access Hospitals. To count towards post-index LTACH care in an MVC episode, a facility claim must contain bill type 011X and the billing facility NPI for the claim must be primarily affiliated with taxonomy code 282E00000X. LTACH claims will continue to be price standardized in the same manner as other inpatient claims.

As a result of LTACH being added as a separate category of care in MVC episodes, MVC members can now also look at their patients’ use of LTACHs on the MVC registry. By index condition, members can view their attributed episodes’ rate of post-index LTACH utilization as well as their average LTACH payment per episode within the Payment by Condition reports for all payers. To do so, users must navigate to the Payment by Condition report, scroll down to the “Payment Measure” filter on the left side of the registry, and select “LTACH ($)” or “LTACH (%)” to look at average payments or utilization rates, respectively.

Updates to Hierarchical Condition Category (HCC) Identification

Another update made to MVC data this year was the application of components from the most recent specifications around hierarchical condition categories (HCC) from the Centers for Medicare & Medicaid Services (CMS). HCCs are patient comorbidities that both CMS and MVC use as part of risk-adjustment processes. When creating episodes of care, MVC uses each patient’s claims data in the 180 days prior to a given index event to retrospectively assess the comorbidities diagnosed for that patient prior to their MVC episode of care. Formerly, diagnoses indicated as “present on admission” on a patient’s index claim were also used to ascertain a patient’s HCCs, but MVC has updated its methodology such that no diagnoses from the index claim will be used in the assessment of patient HCCs going forward. MVC continues to create 79 HCCs according to HCC V22, with new diagnosis codes added each year.

Furthermore, we note that the category hierarchies created by CMS have been applied to the HCC comorbidities that MVC assesses and displays on the registry. The “hierarchical” aspect of the condition categories is applied to groups of similar diagnoses with a goal that patient comorbidities are not over-counted. For example, a patient diagnosed with diabetes may have multiple similar diagnoses reported on claims over a six-month period, such as diabetes without complications, diabetes with chronic complications, and diabetes with acute complications. Rather than describing that patient as having all three diagnoses, a hierarchy is applied so this patient will simply be described as having the most severe of the group of diagnoses (i.e., diabetes with acute complications). To look at the prevalence of HCC comorbidities among your patient population for one of MVC’s 40+ inpatient or surgical episodes of care, members can navigate to the “Comorbidities” report on the registry.

New Medicare Severity Diagnosis-Related Group (MS-DRG) Version

As part of annual maintenance to accommodate newly introduced billing codes, MVC recently updated the version of Medicare Severity Diagnosis Related Codes (MS-DRGs) being used to re-group inpatient claims into categories of similar inpatient stays. MS-DRG v40.1 is now being used by MVC to categorize all inpatient claims containing ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes.

Inpatient Claim Outlier Length of Stay Methodology

MVC updated the method by which inpatient claims with a particularly long length of stay are identified and price standardized. MVC price standardizes each inpatient claim by adding up three components: a standard DRG-based payment, an inpatient transfer payment (if applicable), and a length of stay-based outlier payment (if applicable). An outlier payment is added to the total price-standardized payment amount for a given inpatient claim if the covered patient remained in the hospital significantly longer than an average patient with the same DRG. In the past, MVC identified these “outlier” long length of stay inpatient hospitalizations using publicly available national long length of stay thresholds for every DRG from TRICARE, the uniformed services healthcare program. MVC’s updated outlier methodology uses Medicare Fee-for-Service (FFS) claims to identify the 99th percentile in length of stay (days) among inpatient claims for each MS-DRG. The hospitalization length of stay on each inpatient claim is then compared against the newly identified 99th percentile threshold for the corresponding DRG. Claims with stays exceeding that length threshold are considered outliers. The outlier payment added to that claim’s price-standardized payment amount is then calculated with an unchanged formula as follows: Outlier Payment = (Number of Days Over DRG-Specific Length of Stay Threshold) * $2,500.

All-Cause Readmissions Assessed for All MVC Conditions

New this year, all-cause inpatient readmissions following index hospitalizations will be assessed for all MVC conditions whenever readmission metrics are shown. Specifications around the identification of readmissions will not vary by index condition.

Episodes Containing COVID-19 Care Now Identified by Primary Diagnosis Codes Only

Finally, MVC has modified the identification of episodes containing care for COVID-19. Episodes are now flagged as containing significant COVID-19 care if they meet the following criteria: at any point during the 30- or 90-day episode, a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim categorized as inpatient, inpatient rehab, skilled nursing facility, or LTACH. These episodes are often excluded from metrics displayed in MVC push reports. To exclude episodes containing COVID-19 care from metrics shown on the registry, members can use the registry filter called “COVID Cases.” Users should select “Exclude 30-Day COVID” to exclude episodes in which COVID-19 was found within the index event or 30 days post-index. Selecting “Exclude 90-Day COVID” will exclude episodes where a primary COVID-19 diagnosis was found within the index event or 90 days post-index.

For more information on MVC episodes of care data, please refer to MVC’s data guide. MVC members with questions not covered within the data guide are welcome to reach out to the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

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

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

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

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MVC Welcomes New Analyst, Kim Fox, MPH

MVC Welcomes New Analyst, Kim Fox, MPH

It is a privilege to be welcomed to the Michigan Value Collaborative (MVC) team as a Senior Data Analyst! As a new member of the MVC team, I am excited to learn from and work alongside a talented team of MVC coordinators, administrators, and analysts to help improve the health of Michigan through creating sustainable, high-value healthcare.

My public health journey began after discovering the field of Medical Anthropology. Medical anthropologists show us that medical practices are shaped not only by scientific knowledge, but also by sociocultural, environmental, and economic factors. These factors lead to substantial variation in healthcare practices both globally and in our own neighborhoods. It is this principle that underlies my work in public health and keeps me inspired. My goal is to help find compassionate, creative, and robust healthcare approaches that consider and balance these factors to help improve the health and well-being of communities and populations.

Prior to joining MVC, I served in roles that have ranged from research operations and disease surveillance to global healthcare consulting. I received my Master of Public Health (MPH) degree in Epidemiology from the University of Michigan (U-M) School of Public Health and a Bachelor of Arts in Psychology with a minor in Medical Anthropology from U-M.

I am looking forward to working with MVC and its members to identify best practices and opportunities for continuous improvement through the analysis of clinical and claims data. If you have any questions or wish to get in touch, please feel free to email me.

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MVC Reflects on 2023 Mid-Year Progress and Successes

MVC Reflects on 2023 Mid-Year Progress and Successes

As the Michigan Value Collaborative continues its activity in the second half of 2023, the MVC team is taking a moment to pause and reflect on the tremendous work accomplished over the past six months. Here is a look back at some of the highlights.

NEW ED-BASED EPISODE DATA

MVC spent significant time and effort in Q4 of 2022 and Q1 of 2023 developing a new episode-of-care data structure initialized by index visits to the emergency department (ED). This work was done in collaboration with MEDIC—the ED-focused CQI—and the data science portion was completed by ArborMetrix. ED-based episodes were created for 15 high-volume, ED-relevant conditions from January 2017 through the present using all BCBSM, BCN, and Medicare plans for which MVC has claims data. Episodes were created for index events at all qualifying hospitals in Michigan. Over two million ED-based episodes have been created thus far, with plans to update and add additional claims data on a regular cadence. These data were used in the creation of a new ED-based episodes push report and are also available for use in custom reports for members.

ANALYTICS & REPORTING

Since Jan. 1, the MVC team has completed a total of 11 custom requests as well as six push reports, three of which were new:

  • ED-based episodes report (hospital version) - new
  • Skilled nursing facility (SNF) and home health report (hospital and PO versions) - new
  • P4P final scorecards for PY 2022
  • Preoperative testing report refresh
  • Cardiac rehabilitation report refresh

MVC COMPONENT OF THE BCBSM P4P PROGRAM

So far in 2023, MVC has been busy implementing and adjudicating the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. In March, MVC finalized and evaluated PY 2022, sending final scorecards to participating hospitals. PY 2022 was the first year of a two-year cycle for which MVC data was used to evaluate hospitals on two of seven selected episode spending conditions, including chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. The average total points scored was 6/10 before including bonus points, one point higher than the previous PY average. Consistent with previous years, joint replacement was the highest-scoring condition with an average of 4.6 points earned, while pneumonia was the lowest-scoring condition with hospitals earning 1.5 points on average (Figure 1).

After finalizing the methodology for the PY 2024-2025 cycle, MVC collected selections from all hospitals in early Feb. for one of five episode spending conditions and one of seven value metric options. MVC hosted two explainer webinars and five one-on-one meetings to support sites with their episode spending metric and value metric selections. The most common episode spending selection was for joint replacement and the most common value metric selection was seven-day follow-up after CHF.

Figure 1.

QUALIFIED ENTITY PUBLIC REPORT

MVC was approved as a qualified entity (QE) in 2022 under the Qualified Entity Certification Program (QECP) and continues to fulfill requirements to maintain QE status. In the first half of 2023, MVC continued to provide authorized hospital users with registry access to QE Medicare data that met program requirements. In Jan., MVC also published its 2022 Annual Public QECP Report. MVC’s first public report as a QE provides information on hospital performance for two sets of measures: rehospitalization following post-discharge home health use, and outpatient follow-up receipt following CHF/COPD inpatient hospitalization. The public report was published on the MVC website and shared with MVC contacts via email. MVC will refresh and publish its next annual public report this fall, adding two new years of data.

MAY COLLABORATIVE-WIDE MEETING

MVC held its spring collaborative-wide meeting on May 19. A total of 86 leaders from a variety of healthcare disciplines attended representing 50 different hospitals and 13 POs from across the state of Michigan. “Connecting the Dots: Celebrating 10 years of value-based care” was the theme, putting the spotlight on care transitions, care coordination, and MVC’s 10 years of supporting data-driven quality improvement. MVC was joined by guest speakers from Trinity Health IHA Medical Group and the new lung health CQI, INHALE. MVC also offered a poster session highlighting the work of several members and partner CQIs. MVC staff prepared a variety of unblinded data presentations, including a first look at its new ED-based episode data as well as unblinded breakout session presentations on its new P4P value metrics. Save the date for MVC’s fall collaborative-wide meeting, scheduled for Friday, October 20 at the Radisson Hotel Lansing.

WORKGROUPS

Over the last six months, MVC delivered a total of 14 workgroups, which were designed to provide a highly accessible online platform for hospital and PO leaders to come together, collaborate, and learn from peers. MVC offers workgroups on six topics this year: cardiac rehabilitation, chronic disease management, diabetes, health equity, health in action, and preoperative testing. Visit the MVC 2023 Events Calendar to check upcoming dates and topics and to register.

In addition, MVC launched a new Lunch and Learn series dedicated to MVC-focused activities and topics. The kickoff session in March included an overview of MVC and its offerings for new site coordinators or partners. The next session in June featured an introduction to MVC’s data sources, its episode structure and methodology, and an analyst-led walkthrough of one of MVC’s most recent push reports. MVC plans to host two more Lunch and Learn sessions later this year on other topics.

NEW COORDINATING CENTER STAFF

In June, MVC welcomed two new data analysts to the Coordinating Center: Kushbu Narender Singh, MPH, and Jiaying (“Janet”) Zhang, MPH. MVC published welcome blogs about Kushbu and Janet last month and looks forward to introducing them to members and partners in the coming months.

AND COMING SOON…

The MVC team is hard at work preparing for its first Rural Health Meeting, scheduled for Wednesday, August 9, from 10 a.m. to 12 p.m. via Zoom. The purpose of the meeting is to provide presentations and MVC data tailored to its rural or Critical Access Hospital members. This meeting will feature presentations by leaders from MVC, Scheurer Health, and the Michigan Critical Access Hospital Quality Consortium. RSVP here.

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Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

Study Shows Lasting Impact of a Modifier 22 Initiative on Opioid Use Among Vasectomy Patients

The opioid epidemic continues to harm individuals and communities worldwide; over-prescribing, overuse, and related overdose deaths persist in the United States and abroad. Without proper intervention, the proliferation of opioid use disorder and its negative impact on population health will continue. Healthcare professionals and stakeholders eager to stem this crisis are investing in the development and iteration of interventions that improve control of opioid distribution. As part of this effort, one team of healthcare researchers recently published a paper in Urology investigating the impact of an insurance payer’s novel opioid reduction intervention on the adoption of opioid-sparing pathways.

The authors of this publication, including lead author Dr. Catherine S. Nam, M.D., and her colleagues from Michigan Medicine, sought to compare the percentage of patients who filled peri-procedural opioid prescriptions before and after Blue Cross Blue Shield of Michigan (BCBSM) launched a modifier 22 incentive for opioid-sparing vasectomies in Michigan. This program incentivized the utilization of an opioid-sparing post-operative pathway developed by the Michigan Opioid Prescribing Engagement Network (OPEN) by allowing the use of the modifier 22 reimbursement code for vasectomies performed with minimal or no post-operative opioids. Previous literature has demonstrated success in this approach for other medical procedures. The use of modifier 22 as an opioid reduction intervention was first launched by BCBSM in 2018 for select procedures and was expanded to include vasectomies in 2019. Typically, modifier 22 can be applied to select insurance claims with the primary procedure code when the work attributed to that procedure or medical intervention exceeds the typical amount of required labor. When approved, insurance companies may provide additional reimbursements of up to 35%.

The expanded eligibility for the modifier 22 into vasectomy presented substantial quality improvement potential given both how commonly this procedure is performed—approximately half a million times annually across the US—and the fact that a 2019 survey indicated more than half of urologists prescribed opioids for patients receiving a vasectomy, even though the procedure can be completed without them. For a vasectomy procedure to qualify for the modifier 22 program, a surgeon must intend to follow an opioid-free peri-procedural course as well as provide additional counseling to patients about post-procedural pain expectations, proper opioid disposal, and non-opioid pain management strategies.

Given the novel quality incentive for opioid-sparing pathway application to vasectomy with implications for payers, providers, patients, and policymakers, Dr. Nam and her colleagues were interested in evaluating the impact this policy change had within the state of Michigan.

To perform this analysis, Dr. Nam and colleagues leveraged Michigan Value Collaborative (MVC) administration claims data from beneficiaries in BCBSM’s preferred provider organization (PPO) plan. The data provided by MVC included men ages 20 to 64 who participated in urologic procedures between Feb. 1, 2018, and Nov. 16, 2020.

Between these dates, Dr. Nam and colleagues identified 4,559 men who underwent office-based vasectomies and 4,679 men in the control group, which consisted of men who underwent cystourethroscopies, prostate biopsies, circumcision, and transurethral destruction of prostate tissue. These procedures are all office-based and not eligible for opioid-sparing modifier 22, thus providing a point of comparison.

The results of the analysis demonstrated a strong association between the implementation of modifier 22 for vasectomies and filled opioid prescriptions. Before July 1, 2019—prior to the implementation of the expanded modifier 22 policy—32.5% of men filled an opioid prescription after receiving a vasectomy, whereas after implementation only 12.6% of men filled an opioid prescription post-procedure (see Figure 1). As highlighted in the figure below, Dr. Nam and colleagues found a 19.9% absolute reduction and 61% relative reduction in the percentage of vasectomy patients who filled peri-procedural opioid prescriptions.

Figure 1. Percent of Patients Filling Opioid Prescriptions Before and After Implementation of Modifier 22

Among the vasectomy patients in the analysis, for every three opioid prescriptions filled before the implementation of modifier 22, only one was filled after the initiative was implemented. They did not find a significant decrease in the percentage of patients who filled peri-procedural opioid prescriptions in the control group.

In addition to the decreased frequency of men filling peri-procedural opioid prescriptions for vasectomies, Dr. Nam and colleagues also found a significant decrease in the prescribed amount. After the implementation of modifier 22 for vasectomies, the oral morphine equivalents (OME) of peri-procedural opioid prescriptions fills dropped from 89.7 OME per prescription to 27.1 OME per prescription. Dr. Nam and colleagues estimated that this decrease in prescription size led to the distribution of approximately 8,473 fewer oxycodone 5mg pills in Michigan.

When asked about the significance of these findings, Dr. Nam explained, “This estimate helped us grasp the impact of the Modifier 22 policy change for patients as well as the community. If this was the impact in a bit over a year for a single procedure in one state, how large could this impact be annually? What could the impact be when quality incentive is expanded to additional procedures? What if the quality incentive could be expanded to other states?”

These findings suggest that the modifier 22 incentive does decrease the percentage of patients who fill peri-procedural prescriptions after a vasectomy and its implementation correlates with a reduction in the number of opioids circulating within the community. In addition to reducing the unnecessary presence of opioids in communities, this initiative also emphasizes a shift to refocus healthcare interactions on the patient. The required additional education about pain management and proper use of pain management medications implemented as part of the modifier 22 initiative provides patients with a better understanding of their care and encourages physicians to consistently deliver high-value care.

Despite the significant findings of this study, a question remained. If these practice changes were initiated by incentivized modifier 22 interventions, what would happen if BCBSM terminated the incentive? Since the publication of Dr. Nam and colleagues’ original study, BCBSM terminated the financial incentive using modifier 22 for opioid-sparing vasectomies on Dec. 31, 2021. This termination provided the group with an opportunity to observe the long-term impact modifier 22 had on physician prescribing patterns and patient opioid use after the incentive was no longer in place.

Dr. Nam and colleagues performed another interrupted time series analysis before and after the termination of modifier 22 using the same vasectomy and control groups. After analyzing the data provided by MVC, they observed no significant changes in the opioid fill rate compared to the rate observed when the modifier 22 program was in effect. This was true for both the vasectomy group and the control group (see Figure 2). The persistence of reduced opioid prescription sizes was also observed following termination of modifier 22. Prior to incentive termination, the mean opioid prescription amount was 59 OME, and after termination the mean further reduced to 36 OME.

Figure 2. Percent of Patients Filling Opioid Prescriptions Before and After Termination of Modifier 22

These critical findings demonstrate that physician opioid prescribing behavior remained constant after the removal of financial incentives. More research still needs to be done on the long-term impact of programs such as modifier 22; however, Dr. Nam and colleagues suggest that other payers could implement incentive programs like BCBSM’s modifier 22 initiative in order to spur similar changes in prescribing patterns and are hopeful that short-term financial incentives are part of the solution to creating lasting practice changes.

“This is the first example of a novel quality incentive targeting physicians to provide high-value care by incentivizing opioid-sparing pain pathway,” she said. “However, this incentive can be adapted to incentivize other high-value care – could we recognize physicians that are providing guideline-based care? How about ensuring that appropriate lab and imaging tests are ordered for patients as part of their care plan? And if so, could it be possible for there to be an investment made from the insurance companies to champion high-value care for a short period of time to have lasting effects?”

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. In partnering with clinical, administrative, and CQI experts to leverage MVC data for analyses, MVC aims to identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Catherine S. Nam, MD; Yen-Ling Lai, MSPH, MS; Hsou Mei Hu, PhD, MBA, MHS; Arvin K. George, MD; Susan Linsell, MHSA; Stephanie Ferrante; Chad M. Brummett, MD; Jennifer F. Waljee, MD; James M. Dupree, MD, MPH

Full Citation

Nam, C. S., Lai, Y.-L., Hu, H. M., George, A. K., Linsell, S., Ferrante, S., Brummett, C. M., Waljee, J. F., & Dupree, J. M. (2022). Less is more: Fulfillment of opioid prescriptions before and after implementation of a modifier 22 based quality incentive for opioid-free vasectomies. Urology, 171, 103–108. https://doi.org/10.1016/j.urology.2022.09.023.