06 Jul 2023
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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

July 6, 2023 | 0 Comments | , , ,

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.

29 Jun 2023
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MVC Welcomes New Analyst, Kushbu Narender Singh, MPH

MVC Welcomes New Analyst, Kushbu Narender Singh, MPH

June 29, 2023 | 0 Comments |

I would like to introduce myself as the Michigan Value Collaborative’s (MVC) newest data analyst. I am very thankful to be a part of this incredible team! I am an internationally trained dentist from India with over eight years of clinical and research experience. From childhood, I have been motivated to help people improve their health by overcoming barriers and getting timely access to quality healthcare. This led me to pursue a degree in health science and I greatly enjoyed treating dental diseases and conducting oral cancer research. My thesis research focused on studying the role of nestin - the cancer stem cell marker - in the initiation and progression of oral carcinogenesis.

After a few years of clinical practice, my curiosity about disease prevention increased. I wanted to be involved in providing data-driven healthcare solutions that would create a more significant impact on the community. I recently earned a Master of Public Health degree in epidemiology from the University of Michigan School of Public Health, which provided me with valuable knowledge and opportunities to explore the applications of data-driven research in solving real-world healthcare problems. My most recent research work focused on studying the association of statin usage with the incidence of head and neck cancer.

With this background and experience, I am excited to continue my journey - to integrate my research and clinical skills - working towards MVC’s mission. I look forward to learning and growing in my role as an analyst and continuing to fulfill my passion for improving people’s health outcomes. When not working, I enjoy gardening, bird watching, and hiking, and live by the motto ‘Live and Let Live.’ Please feel free to reach me at kushbu@med.umich.edu.

13 Apr 2023
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MVC Announces Speakers, Breakout Sessions for Spring Collaborative-Wide Meeting

MVC Announces Speakers, Breakout Sessions for Spring Collaborative-Wide Meeting

April 13, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce the agenda for its Spring Collaborative-Wide Meeting on Friday, May 19, 2023, from 10 a.m. – 3 p.m., at the Vistatech Center in Livonia, MI. This meeting’s theme of “connecting the dots” reflects a focus on interdisciplinary collaboration, care transitions, and alternative sites of care. This meeting also serves as the official launch of MVC’s 10-year anniversary celebration, which will highlight MVC’s achievements in promoting high-value healthcare throughout the last decade.

Presentations will highlight unblinded MVC data, inter-organizational partnerships, care team collaboration to improve patient outcomes, and supporting care transitions. Attendees will learn to utilize MVC’s claims data more effectively and efficiently to inform patient-centered quality improvement opportunities at their respective healthcare organizations. After this meeting, attendees will have insights and tools to help improve the following patient outcomes: care transitions and post-discharge support, readmissions, patient experience, treatment adherence, and patient education.

MVC’s Director Hari Nathan, MD, PhD, and Co-Director Mike Thompson, PhD, MPH, will kick off the day with Coordinating Center updates, announcements about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and success stories that celebrate MVC’s 10-year anniversary. This will be followed by the unveiling of new MVC episodes based on care initiated in the emergency department (ED), which were developed in partnership with the Michigan Emergency Department Improvement Collaborative (MEDIC). This presentation will include an unblinded data presentation using new ED-based episodes for congestive heart failure (CHF) patients.

The guest presentations will feature two MVC partners, a physician organization and a fellow Collaborative Quality Initiative (CQI). Speaking in the morning will be the Trinity Health IHA Medical Group. Caitlin Valley, MHA, Senior Population Health Project Manager at IHA, will present on transitional care collaboration and management for healthcare improvement. In the afternoon, attendees will hear from the INHALE (Inspiring Health Advances in Lung Care) team, a new population health CQI focused on the quality of care for adults with chronic obstructive pulmonary disease (COPD) and adults and children with asthma. Speaking about COPD care transitions and post-discharge support on behalf of INHALE will be Co-Director Michael Sjoding, MD, MSc, who is also an Associate Professor of Internal Medicine at Michigan Medicine.

In addition to traditional presentations, attendees will have multiple opportunities to network with and learn from their peers. The meeting includes a mid-day poster session that will highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions. Posters should feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to MVC conditions or 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.

There will also be breakout sessions in the afternoon that focus on the new value metrics for Program Years 2024-2025 of the MVC Component of the BCBSM P4P Program. Attendees were asked to select one of four breakout sessions upon registering, including cardiac rehabilitation, post-discharge follow-up (focus on CHF, COPD, pneumonia), preoperative testing, and sepsis readmissions. MVC members interested in referencing the value metrics selected by specific hospitals participating in P4P can refer to MVC's value metric selection document located here.

Those interested in attending MVC's spring 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. The fall collaborative-wide meeting will take place in October with a focus on health equity.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 4.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Illuminating Intersections: Hunger and Health (Feeding America)

22 Dec 2022
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MVC Team Welcomes a New Site Engagement Coordinator

MVC Team Welcomes a New Site Engagement Coordinator

December 22, 2022 | 0 Comments |

I am excited to join the Michigan Value Collaborative (MVC) in the role of Site Engagement Coordinator. Through my experiences, I have developed a passion for quality improvement in the delivery of healthcare. I have engaged in the collaborative nature needed to improve health outcomes firsthand, and I am excited to foster this environment as a Site Engagement Coordinator with MVC.

Having lived in New York my entire life, I enjoyed exploring what Michigan has to offer in my first few months here. I love being outdoors and finding new hobbies for all seasons of the year. I enjoy participating in triathlons during the summer months and skiing in the winter. I love spending time with family and friends, and my dog, Sable.

I received my undergraduate degree from the State University of New York at Geneseo, where I majored in biology and minored in Spanish. After completing my bachelor’s degree, I earned my Master of Public Health (MPH) from the State University of New York at Albany with a concentration in social behavior and community health.

While completing my MPH, I had the opportunity to work as a Graduate Student Assistant at the New York State Department of Health within the Division of Family Health and the Office of Quality and Patient Safety. Within the Division of Family Health, I provided programmatic assistance to the intervention projects of the New York State Perinatal Quality Collaborative, an initiative that aims to provide the best, safest, and most equitable care to birthing people and infants across New York State.

Within the Office of Quality and Patient Safety, as a part of an evidence-based intervention to increase colorectal cancer screening rates in the Medicaid Managed Care (MMC) population, I worked directly with MMC enrollees to provide them with necessary screening information and connections to appropriate screening resources.

In my most recent role, I served as a Community Support Specialist Team Supervisor for the New York State COVID-19 Contact Tracing Initiative. This position allowed me to be at the forefront of New York State’s efforts to control the spread of COVID-19 and support those who were in isolation and quarantine due to the pandemic.

As Site Engagement Coordinator, I look forward to developing and strengthening partnerships between MVC members and working together to improve the health of Michigan through sustainable, high-value healthcare. If you have any questions, please contact me at kdegener@med.umich.edu.

03 Nov 2022
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MVC Fall Semi-Annual Summary: Prescribing Health in Michigan

MVC Fall Semi-Annual Summary: Prescribing Health in Michigan

November 3, 2022 | 0 Comments | , ,

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

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

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

Figure 1.

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

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

Figure 2.

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

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

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

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

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

20 Oct 2022
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MVC Celebrates Achievements for National Healthcare Quality Week

October 20, 2022 | 0 Comments | ,

As the conclusion of National Healthcare Quality Week approaches, MVC is proud to honor healthcare quality professionals for their unique contributions toward service delivery and improvements in healthcare facilities. Thus far in 2022, much was achieved by MVC staff, members, and partners. Collectively, these teams work to improve outcomes for patients in a way that doesn’t add to the burden of healthcare costs. This week is an opportunity to celebrate those achievements and express gratitude to the dedicated professionals whose hard work made them possible.

MVC strives to help its members better understand their performance using robust multi-payer data, customized analytics, and at-the-elbow support. MVC has been active in each of these areas (summarized in Figure 1) thanks to MVC’s dedicated Coordinating Center staff. Of note is the fact that MVC distributed 16 push reports to 100+ hospitals and 40 physician organizations (POs) so far this year, and prepared 19 custom analytic reports in response to specific member requests. These data help identify areas of opportunity and trends over time that—in conjunction with other internal and external data sets—inform quality improvement initiatives underway at hospitals and POs across the state.

Figure 1.

MVC previously published a detailed mid-year summary of its activities from January to June of 2022, which is available here. Since then, MVC distributed five additional push reports, three of which were new to the collaborative in recent months:

  • Hospital hysterectomy report – new push report!
  • Preoperative testing report refresh
  • Emergency department and post-acute care report – new push report!
  • MVC Pay-for-Performance (P4P) Program Year 2022 mid-year scorecards
  • Chronic obstructive pulmonary disease report for POs – new push report!

MVC’s P4P Program mid-year scorecards also highlighted the extraordinary work taking place at hospitals across Michigan. The MVC Component of the BCBSM P4P Program evaluates each participating hospital’s risk-adjusted, price-standardized episode payments for two selected conditions by measuring improvement over time and achievement relative to their peers. At the conclusion of Program Year 2021, hospitals in the collaborative contributed to an overall price-standardized decrease in payments from 2018 to 2020 for the selected P4P conditions of $7.7 million.

Figure 2.

The average points scored for the recent mid-year scorecards was 5.9/10 before including the survey bonus points—0.9 points higher than the average points scored at the conclusion of Program Year 2021. These points reflect tangible improvements to service delivery and patient outcomes, such as reduced readmissions or shifting post-acute care in skilled nursing facilities (SNF) to home health following joint replacement surgery.

To help facilitate practice sharing among members, MVC workgroups have continued to be a valuable activity, with 28 virtual workgroups completed as of this week. Workgroup topics offered in 2022 include chronic disease management, diabetes, health equity, health in action (ad hoc topics), joint replacement, and sepsis. Quality improvement is a team effort, so MVC is extraordinarily grateful to the long list of members and partners who shared their expertise and time by presenting. Thank you to the following organizations for presenting to the collaborative at an MVC workgroup thus far in 2022:

  • Area Agency on Aging
  • Ascension Genesys
  • Beaumont Dearborn
  • Bronson Healthcare
  • Henry Ford Health
  • Michigan Social Health Interventions to Eliminate Disparities (MSHIELD)
  • Munson Healthcare
  • Olympia Medical, LLC
  • Sparrow Health System
  • Spectrum Health
  • Spectrum Health Medical Group
  • Trinity Health Muskegon
  • Washtenaw County Health Department

As hospitals and POs press ahead to improve the quality of care delivered in 2022, MVC is eager to support your important work. If you have a follow-up question about a report, please contact MVC to discuss a custom analysis. If you have benefitted from or are looking for guidance on a quality initiative, please reach out so MVC can connect you with members undertaking similar initiatives. MVC thanks you for your tireless work, and looks forward to a continued partnership in 2023.

08 Sep 2022
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MVC Welcomes Usha Nuliyalu to Coordinating Center Team

MVC Welcomes Usha Nuliyalu to Coordinating Center Team

September 8, 2022 | 0 Comments |

I am excited to join the Michigan Value Collaborative (MVC) team as a data analyst, where I look forward to utilizing MVC’s robust data to support the vision and goals of the team. Along with a 50% effort at MVC, I am working at the Center for Healthcare Outcomes and Policy analyzing healthcare claims data for health policy research.

I earned a Master’s in Public Health degree in epidemiology from the University of Michigan (U-M) School of Public Health in 2009. I have worked at U-M since then analyzing data for various research projects. In the early part of my career, I worked for U-M’s School of Nursing and the Michigan Medicine Addiction Research Center, where I had many opportunities to work on data management and build on my knowledge. For the past six years, I have had the opportunity to work with Medicare and commercial claims data, performing statistical analysis and preparing summaries. I also have co-authored several research papers related to health policy.

I am passionate about improving health care quality and reducing disparity. I feel I can utilize my data analysis skills to help providers and policymakers understand what works best and support MVC and its members in achieving their goals. I am also looking forward to learning new research and analytic skills and growing as an analyst. When I am not working, I enjoy hiking, biking, gardening with my family, and music. If you have any questions, please reach out to me at nuliusha@med.umich.edu.