28 Apr 2026
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MVC Push Report Benchmarks Follow-Up Rates for CHF, COPD, Pneumonia, and Sepsis Patients

MVC Push Report Benchmarks Follow-Up Rates for CHF, COPD, Pneumonia, and Sepsis Patients

April 28, 2026 | 0 Comments | ,

The Michigan Value Collaborative (MVC) distributed hospital-level follow-up push reports recently intended to support the evaluation of long-term trends as well as the identification of gaps in follow-up care across differing patient demographics. This report focused on follow-up care after hospitalization for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), pneumonia, and sepsis—four of MVC’s value metrics for Program Years 2026-2027 of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program.

While MVC also provides reporting on its P4P value metrics via scorecards and registry reports, this push report provided additional data on follow-up care at member hospitals by showcasing variability across a longer analytic timeframe and more detailed stratifications for its 30-day CHF, COPD, pneumonia, and sepsis episodes. MVC defined follow-up as episodes where a patient had an outpatient follow-up visit (in person or by telehealth) within 30 days or before a readmission, inpatient procedure, emergency department visit, skilled nursing facility admission, or visit for inpatient rehabilitation.

Contained in each hospital’s report was a page dedicated to follow-up following hospitalizations for each condition. On those report pages, MVC hospitals received comparisons to their peers on outpatient follow-up rates and 30-day risk-adjusted total episode payments, as well as their hospital’s outpatient follow-up rates stratified by payer.

The report also featured a patient population snapshot table that highlighted demographic data for patients in each condition cohort. These tables (see Figure 1) provided each hospital with information on race, mean age, common comorbidities, and several indicators of non-medical drivers of health.

Figure 1. Sociodemographic Overview of Patients Receiving Follow-Up Following Discharge for CHF, COPD, Pneumonia, or Sepsis at Hospital A

Table presenting sociodemographic overview of follow-up conditions at Hospital A, including CHF, COPD, pneumonia, and sepsis. It details age groups, race/ethnicity percentages, common comorbidities, and socioeconomic indicators such as diabetes prevalence and living conditions, with data organized in rows and columns for comparison across conditions.

*Patient zip codes categorized as prosperous, comfortable, mid-tier, at-risk, or distressed according to the Economic Innovation Group's Distressed Communities Index 2018-2022, which incorporates economic indicators such as education, employment, and income.

Each figure reflected index admissions between 1/1/2023-12/31/2024 in BCBSM PPO Commercial, BCBSM PPO Medicare Advantage, BCN HMO Commercial, BCN HMO Medicare Advantage, and Medicare Fee-for-Service claims, and between 1/1/2023-9/30/2024 in Michigan Medicaid claims. Individuals insured by both Medicare and Medicaid were categorized as dual-eligible in the payer-specific figures. Hospital reports included pages for each condition if they met the threshold of at least 11 qualifying episodes in each year of data for that condition.

There was wide variation in follow-up rates across the collaborative for all four conditions, with some member follow-up rates averaging less than 20% to greater than 60% among CHF, COPD, and pneumonia patients, and between less than 30% to greater than 70% among sepsis patients.

Among general acute care hospitals, there were consistent decreases in average follow-up rates across the collaborative compared to previous reporting; MVC provided reporting on these same follow-up measures in a Q1 2025 push report based on 2022-2023 claims. Using the updated 2023-2024 timeframe, the collaborative-wide average 14-day follow-up rate for patients hospitalized for COPD fell from 55.3% to 51%. A similar trend was observed for seven-day follow-up after CHF (decreased from 44.8% to 43.1%), seven-day follow-up after pneumonia (decreased from 42.7% to 41.6%), and 14-day follow-up after sepsis (decreased from 58% to 52.5%). Follow-up rates were often lowest among the Medicaid and dual-eligible patient populations (Figure 2), and are therefore a patient group that likely needs additional support and outreach. Additionally, across all four conditions the average risk-adjusted price-standardized total episode payment at general acute care hospitals was higher among patients who did not receive follow-up than among patients who received follow-up care (see COPD example in Figure 3).

Figure 2. 3-Day, 7-Day, and 14-Day Follow-Up Rate Among Patients Hospitalized for Sepsis by Payer for Hospital A

Bar chart comparing follow-up rates across five insurance categories with three time intervals: 3-day, 7-day, and 14-day follow-ups, represented by blue, gray, and orange bars respectively. Notable trends include consistently higher follow-up rates at 14 days, with Commercial insurance showing the highest rates.

Figure 3. Average 30-Day Risk-Adjusted, Price-Standardized Total Episode Payment Among Patients Hospitalized for COPD by 14-Day Follow-Up Status for Hospital A

Bar chart comparing 30-day total episode payments for 14-day and no 14-day follow-up periods across three categories: Your Hospital (blue), Your Region (gray), and GACH Average (orange). No 14-day follow-up shows higher payments overall.

MVC member hospitals who classify as Critical Access Hospitals (CAHs) received alternate versions of the report, which used the averages of other CAHs as their comparison group in addition to MVC region. Similar to general acute care hospitals, the collaborative observed decreases in average follow-up rates among its CAH members for patients hospitalized for CHF (decrease from 39% to 38.2%), pneumonia (37.4% to 32.5%), and sepsis (44.7% to 43.9%). Among patients hospitalized for COPD at a CAH, however, there was an observed increase in the average 14-day follow-up rate from 44.9% to 47.2%. CAHs also observed similar trends of lower follow-up rates among Medicaid and dual-eligible patients.

Members can similarly benchmark the values and data provided in their recent report pages to the previously distributed follow-up push report from Q1 2025.

In addition to providing data on follow-up care, the MVC Coordinating Center offers a regular post-discharge follow-up workgroup series where members and partners share strategies and insights to help improve follow-up performance. The next workgroup will take place on Thurs., July 23, from 12-1 p.m. More information about upcoming MVC events can be found on the MVC events page.

If you have any suggestions on how these reports can be improved or have additional data requests to help support your quality improvement projects, please reach out to the MVC Coordinating Center.

10 Sep 2025
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Push Report Details New MVC Measure that Quantifies Gaps in Patient Outcomes

Push Report Details New MVC Measure that Quantifies Gaps in Patient Outcomes

September 10, 2025 | 0 Comments | , , , ,

MVC distributed a new push report on Aug. 28, highlighting the components and methods for MVC’s newest measure: health outcome variation for all-cause readmissions. The goals of the recently distributed push reports are to familiarize hospital members with the measure methodology as well as provide a first look at their hospital’s performance.

This measure was developed with the goal of addressing common challenges by MVC’s members in identifying and addressing gaps in health outcomes within their patient populations. A survey distributed to the MVC collaborative in 2024 identified barriers such as insufficient data and insufficient financial investments as key causes for lingering variation across their patient population. With the introduction of MVC’s health outcome variation measure, MVC seeks to quantify the magnitude of hospital-level variation in all-cause readmission rates between payer groups using an index of variation calculation. Readmission rates are risk adjusted for patient demographic and comorbidity data, as well as for non-medical drivers of health.

The first two pages of the push report provide a step-by-step walkthrough of the index calculation, beginning with the calculation of absolute differences in hospital-level readmission rates by payer group compared to the hospital-level average readmission rate. The five payer groups included in these calculations are BCBSM and BCN Commercial, BCBSM and BCN Medicare Advantage, Medicaid only, Medicare FFS only, and patients dual-eligible for Medicaid and Medicare; dual-eligible patients have been pulled out of the Medicaid only and Medicare only categories. This initial step helps to highlight which payer group(s) have a higher readmission rate than the hospital’s average rate (Figure 1).

Figure 1.

vertical bar chart of calculation of absolute differences in hospital-level 30-day readmission rates by payer group compared to the hospital-level average readmission rate

The next step in the methodology is to calculate a hospital’s index of variation using absolute differences in payer-specific risk-adjusted readmission rates compared to the hospital’s risk-adjusted average readmission rate. These payer-specific absolute differences are multiplied by the respective payer population proportion to yield weighted differences (Figure 2). The sum of those weighted differences across all five payer groups yields the hospital’s index of variation. This index calculation indicates the magnitude of payer-specific differences in risk-adjusted readmission rates within a hospital. A higher value indicates a larger spread in a hospital’s payer-specific risk-adjusted readmission rates as well as opportunities to develop strategies that reduce gaps in care across patient groups. A lower value is desired and indicates less variation in a hospital’s risk-adjusted readmission rates across payers.

Figure 2.

table: demonstration calculation a hospital’s index of variation using absolute differences in payer-specific risk-adjusted readmission rates compared to the hospital’s risk-adjusted average readmission rate

MVC first announced this measure at its fall 2024 collaborative-wide meeting, where Senior Advisor Jim Dupree, MD, MPH, announced its inclusion in the next cycle of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program. Scoring on this measure will be offered in the Program Year (PY) 2025 scorecards with no points attached and thereafter will be worth one point in the PY 2026-2027 cycle.

Similar index or composite measures have been utilized by other health organizations, and MVC’s risk-adjusted measure can help identify hospital-level preventable differences in readmissions. Hospitals will earn the health outcome variation point by improving relative to their own baseline index or by performing well relative to their peers (i.e., having an index at or below the collaborative-wide median index).

As hospitals review their provided push report and become familiar with this new health outcome variation measure, they are encouraged to reach out to MVC with any questions.

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

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

May 28, 2025 | 0 Comments | , ,

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

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

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

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

Figure 1. Average Risk-Adjusted, Price-Standardized 30-Day Total Episode Payments for Patients with an ED Visit for Diabetes Long-Term Complications

Dot plot: Average Risk-Adjusted, Price-Standardized 30-Day Total Episode Payments for Patients with an ED Visit for Diabetes Long-Term Complications

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

Figure 2. 30-Day Rates of Post-ED Utilization for Patients with an ED Visit for Diabetes Long-Term Complications

Dot plot: 30-Day Rates of Post-ED Utilization for Patients with an ED Visit for Diabetes Long-Term Complications

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

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

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

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

24 Sep 2024
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MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

MVC, MCT2D Introduce New State-of-the-State Report on Type 2 Diabetes in Michigan

September 24, 2024 | 0 Comments | , , , , ,

Chronic disease management was a key driver of healthcare utilization over the last decade and has been cited as the most expensive chronic disease in the U.S. In response, MVC recently partnered with the Michigan Collaborative for Type 2 Diabetes (MCT2D) to develop a statewide report on Type 2 Diabetes (T2D), a chronic illness that impacts over 1 million adults in Michigan. This new report was recently shared by both MVC and MCT2D at the Michigan Obesity Summit and will be distributed to MVC member hospitals later this week.

The report summarized demographics, healthcare utilization, and prescription patterns among those patients with T2D in Michigan insured by Blue Cross Blue Shield of Michigan (BCBSM), Blue Care Network (BCN), Medicare Fee-for-Service (FFS), and Michigan Medicaid between 2017 and 2023. To create this report, MVC first used its claims data to identify beneficiaries aged 18 and older with a qualifying T2D diagnosis in the past year. After identifying annual cohorts of beneficiaries with T2D for each year, 2017-2023, MVC assessed annual utilization of T2D prescription medications, emergency department (ED) visits, inpatient hospitalizations, and provider visits.

MVC assessed filled prescriptions among T2D beneficiaries with corresponding prescription coverage using its pharmacy claims. This was the first time MVC included prescription claims data in a member push report and the first time that prescription claims from all MVC payer sources were utilized in a single MVC analysis. Medicare beneficiaries were excluded from 2022 and 2023 prescription utilization rates because Medicare pharmacy claims were only available through 12/31/2021. Diabetes-related drug classes were identified in pharmacy claims based on National Drug Code (NDC) as well as standardized prescription names and classes.

Newer medications such as GLP-1 receptor agonists and SGLT2 inhibitors are frequently prescribed to improve glucose control, reduce mortality, slow kidney disease progression, and aid in weight loss. The American Diabetes Association now recommends the use of these medications for patients with cardiovascular disease, kidney disease, and obesity. In keeping with these guidelines, MVC’s analyses indicated a large increase in utilization of GLP-1 receptor agonists (3.1% to 18.6%) and SGLT2 inhibitors (2.3% to 14.2%) between 2017 and 2023 (Figure 1). In the same period, prescriptions decreased from 2017 to 2023 for insulins (20.9% to 16.5%) and sulfonylureas (17% to 10.9%).

Figure 1.

Demographic characteristics including age, sex, race (Figure 2), and insurance provider (payer) were described within the report for all beneficiaries with T2D across all payers 2017-2023 and compared to the characteristics of all beneficiaries reflected in MVC data during those years. Compared to all beneficiaries, those with T2D were older, with an average age of 66 years versus the average of 43 years among all beneficiaries. T2D beneficiaries were also more likely to be male (50% vs 43%), Black (20% vs 15%), and more often covered by non-commercial insurance plans (45% vs 28%).

Figure 2.

From 2017 to 2023, rates of diabetes-related ED visits and hospital admissions remained relatively infrequent among T2D beneficiaries. Around two percent of T2D beneficiaries visited an ED for a reason related to diabetes each year, and one percent were hospitalized in relation to diabetes. ED utilization unrelated to diabetes decreased from 37.4% in 2017 to 33.1% in 2023 among T2D beneficiaries (Figure 3). Hospital admissions unrelated to diabetes decreased from 21.3% to 16.4% (Figure 4).

Figure 3.

Figure 4.

In contrast, T2D beneficiaries saw primary care physicians, nephrologists, and endocrinologists more frequently between 2017 and 2023, with observed increases for all three provider types (Figure 5). Most notably, visit utilization with primary care providers increased from 18.3% to 32.9%. Nephrologist visit utilization increased from 1.2% to 2.2%, and endocrinologist visit utilization increased from 1.9% to 3.6%.

Figure 5.

This new report created in partnership with MCT2D provided a high-level overview of healthcare utilization among T2D beneficiaries within Michigan. Since the analyses utilized data derived from medical insurance claims, one key limitation was the exclusion of uninsured individuals as well as key indicators of T2D outcomes that are not accurately captured in claims data, such as HbA1C levels, blood pressure, continuous glucose monitor utilization, and retinopathy screening. Despite these gaps, the data revealed promising trends in diabetes care, including increased primary care visits, greater use of guideline-directed medications proven to show significant benefit, and reduced emergency department visits. MVC’s analyses also underscored areas for improvement, such as the need to address health equity gaps and continued promotion of guideline-directed medical therapy.

MVC will share copies of the completed report directly with members later this week, and a copy is also available on the MVC website [PDF]. If you are interested in pursuing a custom analysis for any of these measures or a different tailored custom analysis, please reach out to MVC.

10 Jul 2024
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MVC’s Updated Common Conditions Report Now Available to Hospital Members

MVC’s Updated Common Conditions Report Now Available to Hospital Members

July 10, 2024 | 0 Comments | ,

On Monday, the Coordinating Center distributed a refreshed version of MVC’s common conditions report. This report delivers a comprehensive analysis of care episodes for eight prevalent medical and surgical conditions, frequently targeted for quality improvement initiatives within MVC hospitals. It assesses hospital performance and highlights potential areas for growth. The report’s current conditions include chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), total knee and hip (joint) replacement, percutaneous coronary intervention (PCI), pneumonia, and sepsis. Notably, acute myocardial infarction (AMI) and spine surgery, which were previously included, have been replaced by two new conditions, PCI and sepsis, in the latest report.

MVC generated reports for 96 eligible hospitals. General acute care hospital and Critical Access Hospital (CAH) members received tailored versions of the report, which included benchmark data specific to their respective hospital categories and tailored comparison groups.

Although the provided metrics vary by condition and case count, report pages generally focus on 30-day total episode payments, post-acute care and post-discharge ED utilization, readmission rates, and common reasons for readmissions. MVC price standardizes total episode payments to Medicare FFS amounts so that comparisons can be made across hospitals over time. Payments are risk-adjusted for patient age, gender, payer, comorbidities, and high or low prior healthcare utilization/payments.

The report has been updated to feature recent data covering the period of January 1, 2022, through December 31, 2023, for Blue Cross Blue Shield of Michigan (BCBSM) / Blue Care Network (BCN) Commercial, BCBSM/BCN Medicare Advantage (MA), and Michigan Medicaid; Medicare FFS data covers the period of January 1, 2022, through November 30, 2022.

Upon opening the latest report, MVC members will find the integration of a “Common Conditions and Procedures Report”, which consolidates the patient population data for all conditions at each hospital, facilitating a more comprehensive and effective comparison.

Additionally, each page now features a figure displaying the breakdown of 30-day risk-adjusted, price-standardized post-acute care payments by new payer categories (See Figure 1). The new categories include BCBSM/BCN Commercial, BCBSM/BCN Medicare Advantage, Medicare Only, Medicaid Only, and Dual Eligible. With the addition of the “Dual-Eligible” category, it should be emphasized that dual-eligible patients have been reclassified as such and are now exclusively represented within this new category and no longer represented in the separate Medicare and Medicaid categories.

Figure 1.

Beyond offering insights into payments by payer and post-acute care categories, this figure gains significant value when analyzed alongside the new graphical representation of post-acute care utilization rates (See Figure 2). This comparative analysis serves to clarify the spending trends associated with each post-acute care category, illustrating how spending aligns with utilization frequency. The updated dot figure now features expanded post-acute care categories, with the addition of Inpatient Rehabilitation (IP Rehab), Outpatient Rehabilitation (OP Rehab), Emergency Department (ED), and Long-Term Acute Care Hospital (LTACH) services. This figure also depicts the percentage of each hospital’s patients who utilized home health care, skilled nursing facility (SNF) care, and outpatient services.

Figure 2.

Across the collaborative, reports continue to show high use of 30-day home health care and outpatient services for these common conditions. For patients initiating their episode of care at a general acute care hospital within the collaborative, the home health care utilization rate was highest following CABG and joint replacement.

Patients experiencing a CABG episode were noted to have significant use of outpatient services within the 30 days following the index event, demonstrating an average utilization rate of 66%. This rate reflects a 7% decline in utilization rate from the figures reported in the previous common conditions report. Patients with episodes of CHF and PCI were also high utilizers of outpatient services.

One final trend noted across the collaborative is a general decrease in 30-day readmission rates for colectomy, COPD, CABG, CHF, pneumonia, and sepsis (See Figure 3).

Figure 3.

MVC is dedicated to regularly updating its commons conditions report, aiming to equip collaborative partners with insightful data that can drive and reinforce meaningful advancements in healthcare quality. We hope these reports prove beneficial and welcome MVC members to contact MVC with any questions or analytic requests.

13 Mar 2024
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Refreshed Hospital-Level, ED-Based Episode Push Reports Coming Soon to Members

Refreshed Hospital-Level, ED-Based Episode Push Reports Coming Soon to Members

March 13, 2024 | 0 Comments | , ,

The MVC Coordinating Center will soon distribute refreshed hospital-level versions of its push report utilizing emergency department-based episodes (“ED-based episodes”). MVC generated separate versions for acute care hospitals and Critical Access Hospitals (CAHs) with tailored comparison groups. In addition to reflecting more recent data across all included payers, these refreshed hospital-level reports differ from prior versions due to the addition of three high-volume ED conditions and the incorporation of Michigan Medicaid claims.

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

Among general acute care hospitals receiving a report, the average risk-adjusted, price-standardized 30-day total episode payment (Figure 1) for the reported conditions is highest for diabetes with long-term complications ($20,568), CHF ED-based episodes ($17,245), diabetes with short-term complications ($12,087), and COPD ED-based episodes ($10,289). The collaborative-wide average is lowest for chest pain ($3,111) and abdominal pain ($3,123) ED-based episodes. Within each condition, MVC 30-day total episode payments are consistently higher for episodes in which the patient had a same-day inpatient admission compared to episodes in which the patient did not have an inpatient stay beginning on the date of their ED visit. With that information in mind, hospital members can also use their individualized reports to track their same-day inpatient admission rate at six-month intervals using trend graphs for each included ED-based condition (Figure 2).

Figure 1.

Figure 2.

A key goal for these ED-based episode reports is to provide insight into healthcare utilization following index ED visits. Therefore, reports continue to include a dot plot (Figure 3) comparing patient post-ED utilization at a member hospital against their peer comparison group. Dot plots provide information on what percent of episodes had a same-day inpatient admission, what percent did not have a same-day inpatient admission but did see the patient admitted in the 1 to 30 days following the index ED visit, and the percent of patients who had two or more inpatient admissions (thus, at least one readmission) during the episode of care. Also provided are rates of subsequent ED visits, receipt of outpatient services, home health, skilled nursing facility care, and inpatient or outpatient rehab.

Figure 3.

These ED-based episodes are built using MVC’s most recent medical claims data from Medicare FFS, Blue Cross Blue Shield of Michigan PPO Commercial and Medicare Advantage plans, Blue Care Network HMO Commercial and Medicare Advantage plans, and Michigan Medicaid.

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

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

09 Nov 2023
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Members to Receive Refreshed Preoperative Testing Reports

Members to Receive Refreshed Preoperative Testing Reports

November 9, 2023 | 0 Comments | ,

MVC hospital members will soon receive their second preoperative testing push report of 2023, providing an opportunity to benchmark progress on reducing low-value testing rates within their facility. MVC first introduced its preoperative testing push reports in 2021 to support members in reducing this low-value practice. Ordering these tests before low-risk elective and outpatient procedures often provides no clinical benefits to patients but is ordered regularly at hospitals across Michigan.

Similar to the report distributed earlier this year, members will continue to see their rates across various tests for three elective and outpatient procedures: laparoscopic cholecystectomy, laparoscopic inguinal hernia repair, and lumpectomy. Claims were evaluated in the 30 days before the procedures for the following common tests: electrocardiogram (ECGs), echocardiogram, cardiac stress test, complete blood count, basic and comprehensive metabolic panel, coagulation studies, urinalysis, chest x-ray, and pulmonary function with index admissions from 1/1/2021 through 12/31/2022. This refreshed push report exclusively utilizes claims from the Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN) plans. Members will receive reports if they have at least 11 index admissions in one of the three conditions and at least 20 admissions across all three conditions during the reporting period.

Like other MVC push reports, members will see a patient population snapshot table that identifies rates for preoperative testing and no preoperative testing in patients with varying demographic characteristics (Figure 1). Compared to the version received by hospitals this summer, the latest version of this report now also includes testing rates among patients who identified as Hispanic or American Indian/Alaska Native. On average, patients who had preoperative testing were older and had more than one comorbidity than patients who had no preoperative testing.

Figure 1.

Members will see their average testing rate across all three procedures, as well as their rate for each specific procedure (Figure 2). A hospital’s combined rate can easily be compared with the average for that hospital’s geographic region within the state of Michigan as well as the collaborative-wide average. This figure showcases the wide variability across the collaborative in average testing rates across procedures—some in the collaborative have an average testing rate close to 10% and some nearly 100%.

Figure 2.

The next figure in the report showcases overall preoperative testing rates by six-month intervals for 2021 and 2022. It includes data points for the MVC average and regional comparison groups (Figure 3), with evidence of very little change in overall testing rates over time when looking at all three procedures combined.

Figure 3.

Although the overall rate across the collaborative has been steady, MVC has identified shifts in testing rates for individual members. To support members in tracking these changes, a caterpillar plot is also included that depicts the absolute change in any preoperative testing from 2021 to 2022 (Figure 4). Members can see the percentage change—positive or negative—in their annual testing rate from 2021 to 2022 for a specific procedure, as well as how their absolute change compares to the rest of the collaborative. This figure showcases that although the collaborative is not seeing much change in its overall rates for any testing over time, individual members might see greater variability over time for specific tests or procedures, especially in instances of low case counts. Overall, MVC observed slight reductions in the average collaborative-wide procedure-specific testing rates from 2021 to 2022 for all three surgical procedures, with the highest reduction observed among lumpectomy episodes (-6.2%).

Figure 4.

Members will also be able to take deeper dives into their rates for specific tests (Figure 5) in the figures that make up the remaining pages of the report. Viewing one’s preoperative testing rates for each specific test can help members understand if any specific tests are driving their overall testing rate or are ordered more frequently than the majority of their peers.

Figure 5.

MVC is eager to drive improvement in this area and encourages members to visit the Waive the Workup resource website developed in partnership with the Michigan Surgical Quality Collaborative (MSQC) and the Michigan Program on Value Enhancement (MPrOVE). If you are interested in a more customized report, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

19 Oct 2023
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MVC Refreshes Sepsis Push Reports for Hospital Members

MVC Refreshes Sepsis Push Reports for Hospital Members

October 19, 2023 | 0 Comments | ,

The Michigan Value Collaborative distributed refreshed sepsis push reports this week, providing its hospital members with updated figures and measures using the latest MVC episode data. In addition, the latest reports were also distributed to members of the Michigan Hospital Medicine Safety Consortium (HMS), a valued partner in the initial development of this service line within MVC's registry.

This week’s reports included MVC’s updated race and ethnicity categories, which were modified and expanded to ensure greater inclusivity and accuracy. MVC also recently adopted a methodological change to its identification of patients admitted with COVID-19 that impacted the episode data used in this analysis. MVC episodes were flagged as containing significant COVID-19 care if a COVID-19 diagnosis (U07.1) was found in the primary diagnosis code position on a facility claim during the 90-day episode. Previously, MVC looked for COVID-19 diagnosis in the first three diagnosis code positions. These episodes are often excluded from MVC’s push reports but have historically been included in sepsis reporting to help hospitals gauge the impact of COVID-19 diagnosis on their sepsis metrics. Combined with the natural decline in disease prevalence, there was a significant reduction in the percentage of patients with a COVID-19 diagnosis who were treated for sepsis, compared to the previous reporting period.

The version shared with MVC members this week continued to provide price-standardized, risk-adjusted benchmarking for total episode payments, as well as length of inpatient stay, Intensive Care Unit (ICU)/Cardiac Care Unit (CCU) utilization, inpatient mortality or discharge to hospice, 90-day post-acute care utilization, and 90-day readmission rates. MVC’s general acute care hospital (GACH) and Critical Access Hospital (CAH) members were provided with tailored versions using comparison groups most suitable to their hospital category.

Sepsis is currently the third leading cause of death in U.S. hospitals, so inpatient mortality and discharge or hospice were included in MVC’s sepsis reports as important quality checks. The average inpatient mortality rate among patients hospitalized for sepsis was 13.3% across member GACHs (Figure 1) and 6.5% for CAHs (Figure 2). Rates for discharge to hospice at home or a medical facility were lower.

Figure 1.

Figure 2.

The latest report also investigated differences in 90-day readmission rates for patients hospitalized for sepsis. Within GACH, patients with Medicare FFS coverage exhibited the highest average readmission rate (30.4%), followed by patients insured by BCBSM/BCN MA plans (25.6%) and BCBSM/BCN Commercial plans (16.4%), respectively (Figure 3). BCBSM/BCN Commercial patients had a younger average age and lower average comorbidity count than patients with Medicare or MA plans. Within CAHs, the average 90-day readmission rate was 22.4%.

Figure 3.

The report also included benchmarking for average index length of stay by specific payer groups as well as for all payers combined. The average index length of stay across all payers was 8.7 among GACH patients and 5.5 among CAH patients.

Another significant finding was the difference in post-acute care utilization by service type among patients hospitalized for sepsis (Figure 4). On average across GACHs in the collaborative, outpatient services had a noticeably higher utilization rate (59.3%) compared to home health (29.4%) or skilled nursing facility (21.9%). The same was true for CAHs (Figure 5), with a much higher average utilization rate for outpatient services (75.2%) compared to home health (29.5%) or skilled nursing facilities (18.6%).

Figure 4.

Figure 5.

These reports were prepared using 90-day MVC episode data with index admissions from 7/1/19 – 6/30/22 for the following insurance plans: Medicare Fee-For-Service (FFS), Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, Blue Care Network (BCN) Commercial, BCBSM PPO Medicare Advantage (MA), and BCN MA.

MVC welcomes your recommendations for enhancing these reports and welcomes your feedback on how collaborative members are using these data to support their quality improvement efforts. Please don't hesitate to contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.

12 Oct 2023
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MVC’s Refreshed Common Conditions Report Coming to Hospital Members Soon

MVC’s Refreshed Common Conditions Report Coming to Hospital Members Soon

October 12, 2023 | 0 Comments |

MVC members will receive their next batch of updated push reports in the coming days with a refreshed version of MVC’s common conditions report. These reports provide insight into episodes of care for eight medical and surgical conditions that are commonly a focus for quality improvement efforts at MVC hospitals: acute myocardial infarction (AMI), chronic obstructive pulmonary disease (COPD), colectomy (non-cancer), congestive heart failure (CHF), coronary artery bypass graft (CABG), total knee and hip (joint) replacement, pneumonia, and spine surgery. MVC’s general acute care hospital and Critical Access Hospital (CAH) members will receive tailored versions of the report, with each group receiving benchmark data specific to their own category of hospitals.

Although the metrics provided vary by condition and case count, report pages generally focus on 30-day total episode payments, readmission rates, common reasons for readmissions, and post-acute care utilization. MVC price standardizes total episode payments to Medicare FFS amounts so that comparisons can be made across hospitals and over time. Payments are risk adjusted for patient age, gender, payer, comorbidities, and high or low prior healthcare utilization/payments.

Post-acute care utilization benchmarking for each of the eight medical and surgical conditions includes graphs displaying the percentage of each hospital’s patients who used home health care, inpatient/outpatient rehab, skilled nursing facility care, outpatient services, or emergency department care in the 30 days following their index hospitalization or surgery. Across the collaborative, reports show high use of 30-day home health care and outpatient services for these common conditions. For patients initiating their episode of care at a general acute care hospital within the collaborative, the home health care utilization rate was highest following CABG (69%) and joint replacement (50%).

Patients with a CABG episode were also high utilizers of outpatient services in the 30 days post-index (Figure 1), with a 73% average utilization rate. Patients with episodes for CHF (58%) and AMI (53%) were also high utilizers of outpatient services. Across conditions, use of outpatient services in the 30 days post-index was generally higher among episodes originating at CAHs than among episodes originating at general acute care hospitals.

Figure 1.

Reports also assess the setting of care for joint replacements and spine surgeries. For total knee and hip replacements, MVC data shows that the percent of joint replacements performed in an outpatient setting at general acute care hospitals across Michigan continued to rise from January 2021 through September 2022 (Figure 2).

Figure 2.

The patient population in these reports comprises adult patients who had surgery or an inpatient hospitalization at an MVC-participating hospital between January 2021 and September 2022. Measures are based on 30-day inpatient and surgical-based episodes of care data, incorporating paid claims from Blue Cross Blue Shield of Michigan and Blue Care Network Commercial and Medicare Advantage plans as well as paid claims from Medicare Fee-for-Service. Episodes meeting any of the following criteria were excluded from calculations: patients transferred to another acute care hospital or to hospice, patients who died during their index stay, and patients with a primary diagnosis of COVID-19 received in an inpatient setting at any point during their 30-day episode.

We hope our collaborative participants find these reports valuable, and as always, we welcome MVC members to contact MVC with any questions or analytic requests.

28 Sep 2023
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MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

MVC’s 2023 Chronic Disease Management Follow-Up Reports Coming to Members Soon

September 28, 2023 | 0 Comments | ,

MVC will soon distribute the 2023 version of its chronic disease management follow-up reports to members. This refreshed version provides summary data on patients eligible for follow-up care after discharge from hospitalizations for congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD).

MVC defines timely follow-up care as receipt of an in-person or remote outpatient follow-up visit within 30 days of hospital discharge to home or home health care and before any readmission, emergency department (ED) visit, or procedure. Patients admitted to a skilled nursing facility, long-term acute care hospital, or inpatient rehab within the 30-day episode were excluded. MVC’s follow-up analyses was performed using claims-based episodes of care with index hospital admissions between 7/1/2019 and 06/30/2022 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and Medicare Advantage (MA), Blue Care Network (BCN) HMO Commercial and MA, and Medicare Fee-for-Service insurance plans. For each of the two chronic conditions included in the report, hospitals with at least 11 episodes per year for a given condition received that condition-specific data.

The report offers a comparison of demographic characteristics for CHF and COPD patients who received a follow-up visit within 30 days versus those who did not receive follow-up. Demographic characteristics tabulated for each condition include the percent of patients living in “at-risk” or “distressed” Zip codes as defined by the Economic Innovation Group’s Distressed Community Index, patients’ average number of comorbidities, the mean age of patients, and the distribution of race and ethnicity. MVC recently refined and expanded its reporting of race and ethnicity identities, and these updates were reflected in the report. Patients are grouped as Hispanic if their insurance provider categorized their combined race/ethnicity as Hispanic or their ethnicity as Hispanic. Additionally, MVC no longer combines smaller groups and discontinued its use of the terms “other” and “unknown.”

On the first page provided for each condition, hospital follow-up rates are provided for three windows of time compared to those at other MVC hospitals (Figure 1), as well as trends over time for each follow-up window (Figure 2). For CHF, follow-up rates are provided in 3-day, 7-day, and 14-day time windows. For COPD, follow-up rates are provided in 7-, 14-, and 30-day time windows.

Figure 1.

Figure 2.

The second page of condition-specific feedback includes a summary of average 30-day risk-adjusted, price-standardized total episode payments by follow-up status compared to statewide and regional averages. Among general acute care hospitals included in the analysis, the statewide total average payment for CHF episodes was $17,235 for patients who received follow-up and $20,069 for those who did not; for COPD episodes, the statewide average payments were $13,815 among those with follow-up and $16,056 among those without. In reports generated for Critical Access Hospitals (CAHs), payments were compared to averages across all MVC CAH members. Rates of 30-day follow-up were also compared by payers across the same groups.

The final figure (Figure 3) in the report for each condition is a summary of follow-up method among those who received any follow-up care. Patients who received follow-up were categorized as having received only in-person follow-up visit(s), only remote follow-up, or both in-person and remote follow-up. MVC found that more than 80% of CHF and COPD patients statewide exclusively received in-person follow-up after a hospitalization.

Figure 3.

If you have any questions or feedback about this report, please contact the MVC Coordinating Center.