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Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY23 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

This week the Michigan Value Collaborative (MVC) distributed mid-year scorecards for Program Year (PY) 2023 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. PY2023 scores achievement and improvement points for each hospital’s selected episode spending conditions using index admissions from 2022 as the performance year against admissions in 2020 as the baseline year. Hospitals can earn up to five points for each condition using the higher of a hospital's achievement and improvement point scores. This is the second year of a two-year (PY22-23) P4P cycle.

This cycle also offers hospitals bonus points for completing and submitting a survey for each selected condition by November 15, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and support practice sharing between members. The full methodology for this program cycle can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the current distribution of total hospital points out of 10. The average points scored across the mid-year scorecards was 6.4/10 before including the survey bonus points. This is 0.4 points higher than the average points scored at the conclusion of PY22 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition. Hospitals could earn up to five points for each condition. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.6 points. Much of the success observed for the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than two points on average.

Figure 2.

These mid-year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2022 claims are incorporated. Hospitals can track their score through the P4P PY22-23 reports on the MVC registry, which provides all relevant scoring information for both improvement and achievement points in one place (bonus points are not reflected on the registry). These registry reports can be filtered by selected conditions to make the tracking of P4P points easier. Contact the MVC Coordinating Center for a walkthrough of your hospital’s PY23 mid-year scorecard or P4P registry reports.

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

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

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

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MVC Component of the BCBSM P4P Program: PY22 in Review

MVC Component of the BCBSM P4P Program: PY22 in Review

Last month the Michigan Value Collaborative (MVC) distributed final scorecards for Program Year (PY) 2022 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. 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. These P4P condition options included chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure one shows the frequency of hospital condition selections for this two-year program cycle. Joint replacement was the most commonly selected condition, while colectomy was selected by the fewest hospitals.

Figure 1. Distribution of Hospital Condition Selections for PY 2022

The MVC Component of the BCBSM P4P Program evaluates each participating hospital’s average 30-day, risk-adjusted, price-standardized episode payments for their two selected conditions through two methods. One way that hospitals earn points is by reducing their payments from the baseline period (which included index admissions in 2019) to the performance period (which included index admissions in 2021). These are termed “improvement points.” Alternatively, hospitals can earn points by being less expensive than the other hospitals in their cohort. These are referred to as “achievement points.” The MVC cohorts are groups of hospitals determined to be peers using bed size and case mix index.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each condition. Hospitals were also eligible to receive a bonus point for each condition by completing a questionnaire designed to inform MVC of member hospital quality improvement practices. While 12 points were available, a maximum of 10 points were awarded to participating members. Figure 2 shows the distribution of total points earned by hospitals for PY 2022.

Figure 2. Distribution of Total P4P Scores for PY 2022

On average, hospitals earned 7.7 points total, a nearly one-point increase from the average of 6.8 points in PY 2021. A majority (98.7%) of hospitals earned at least one of the two possible participation bonus points. The condition with the highest average point total was joint replacement at 4.6 points with spine coming in second at 3.4 points (Figure 3).

Figure 3. Average Points by Condition

If you have any questions regarding the MVC Component of the BCBSM P4P Program, please reference the P4P Technical Document for Program Years 2022 and 2023 and the MVC P4P FAQ PY 2022-2023. If you would like to set up a meeting to review your hospital’s scorecard, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.  MVC plans to evaluate and release mid-year scorecards for PY 2023 in the summer of 2023.

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Follow-Up After CHF, Cardiac Rehab Top New Value Metric Selections for P4P PYs 24-25

Follow-Up After CHF, Cardiac Rehab Top New Value Metric Selections for P4P PYs 24-25

In the final months of 2022, the MVC team distributed metric selection reports for Program Years 2024 and 2025 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These reports were provided in conjunction with details pertaining to the selection process as well as changes to the program structure, scoring methodology, and cohort assignments for the upcoming two-year cycle.

Eligible hospital members were tasked with reviewing these reports and returning their selections in recent months. MVC has now received metric selections for PYs 2024 and 2025. This program cycle will award a maximum score of 10 points, made up of a maximum of four points from an episode spending metric, a maximum of four points from a value metric (a new component), and a maximum of two points from engagement activities completed in the program year (the calendar year following the performance year). Each participating hospital selected one of the six available conditions for the 30-day episode payment component: chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, and pneumonia. The episode spending metric that the most hospitals selected was joint replacement (32), followed by CHF (20). No sites selected colectomy. See Figure 1 for a depiction of the total selections for each condition.

Figure 1.

The distribution in episode spending selections was consistent when stratified by MVC region of Michigan; joint replacement was the top choice within all four MVC regions, and CHF was generally the next most common. However, Region 1 (which constitutes Northern Michigan) had a smaller percentage of sites select CHF, with a slight preference for pneumonia. In addition, hospitals located in Region 4 (southeast Michigan) were more likely to select COPD (Figure 2).

Figure 2.

Brand new in PYs 2024-2025 will be value metrics, which are evidence-based, actionable measures with variability across the state. Hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Seven value metrics were available for hospitals to choose from: cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), seven-day follow-up after CHF, 14-day follow-up after COPD, seven-day follow-up after pneumonia, preoperative testing, and risk-adjusted readmission after sepsis. The preoperative testing value metric is composed of a group of three low-risk procedures: cholecystectomy, hernia repair, and lumpectomy. Each preoperative testing procedure will be scored separately, and points for that value metric will be awarded based on the highest points achieved for a hospital’s eligible procedures.

In its first year offering a value metric, MVC found that seven-day follow-up after CHF was selected by the most participants (25). Metrics related to cardiac rehabilitation participation accounted for 23 selections; 17 sites selected cardiac rehabilitation after PCI and five selected cardiac rehabilitation after CABG (Figure 3).

Figure 3.

There was more variation by MVC region for value metric selections than for episode spending selections (Figure 4). In Region 1 (Northern Michigan), seven-day follow-up after pneumonia was the most common selection. Nearly all the sites located in Region 2 (west Michigan) selected seven-day follow-up after CHF—this metric accounted for 71% of selections in this part of the state. Region 3 (mid-Michigan and the thumb region) had more sites select risk-adjusted readmission after sepsis, but Region 3 had a more even distribution of selections across the available metrics than Regions 1 or 2. Finally, Region 4 (southeast Michigan) had selections for all the available value metrics. Region 4 also had the most interest in 14-day follow-up after COPD.

Figure 4.

Two of MVC’s new value metrics align with existing value campaigns for which MVC is offering additional support. MVC established campaigns for both cardiac rehabilitation and preoperative testing in October 2020. Since then, MVC has developed reports on these two areas of healthcare utilization, which have historically been shared biannually. In addition, beginning in 2023, MVC is offering workgroups tailored to these value metrics. MVC’s first cardiac rehabilitation workgroup of 2023 took place on Feb. 16 during cardiac rehabilitation week featuring guest presentations by Haley Stolp of Million Hearts and Mike Thompson, PhD, MPH, Co-Director of MVC and Co-Director of the Michigan Cardiac Rehabilitation Network. A full recording of this session is available here. MVC’s first preoperative testing workgroup of 2023 will take place next week on Wed., March 15, from 1-2 p.m., featuring MVC Director Hari Nathan, MD, PhD. Those interested in learning about ready-to-use tools and strategies for the de-implementation of low-value testing may register here. Attending hospital sites will be encouraged to share their experience thus far with quality improvement related to preoperative testing, such as resources in use or in development and common barriers to change.

P4P cohorts were reassigned for PYs 2024 and 2025. Those cohort assignments and the new technical document have been published on the MVC website’s P4P page. The cohorts were not intended to group hospitals that are exactly alike; rather, they create a reasonably comparable grouping from which MVC can complete statistical analyses.

MVC’s P4P measure began in 2018 when BCBSM allocated 10% of its P4P program to an episode of care spending metric based on MVC data. If you would like to receive notices about the MVC workgroups or have questions about any aspect of the MVC Component of the BCBSM P4P Program, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

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MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

Next week marks the kickoff of American Heart Month, commemorating the more than 600,000 Americans who die from heart disease each year and raising awareness about strategies that support heart health. Cardiac rehabilitation (CR) is one of those critical strategies, with the second full week of February each year dedicated to promoting its role in reducing the harmful effects of heart disease. In support of efforts to promote this life-saving program, MVC will host a CR-focused workgroup on Feb. 16, from 2-3 p.m., with MVC Co-Director Mike Thompson, Ph.D., assistant professor in the Department of Cardiac Surgery at Michigan Medicine, as its guest speaker. He will highlight some recent efforts to increase patient enrollment.

This is the third time MVC has hosted a workgroup dedicated to CR utilization; the first took place during last year’s CR week in February 2022 and featured guest presenters Steven Keteyian, Ph.D., Director of Preventive Cardiology at Henry Ford Medical Group, and Greg Merritt, Ph.D., patient advocate, in a discussion about strategies for increasing CR use. The second in November 2022 featured Diane Hamilton, BAA, CEP, of Corewell Health Trenton Hospital, who discussed addressing transportation barriers as an obstacle to CR attendance.

CR is a medically supervised program encompassing exercise, education, peer support, and counseling to help patients recovering from a cardiac event, disease, or procedure. There is high-quality evidence that it saves lives and money. A 2016 meta-analysis estimated that for every 37 coronary heart disease patients who attended CR, one of their lives was saved on average. Additionally, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) and the Michigan Value Collaborative (MVC) came together recently to measure the impact attributed to CR for percutaneous coronary intervention (PCI) patients treated between 2015 and 2019, and estimated 86 lives saved, 145 readmissions avoided, and approximately $1.8 million in savings.

Despite the evidence in favor of its clinical impact and cost-effectiveness, CR remains heavily underutilized, with only one in three eligible Michiganders participating. MVC’s hospital-level cardiac rehab reports showcase similar findings (Figure 1). These reports were rebranded recently under the new Michigan Cardiac Rehabilitation Network (MiCR) umbrella in partnership with BMC2. They measure whether and when patients started CR at MVC hospitals and how long they kept going. The collaborative-wide average for PCI patients, for example, was 38.3%, with hospital rates ranging from approximately 10%-60%. Such a wide range in patient participation rates suggests MVC member hospitals would benefit from the insights of top-performing peers.

Figure 1.

MVC is pursuing several strategies to address this critical gap in utilization. The upcoming Feb. 16 workgroup will be one of several CR-focused workgroups offered throughout 2023. The Coordinating Center decided to offer workgroups on this topic in part because of its recent incorporation of a CR measure into the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. MVC member hospitals were recently asked to make metric selections for the upcoming Program Year 2024-2025 cycle, and as of February 2023 just over one quarter of hospitals elected to be scored on their CR rates for the new value metric component of the MVC measure. These hospitals will receive more P4P points if their CR utilization rate improves over time or is greater relative to their peers. These hospitals are currently treating the patients who will make up their performance year data for Program Year 2024 of the MVC measure. Therefore, MVC aims to offer tailored workgroups to support those sites being scored on CR utilization, most likely incorporating some unblinded data presentations and highlighting key resources and practices for quality improvement purposes.

The MVC team hopes these efforts to facilitate peer learning within the collaborative will help hospitals across the state improve CR participation. Doing so would save the lives of patients and improve the value of healthcare in Michigan. Sites that selected CR as their value metric component of the MVC P4P measure are encouraged to attend; however, anyone interested in this area of healthcare is welcome. Those interested in attending may register here. Please contact the MVC Coordinating Center with any questions at Michigan-Value-Collaborative@med.umich.edu.

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PY 2024-2025 Selection Reports Sent for MVC Component of BCBSM P4P Program

PY 2024-2025 Selection Reports Sent for MVC Component of BCBSM P4P Program

Beginning in 2018, Blue Cross Blue Shield of Michigan (BCBSM) allocated 10% of its Pay-For-Performance (P4P) Program to a metric based on Michigan Value Collaborative (MVC) claims data. In 2022, the BCBSM P4P Quarterly Workgroup approved changes to how hospitals are evaluated in future program cycles. The upcoming two-year cycle including Program Years (PYs) 2024 and 2025 will be the first impacted by these changes, with performance years in 2023 and 2024, respectively (see Figure 1). Hospitals received selection reports for the next cycle this week to aid in their decision-making on metrics within the new program structure.

Figure 1.

What is staying the same?

The program will continue to be scored out of 10 points maximum, and hospitals will continue to be evaluated on their risk-adjusted, price-standardized total episode payment, though this will make up a smaller component of the overall program. In addition, most conditions hospitals could select previously for episode payment scoring will still be available for that component of the program. Those include chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass grafting (CABG), joint replacement, and pneumonia. Additionally, a hospital’s metric selections will continue to be scored on improvement compared to the hospital’s own past performance and scored on achievement related to an MVC cohort. Each hospital will continue to be awarded the greater of the two scores, either improvement or achievement, which are calculated using Z-scores. Cohort designation is still based on bed size, critical access status, and case mix index.

What is changing?

The PY 2022-2023 program was scored out of 10 points, but 12 points could be earned (10 points from episode spending plus two bonus points). In PYs 2024-2025, the overall program structure (Figure 2) will change so that the maximum score will be 10 points, made up of a maximum of four points from an episode spending metric, a maximum of four points from a value metric (a new component), and a maximum of two points from engagement activities completed in the program year (the calendar year following the performance year). This means that rather than selecting two conditions as in previous program cycles, hospitals will now select one condition for the episode spending metric and select one value metric. In order to be eligible to select a payment condition or value metric, a hospital must be projected to have at least 20 cases in the full baseline year of 2021. No bonus points will be available for PYs 2024-2025.

Figure 2.

Brand new in PYs 2024-2025 will be value metrics, which are evidence-based, actionable measures that show variability across the state. Hospitals will be rewarded for high rates of high-value services or low rates of low-value services. Seven value metrics are available for hospitals to choose from: cardiac rehabilitation after CABG, cardiac rehabilitation after percutaneous coronary intervention (PCI), seven-day follow-up after CHF, 14-day follow-up after COPD, seven-day follow-up after pneumonia, preoperative testing, and risk-adjusted readmission after sepsis. The preoperative testing value metric is composed of a group of three low-risk procedures: cholecystectomy, hernia repair, and lumpectomy. Each procedure will be scored separately, and points for this value metric will be awarded based on the highest points achieved for a hospital’s eligible procedures.

Finally, engagement in MVC activities will be built into the program’s scoring structure, rather than being offered as “bonus” points. Hospitals will be eligible to earn up to two points by attending and participating in MVC activities throughout each program year. These points are intended to increase engagement with other hospitals and the MVC Coordinating Center. Hospitals may select their own combination of activities but must include at least one activity from each of the attendance and participation categories to earn any points.

The P4P selection reports distributed this week include tables for the various episode spending and value metrics that identify projected case counts, the hospital’s average payment or rate of utilization, the cohort and MVC All average payments or rates, and the projected changes necessary for the hospital to earn 1 – 4 points. Accompanying the reports was an interpretation guide to walk recipients through a blinded sample report. It includes guidance on how to interpret the tables with suggestions for how this data could be used to inform a hospital’s P4P selections. The guide can be viewed here.

A complete summary of changes to PYs 2024 and 2025 is available here. These changes will not be retroactively applied to PYs 2022-2023. For complete details about PYs 2024-2025, please refer to the P4P Technical Document. Contact the MVC Coordinating Center with any questions. MVC requests that member hospitals complete and submit their PY 2024-2025 selections by December 23, 2022.

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Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

Hospitals Receive PY22 Mid-Year Scorecards for MVC Component of BCBSM P4P Program

This week the Michigan Value Collaborative (MVC) Coordinating Center distributed the Mid-Year Scorecards for Program Year (PY) 2022 of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. These were the first scorecards for the new two-year program cycle for PYs 2022 and 2023.

PY2022 evaluates the index admissions from 2021 as the performance year against admissions in 2019 as the baseline year. MVC is using an improved z-score methodology to calculate both improvement and achievement scores. Hospitals will continue to receive the better of the two scores for each of their two selected conditions. For a description of how the program has changed from the last two-year cycle see the Change Document.

Additionally, this cycle offers hospitals bonus points for completing and submitting a survey for each selected condition by November 1, 2022. These surveys will be used by the MVC Coordinating Center to improve the program for future years and elicit improved best practice sharing between members. The full methodology for the new program can be found in the PY2022-2023 Technical Document.

Figure 1 below illustrates the distribution of total hospital points out of 10. The average points scored for the Mid-Year Scorecards was 5.9/10 before including the survey bonus points. This is 0.9 points higher than the average points scored at the conclusion of PY21 excluding all bonus points.

Figure 1.

Figure 2 below illustrates the breakdown of average points by condition out of five. Consistent with previous years, joint replacement was the highest scoring condition with an average of 4.5 points earned. The success of the joint replacement condition can be attributed to the shift from post-acute care in skilled nursing facilities (SNF) to home health and the move towards outpatient surgeries. Pneumonia was the lowest scoring condition with hospitals earning less than one point on average. The MVC average payment for a 30-day pneumonia episode increased by $792 from the baseline in 2019 to the performance year in 2021. The largest contributors to this increase were the base payment and readmission payments.

Figure 2.

The Mid-Year P4P scores are subject to change as new data is added. The final scorecards will be distributed after all 2021 claims have been added to the data in quarter one of 2023. Hospitals can track their score through the new P4P PY2022-2023 reports on the MVC registry. These new reports provide all relevant scoring information for both improvement and achievement points in one place except for the survey bonus points. They can be filtered by selected conditions to make the tracking of P4P points easier. For a walkthrough of your hospital’s Mid-Year P4P Scorecard or P4P registry reports, please contact the MVC Coordinating Center.

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MVC Distributes New Push Report Dedicated to P4P Conditions

MVC Distributes New Push Report Dedicated to P4P Conditions

MVC launched a new push report this week dedicated to the MVC P4P conditions. Its purpose is to support hospitals in identifying areas of opportunity within past and present conditions of the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. The conditions currently included in P4P and in this report are chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), colectomy (non-cancer), coronary artery bypass graft (CABG), joint replacement (hip and knee), pneumonia, and spine surgery. Acute myocardial infarction (AMI) is also included in this report as a historical P4P condition. Hospitals received a page for each condition if they met a case count threshold of 11 episodes in 2019 and 2020.

This report was limited to episodes included in the P4P program with index admissions in 2019 and 2020, and thus included the following payers: BCBSM Preferred Provider Organization (PPO), BCBSM Medicare Advantage, Blue Care Network (BCN) Health Maintenance Organization (HMO), BCN Medicare Advantage, and Medicare Fee-For-Service (FFS). To align with the P4P program, MVC excluded patients with a discharge disposition of inpatient death or transfer to hospice, episodes that started with an inpatient transfer, and episodes with a COVID-19 diagnosis on a facility claim in the inpatient setting. To fully exclude COVID-19 patients, pneumonia episodes in March 2020 were also excluded.

The reports provided data on hospital trends in episode payments, readmission rates, post-acute care utilization, and emergency department utilization for P4P patients. Data from the push report can be used in conjunction with the registry reports to inform areas of opportunity in the P4P conditions. The push reports also provided a snapshot of each hospital’s P4P patient population (see Figure 1), including race, mean age, and the average number of comorbidities.

Figure 1. Patient Population Snapshot for Blinded Hospital

For Critical Access Hospitals (CAHs), the report also included index length of stay. For acute care hospitals, the report included a “reasons for readmissions” table that identified the top five reasons a P4P patient was readmitted. However, this table was removed from the report’s joint replacement page due to low readmission rates among joint replacement surgeries. In its place, acute care hospitals received their ratio of outpatient to inpatient surgeries.

As with other push reports, hospitals were compared to other members in the collaborative for select measures. For acute care hospitals, each hospital’s report includes a comparison point for all MVC episodes (“MVC All”) as well as for episodes at hospitals in the same geographic region (“Your Region”). These reference points do not include episodes that occurred at hospitals with a CAH designation. Similarly, the reports distributed to CAHs included comparison points for MVC episodes at all CAHs in the collaborative (“CAH Average”).

This report takes the place of the cardiac service line reports, which included data on CHF, AMI, and CABG. The new P4P conditions push report uses many of the same measures and figures from the cardiac service line reports, but for the complete list of P4P conditions.

For more information on the MVC Component of the P4P Program, see the MVC P4P Technical Document. Please share your feedback on the newest P4P conditions push report with the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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Virtual Site Visits Underway with MVC Members

The COVID-19 pandemic affected hospital operations in a myriad of ways, with many Michigan Value Collaborative (MVC) members experiencing circumstances that could impact their score on the MVC Component of the BCBSM Pay-for-Performance (P4P) program. In order to mitigate some of the effect of COVID-19, the MVC Coordinating Center introduced two extra bonus points to be earned for Program Year 2021 only. One bonus point can be achieved by attending both MVC semi-annual events; the first was held in May and the second will be held in October. The second bonus point can be earned by undertaking a virtual site visit with the MVC Coordinating Center.

To date, the Coordinating Center has completed 26 site visits, and a further 25 “visits” are scheduled with a variety of hospitals around the state. During these 90-minute virtual visits, MVC provides an overview of the collaborative, our data, and engagement activities. Hospitals receive a quality improvement slide (Figure 1) in advance that they complete and return prior to their scheduled date. These responses drive the main discussion of the site visit.

Figure 1.

Much has been learned about various quality improvement projects being implemented and what hospitals are focusing on for 2021 and 2022. MVC plans to use the information from these slides to connect hospital members with peers interested in implementing similar projects.

In addition, the Coordinating Center is interested in learning: who is utilizing the registry and any individualized reports, the types of MVC data that are most useful, and any challenges hospitals have with using the data. This feedback will help MVC make improvements to the registry and individualized reports to make them more actionable for members.

Finally, the hospital relationship with physician organizations (POs) is discussed. One of MVC’s goals is to help facilitate collaboration between POs that have patients attributed to each hospital, especially in the patient outcomes and quality of care arenas.

If you have not yet scheduled a site visit, please do so here. Slots are available between now and October. If you have any questions or would like further information on a site visit, please contact the MVC Coordinating Center at michiganvaluecollaborative@gmail.com.

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MVC Component of the BCBSM P4P Program: PY20 in Review

MVC Component of the BCBSM P4P Program: PY20 in Review

In early January, the Michigan Value Collaborative (MVC) distributed 2020 Program Year (PY) scores to hospitals for the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay for Performance (P4P) program. This marked the completion of the first year of a two-year cycle for which hospitals have selected two service lines (out of seven) to be scored on their episode spending using MVC data. These service lines include chronic obstructive pulmonary disease (COPD), colectomy, congestive heart failure (CHF), coronary artery bypass graft (CABG), joint replacement, pneumonia, and spine surgery. Figure 1 shows the frequency of hospital service line selections for the two-year program cycle.

Figure 1.

The program evaluates hospital’s risk-adjusted, price standardized, average 30-day episode payments for their two selected conditions through two methods. One way that hospitals earn points in the program is by reducing their payments from the baseline period (index admissions in 2017) to the performance period (index admissions in 2019). These are termed ‘improvement points’. Alternatively, hospitals are able to earn points by being less expensive than the other hospitals in their cohort. These are referred to as ‘achievement points’. The MVC cohorts are groups of hospitals determined to be peers using bed size, case mix index, and teaching status.

While participants are scored on both improvement and achievement, members receive the higher of the two scores for each service line. Hospitals are also eligible to earn a bonus point for each service line provided all hospitals in their respective cohort who selected the same condition reduce spending by five percent. A maximum of ten points can be awarded for participating members. Figure 2 shows the distribution of total points earned by hospitals for Program Year 2020.

Figure 2.

On average, hospitals earned six points, an increase of around one point from the 2019 program year average. Twenty-four hospitals received bonus points within the COPD, colectomy, joint replacement, and pneumonia service lines. Consistent with previous years, joint replacement had the average points, with pneumonia coming in a close second (see Figure 3).

Figure 3.

If you have any questions regarding the MVC Component of the BCBSM P4P program, please refer to the P4P Technical Document for Program Years 2020 and 2021 and the MVC P4P FAQ PY 2020-2021 . If you would like to set up a meeting to review your hospital’s performance, please contact the Coordinating Center at MichiganValueCollaborative@gmail.com.