04 Dec 2024
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November Workgroups Highlight Preop Testing Project and Cardiac Rehab Access Initiative

November Workgroups Highlight Preop Testing Project and Cardiac Rehab Access Initiative

December 4, 2024 | 0 Comments | , , , ,

In November, MVC hosted two virtual workgroup presentations – the first on preoperative testing was led by a fellow Collaborative Quality Initiative (CQI), and the second on cardiac rehabilitation was delivered by an MVC member hospital. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from these presentations to support resource and best practice sharing across the state.

November Preoperative Testing Workgroup: Michigan Surgical Quality Collaborative (MSQC)

The first workgroup of November focused on preoperative testing and featured a presentation by Pamela Racchi, Clinical Site Coordinator with the Michigan Surgical Quality Collaborative (MSQC), and Susanna Fortney, Clinical Quality Specialist at ProMedica Charles and Virginia Hickman Hospital. To start, Racchi’s presentation provided an update on MSQC’s Preoperative Testing for Low-Risk Surgeries Project, including updated findings for 2024 and plans for 2025. Fortney then presented on ProMedica Charles and Virginia Hickman’s progress with reducing preoperative testing through the lens of participating in both the MSQC preop testing project and the RITE-Size pilot.

MSQC’s preoperative testing project is a continuation of a pilot started in 2022. The goals of the project include:

  1. To define the extent of routine preoperative testing in low-risk surgeries,
  2. To identify underlying reasons for overuse of preoperative testing in low-risk surgeries, and
  3. To implement interventions to heighten awareness and reduce variation among hospitals

Their project varies slightly from MVC’s preoperative testing offerings in that MSQC includes a slightly broader range of low-risk surgeries. The MSQC preop testing project includes abstraction for cases of minor hernia (abdominal hernias <3 cm and all inguinal/ femoral hernia repairs), laparoscopic cholecystectomy, and breast lumpectomy.

During the pilot, MSQC included all ASA classes in their analysis. Based on feedback from site participants, however, MSQC has since limited their evaluated cases to only ASA class I and II, elective cases, and low-risk surgeries identified as the intended primary procedure (based on CPT codes) for 2024. Patients falling into ASA classes I and II are expected to be stable with their comorbid conditions and therefore require less frequent testing.

Overall, results since September 2024 suggest ASA I and II cases are all trending in the right direction; abstracted data currently indicates preop testing rates of 18% among ASA I cases (with a goal of 25% or less) and 31% among ASA II cases (with a goal of 32% or less), as shown in Figure 1.

Figure 1.

Racchi also noted that the success of reducing preoperative testing is dependent on there being no further increases in unnecessary testing on the day of surgery. Historically, MSQC has calculated preoperative testing rates like MVC, up to 30 days prior to a surgery but not including the day of surgery. However, MSQC’s abstractors can additionally identify testing completed on the day of surgery. In 2024, MSQC abstractors are assessing cases that received testing on the day of surgery as well as those that received testing in the 30 days prior to a surgery. Preliminary performance results suggested there was an increase in day of preoperative testing when compared to baseline for both ASA I and II cases. Racchi noted that these analyses help determine whether testing was clinically necessary versus a result of physician habit.

Racchi and Fortney both spoke to the benefits of increasing engagement between surgery and anesthesiology to streamline preoperative testing protocols and processes. Between 2022 and 2023, ProMedica Charles and Virginia Hickman was able to reduce their preoperative testing rate by nearly 20% with just a few modifications to their testing protocol and additional onboarding of the anesthesiology providers.

A recent review of preoperative testing cases at ProMedica Hickman that were labeled unnecessary revealed nearly 40% were, in fact, medically justified and another 42% were due to protocol misinterpretation. Interestingly, the greatest rate of unnecessary preoperative testing was found to derive from ProMedica Hickman’s preadmission testing department. Fortney noted they had success embedding an adapted version of the RITE-Size program’s decision aid (Figure 2) within their anesthesiology preoperative protocols, and this helped to provide a more robust visual for their providers to reference when completing preop documentation.

Figure 2.

ProMedica Hickman additionally implemented a process for one-on-one training with preadmission testing (PAT) nursing staff, re-education, and the inclusion of case studies. The PAT nurses have also been included in MSQC/RITE-Size project update meetings and are given access to push reports so they can better understand their progress and impact.

The RITE-Size project is a collaboration between several CQI organizations – the Michigan Program on Value Enhancement (MPrOVE), the Michigan Value Collaborative (MVC), MSQC, and the Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE). Each organization has individual projects underway to address unnecessary preoperative testing, but also collaborate under the umbrella of RITE-Size to support de-implementation with additional customized support and coaching. Learn more about RITE-Size by visiting the program website here.

November 5 Preoperative Testing Workgroup

November Cardiac Rehab Workgroup: Marshfield Medical Center – Dickinson

The second November workgroup focused on cardiac rehabilitation – another of MVC’s value-based initiatives. This workgroup featured a joint presentation by Carolyn Hoy, BSN, Director of Quality; Courtney Swanson, BSN, RN, Heart Care Clinic and Cardiopulmonary Rehab Manager; and Lacey Schjoth, BS, Cardiac Rehab Coordinator at Marshfield Medical Center – Dickinson. Hoy, Swanson, and Schjoth’s presentation introduced Marshfield – Dickinson’s cardiac rehab Patient Access Improvement Project, an initiative rooted in one of their core values of patient-centered care.

Although part of a much larger system, Marshfield Medical Center – Dickinson is a relatively small hospital with about 49 general med/surgical beds. To support a significantly rural population in the Upper Peninsula, the Marshfield – Dickinson team identified the need to modify their cardiac rehab program to improve access. Their three main goals included:

  • Increase the volume of patients seen,
  • Accurately track referrals,
  • Expand services to include a supervised exercise therapy (SET) peripheral artery disease (PAD) program

Swanson and Schjoth described how the Northern Michigan landscape and weather contributed to some of the barriers patients faced in accessing cardiac rehab care. Outside of Marshfield – Dickinson’s cardiac rehab center, the next rehabilitation facility is nearly 45 miles away. To support patients driving a long distance to receive cardiac rehab, the team worked to coordinate with their patient’s other appointments. They also flexed their schedules to accommodate earlier or later availability and were willing to shift the appointment times as needed pending weather conditions.

Ultimately, the team was able to increase their class size to five patients per class and increased their class offerings by one cardiac rehab (and one pulmonary rehab) class per day by December 2023. They saw a nearly 27% increase in patient enrollment between 2022 and 2023 (Figure 3). Thus far in 2024, their patient volumes are on track to match or exceed 2023.

Figure 3.

Since Marshfield – Dickinson is unable to support a Phase 1 cardiac rehab program, most of their referrals come from outside facilities located in Wisconsin. Connecting with patients quickly after referrals are received is helpful to reduce the duration of time between referral and enrollment. With adjustments to their workflow, the team was able to reduce the average time from referral to initial contact to an average of just 3.5 days as of November 2024. The team also observed a corresponding reduction in the time to first cardiac rehab visit of just 16.5 days on average.

However, rectifying referral documentation from multiple outside sources can slow down this process. Additionally, surveyed patients reported that one of the largest barriers to starting cardiac rehab was a lack of insurance coverage or high copays, with nearly 9% of patients identifying this as the primary reason they did not schedule their initial cardiac rehab appointment in 2024.  The team has recently brought on a financial counselor to assist in contacting insurance companies and ensuring adequate and accurate referrals documentation.

Lastly, the Marshfield – Dickinson cardiac rehab team worked to develop close partnerships with local cardiology providers. Ensuring local cardiology providers are aware of and supportive of cardiac rehab is a critical step that generates additional opportunities for program endorsement and patient education by the provider. Marshfield – Dickinson has additionally added Dr. Massabni, an interventional cardiologist specializing in peripheral artery disease, to their staff. This allowed them to further develop their SET PAD program in January 2024 and they are seeing increasing enrollment in this specialized vascular program.

Much of MVC’s work with its members and partners in the space of cardiac rehab is delivered under the umbrella of the Michigan Cardiac Rehab network (MiCR), a collaborative partnership with the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2). You can see the MiCR website and offerings here. MVC also offers a robust registry of medical insurance claims data and data specialists that can help navigate and create custom analytic reports on cardiac rehab utilization metrics. Please reach out to the Coordinating Center by email if you would like to learn more about MVC data or engagement offerings.

November 21 Cardiac Rehab Workgroup

To learn more about the efforts showcased by November’s workgroup presenters, or other past workgroup presentations, please visit MVC’s YouTube Channel here.

December’s workgroups will feature a post-discharge follow-up presentation on December 3 led by Crystal Young of Corewell Health Trenton and Natalie Holland of MDHHS. Additionally, on December 12, Toni Moriarty-Smith of McLaren Northern Michigan will present a rural health presentation. The complete 2024 and 2025 MVC event calendars and workgroup registration links are available here.

06 Nov 2024
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October MVC Workgroups Highlight Hospital Care at Home and Sepsis Compliance Work

October MVC Workgroups Highlight Hospital Care at Home and Sepsis Compliance Work

November 6, 2024 | 0 Comments | , ,

Last month, MVC hosted virtual presentations for a health in action workgroup as well as a sepsis workgroup. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from these presentations to support resource sharing and collaboration across the state.

October Health in Action Workgroup: University of Michigan Health

In early October, MVC’s health in action workgroup focused on Hospital Care at Home (HCAH) and featured a presentation by Jessie DeVito, Administrative Director of HCAH at University of Michigan Health. DeVito’s presentation reviewed University of Michigan Health’s HCAH program from inception in 2019 through relaunch in February 2024, including valuable insights into their program development and implementation.

University of Michigan Health piloted their HCAH program in coordination with Blue Cross Blue Shield Commercial, and then expanded payer coverage to Medicare once the Centers for Medicare & Medicaid (CMS) established the Acute Hospital Care at Home Waiver during the COVID-19 pandemic. The intent for the HCAH program was to alleviate significant capacity issues within the brick-and-mortar hospital. By reviewing inpatient cases that met specific HCAH criteria, patients were able to continue necessary inpatient care at home while hospital beds were made available for more acute care needs.

Due to logistical and management barriers, the HCAH program decided to partner with an external vendor, Medically Home, in late 2023 to meet the needs of their patients and provide more in-home inpatient care and services. This vendor manages a 24/7 care team model, including a virtual hospitalist team, while providing services such as mobile diagnostics (e.g., X-ray, ultrasound), paramedicine, STAT labs and IV, and offering pathways to in-hospital services such as MRI or CT scans (Figure 1).

Figure 1.

The HCAH program has seen a maximum daily census of 10 patients and has an average length of stay of approximately 4 days. Patients who participated in the program had a lower 30-day readmission rate (17%) compared to patients who stayed in the hospital (20-24%). This correlates with a recent report from CMS on HCAH service data showing reduced 30-day readmission rates in most of the associated diagnosis related groups (DRGs) (Centers for Medicare & Medicaid Services, 2024) and is a promising trend for future program development.

One of the challenges the HCAH program faced was engaging providers in utilizing the at-home inpatient service. One proposed solution is to offer education and useful tools within the EPIC medical record, allowing providers to track which patients meet eligibility criteria and make appropriate referrals to the program. Additionally, once providers are educated on the HCAH program, they can share and educate their patients about this care option. By continuing to engage and educate providers and patients, the HCAH program anticipates continued expansion, with a goal to cover a broader patient population with increased payer coordination.

Oct. 8 Heath in Action Workgroup

October Sepsis Workgroup: Garden City Hospital

The second October workgroup focused on sepsis, one of MVC’s value metrics within the MVC Component of the BCBSM P4P Program. This workgroup featured a presentation by Akhil Vijay, Director of Quality Assurance and Performance Improvement at Garden City Hospital. Vijay’s presentation reviewed Garden City Hospital’s sepsis care program, sharing their development process and progress since the program’s implementation.

Following CMS and the Joint Commission's Sepsis Core Measure launch in 2015, Garden City Hospital has worked to build an effective sepsis care program reflective of all core elements (Figure 2). Starting in February 2024, their sepsis compliance rate was approximately 46%. After meeting with leadership, a root cause analysis was completed to determine why the compliance rate was low compared to the national average.  Building a partnership between leadership and providers proved to be a key strategy for successfully establishing weekly quality meetings to review sepsis cases and identify patterns of fallouts.

Figure 2.

Common case fallouts that were identified included delay in fluid/medication administration, missed labs or delays in results, incorrect antibiotic prescription, and no follow-up blood pressure reading after the patient received a required bolus. Using this information, the quality team was able to structure a successful follow-up plan to address sepsis case compliance issues (Figure 3).

Figure 3.

The quality team developed several methods for engaging leadership and providers in the program, such as:

  • developing an interdisciplinary sepsis committee to review cases,
  • following a standardized approach for case review with action plan development,
  • presenting sepsis cases at weekly didactic resident physician meetings,
  • and attending rounds with an infection prevention specialist to educate providers.

In addition to making this case education more visible in providers’ daily work, the program shared sepsis case scorecards with providers highlighting successes and areas for improvement. This in turn motivated the healthcare team to engage in friendly competition to achieve the best results.

Since January 2024, Garden City Hospital has improved its sepsis compliance, going from approximately 45% in January to a monthly average of approximately 63% by September 2024.

If you are interested in pursuing a sepsis care improvement program, MVC has a robust registry of medical insurance claims data that can be utilized as well as data specialists to help navigate and create custom analytic reports. Please reach out to the Coordinating Center [email] if you would like to learn more about MVC data or engagement offerings.

Oct. 17 Sepsis Workgroup

To learn more about the efforts showcased by University of Michigan Health, Garden City Hospital, or other past workgroup presentations, visit MVC’s YouTube channel here.

November’s workgroups include a preoperative testing presentation that occurred Nov. 5 with a presentation by Pam Racchi, BSN, RN, Clinical Site Coordinator with the Michigan Surgical Quality Collaborative. MVC will also host a cardiac rehabilitation workgroup on Nov. 21. You can view the complete 2024 and 2025 event calendars here.

02 Oct 2024
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September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

October 2, 2024 | 0 Comments | , , , ,

Since its founding, a core component of MVC’s strategy has been organizing opportunities to collaborate with and learn from peers, leading to the ongoing facilitation of MVC workgroups. MVC has hosted workgroup presentations twice per month in recent years, and this year’s workgroups are focused on six topic areas: post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. Going forward, MVC will publish a monthly blog to highlight key takeaways and shared resources from the prior month’s presentations. In doing so, all MVC members and partners may utilize and benefit from the content regardless of their live participation.

September Post-Discharge Follow-Up Workgroup

MVC hosted a post-discharge follow-up workgroup on Sept. 10 featuring a presentation by Brian Leideker, RRT, COPD Navigator for Trinity Health Oakland Hospital. Leideker’s presentation summarized Trinity Heath Oakland Hospital’s progress since initiating an A3 COPD readmission committee in June 2021, including the key interventions their team has implemented to date.

One initial intervention was the hiring of a COPD navigator. Leideker described how his unique role as a respiratory therapist involved in case management has allowed him to be “a middleman between respiratory physicians and other entities trying to deliver and support services” for COPD patients.

Following several root cause analyses, the COPD committee identified that nearly 90% of patients readmitted for COPD at Trinity Health Oakland Hospital had an interruption in intended continuation of pharmacotherapy and/or non-pharmacotherapy treatments. This finding encouraged Leideker’s team to work to improve the education of patients, providers, and the greater healthcare community on ambulatory treatment for COPD as well as reviewing the testing and documentation needed to ensure coverage of durable medical equipment (DME) post-discharge.

With the help of an MVC custom analytic report, Leideker was able to trend DME utilization rates for patients hospitalized with COPD since the initiation of these interventions, as seen in Figure 1.

Figure 1. Annual Select* DME Utilization Rates During the Index and 30-Day Post-Discharge Period Among Patients Hospitalized for COPD at Trinity Health Oakland (2020-2023)**

Generally, the utilization rate of post-discharge non-bi-level home ventilators (E0466) was found to increase over time, while bi-level home ventilator (E0470) utilization has decreased. Leideker noted that this was somewhat expected since patients routinely report difficulty with the utilization of bi-level home ventilators (BiPAP) and often move on to non-bi-level home ventilators (CPAP). Additionally, based on Trinity Health Oakland’s internal analyses as of May 2024, their COPD three-day readmission rates have been reduced to <18% for all payers.

Sept. 10 Post-Discharge Follow-Up Workgroup

September Rural Health Workgroup

MVC hosted a rural health workgroup on Sept. 26 featuring a presentation by Brent Mikkola, MBA, PMP, Manager of Community Health at MyMichigan Health. Mikkola’s presentation summarized MyMichigan Health’s approach to developing a strategic plan for health equity and an overview of some specific community programs currently in place. MyMichigan Health’s phased approach to integrating health equity is currently focused on evaluating social determinant of health (SDoH) opportunities in an “assess, analyze, and address” model.

Some unique community partnerships that resulted from this process include:

  • Gratiot County Public Transit voucher program
  • Rx 4 Health – partnership with Michigan State Extension and specific grocery suppliers including SpartanNash, SaveALot, and Meijer
  • Food Pharmacies & Weekend Kits - partnership with the Greater Lansing Food Bank and the Food Bank of Eastern Michigan
  • Bridge to Belonging - virtual series on loneliness and social connection
  • Continuing Care Clinic Pilot with Community Health Workers (CHWs)
  • Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) Suspension Diversion Program

In addition to developing a strategic framework for reporting and developing objectives around health equity, Mikkola described how MyMichigan Health delved into the data collection, analysis, and quality improvement work surrounding health equity. For example, after initially integrating CHWs into community practices and inpatient services, MyMichigan Health further integrated CHWs following the WHO’s CHW Lifecycle Approach, as seen in Figure 2.

Figure 2.

CHWs have become instrumental to MyMichigan’s assessment of SDoH as required by CMS and JCAHO mandates by filling gaps in system workflows and in the expansion of the Continuing Care Clinic Pilot. To date, nearly 500 well visit appointments have been completed by CHWs at MyMichigan. Of those patients, 34% were identified as having SDoH needs and 50% of those needs have now reportedly been met through connections to community support services.

To learn more about the efforts showcased by Trinity Health Oakland and MyMichigan Health, or to view past workgroup presentations, visit MVC’s YouTube channel here.

October’s workgroups will include a health in action presentation on Oct. 8 about the University of Michigan’s Hospital Care at Home program, as well as a sepsis presentation on Oct. 17 by Garden City Hospital. You can view the complete 2024 calendar of events and register for workgroups here. To learn more about MVC workgroups or other presentation opportunities, contact the MVC Coordinating Center by emailing us here.

16 Nov 2023
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MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

November 16, 2023 | 0 Comments | , , ,

Today is National Rural Health Day. Since 2010, the National Organization of State Offices of Rural Health set aside the third Thursday of every November to highlight the unique healthcare challenges facing residents within rural communities and celebrate providers who deliver innovative, affordable, and coordinated rural healthcare. MVC’s current membership includes 44 hospitals based in rural communities, 22 of which are designated as Critical Access Hospitals (CAHs). In tribute to National Rural Health Day and the needs of its growing rural membership, MVC hosted a special rural health workgroup yesterday.

The workgroup featured a guest presentation by Stephanie Pins, MSA, CPHQ. Pins is the Director of Quality, Risk, and Compliance for MyMichigan Medical Center Sault, formerly War Memorial Hospital, and is co-leading the Health Equity Council for MyMichigan Health. She led the creation of a transportation program for War Memorial Hospital by working with local transportation companies and applying for grants to cover the cost of the program.

This guest presentation focused on how MyMichigan is supporting rural communities through their Non-Emergency Medical Transportation (NEMT) Project, and the steps their team took to develop this program. Beginning in 2024, CMS will require that hospitals screen admitted patients for five social determinants of health (SDOH) domains. One of those five required domains is transportation needs since access to transportation and distance to care have a significant impact on healthcare outcomes.

MyMichigan Medical Center Sault primarily services the very rural communities of Chippewa, Luce, and Mackinac counties, located in the eastern Upper Peninsula of Michigan. A resident of Drummond Island—part of Chippewa County—may have to drive as many as 70 miles each way to get to an appointment at MyMichigan Medical Center Sault. Limited vehicle access in this part of the state was highlighted recently at MVC’s fall collaborative-wide meeting; the eastern Upper Peninsula had some of the highest rates in the state for housing units with no vehicle (Figure 1).

Figure 1.

While presenting, Pins emphasized that once MyMichigan identifies a need through screening, the next step is to find a way to connect those patients with the assistance they need to access medical care. One transportation solution utilized by MyMichigan Medical Center Sault is the Road-to-Recovery program, offered in partnership with McLaren Northern Michigan in Petoskey. The MyMichigan Medical Center Sault location offers some oncology cancer treatment services, but not radiation, so patients may need to travel to Petoskey—a distance of over 90 miles—to receive radiation therapy as part of their cancer treatment. The fully funded Road-to-Recovery program is available five days a week free of charge to anyone in the eastern Upper Peninsula. A hospital-owned van is driven by a volunteer driver from the MyMichigan Medical Center Sault location to scheduled pick-up locations along the I-75 corridor to Petoskey. Service times are coordinated with McLaren Northern Michigan’s oncology group so all the patients using this service have aligned appointment times. Pins shared that one noteworthy ancillary benefit of this program has been the peer support and relationship building that resulted from patients traveling together for extended periods while going through a similar treatment experience.

A second transportation solution utilized by MyMichigan Medical Center Sault is the Rides-to-Wellness Program, a partnership effort with local transportation companies and Connect UP. Patients can use this service to travel to other appointments or patient care services and serves as a critical stopgap in ensuring patients have somewhere to turn for time-sensitive transportation needs. Pins shared that the patient testimonials from those utilizing the service are helpful evidence of its value to the eastern Upper Peninsula (Figure 2).

Figure 2.

MyMichigan Medical Center Sault identified several lessons learned from delivering its Rides-to-Recovery Program over the last 10 years and applied many of those lessons to the development of its more recent Rides-to-Wellness Program. Pins also shared several tips for starting similar hospital-based transportation support programs at other locations throughout the state (Figure 3).

Figure 3.

Those who missed the workgroup and would like to learn more about these two programs, how they are managed, and how they were developed can review the full recording here. MVC is excited to offer a new rural health workgroup series quarterly in 2024. Contact MVC if you are interested in receiving invitations to those workgroups.

26 Jan 2023
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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

January 26, 2023 | 0 Comments | , ,

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.

19 Jan 2023
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Healthy Weight Awareness Month Inspires Workgroup Collaboration

Healthy Weight Awareness Month Inspires Workgroup Collaboration

January 19, 2023 | 0 Comments | , ,

This January, healthcare organizations and advocacy groups across the country are promoting Healthy Weight Awareness Month, as well as innovations in weight loss procedures. In alignment with this national conversation, MVC recently hosted its first workgroup of 2023 with a guest presentation by Oliver Varban, MD, FACS, FASMBS, Associate Director at the Michigan Bariatric Surgery Collaborative (MBSC), about obesity in Michigan, the main challenges of treatment, and how MBSC uses data to improve surgical management outcomes. The aim of such workgroups is to impart relevant data, best practices, and success stories for the benefit of MVC members and partners working in that clinical area.

According to data from CDC, the prevalence of obesity increased from 30% to 42% over the past 20 years, with 41% of Americans currently considered clinically obese. Excess body weight is associated with many different conditions and comorbidities (e.g., certain types of cancer, heart disease, diabetes, and stroke) and is a risk factor for increased severity and fatality of various conditions, such as those who experienced more severe illness from COVID-19 infection. Clinical management interventions range from screening and lifestyle changes to medication and surgery.

Identification and treatment of obesity often begins by measuring a patient’s body mass index (BMI), an estimate of body fat based on height and weight. The CDC uses BMI to measure obesity, but this measure falls short in several ways. For one, the accuracy of the measurement is lower among men, the elderly, and those in the intermediate BMI ranges. In addition, racial groups experience differing levels of disease for a given BMI. On its own BMI is not an accurate predictor of health. There are also a number of complex connections to social determinants of health since patients residing in environments with more limited access to healthy food and physical activity often have higher BMIs.

MBSC has been working to support quality improvement in healthy weight management since 2005 and aims to innovate the science and practice of metabolic and bariatric surgery through comprehensive, lifelong, patient-centered obesity care. MBSC utilizes its extensive clinical registry data to generate tools that support clinicians and patients in decision-making, including several patient- and provider-facing tools that outline a patient’s likely risks, benefits, and costs for various treatment pathways.

Given obesity’s prevalence and association with other chronic conditions, improved outcomes for patients managing obesity have far-reaching implications. Therefore, MVC and MBSC partnered last year to measure the value of bariatric surgery in treating diabetes, one of the most common and costly chronic conditions. According to the American Diabetes Association, $1 in $7 healthcare dollars are spent treating diabetes and its complications, and patients diagnosed with diabetes face 2.3 times the average person's healthcare costs. The analysis performed by MVC and MBSC was largely driven by existing evidence in the literature that bariatric surgery resolved or improved Type 2 diabetes symptoms in a large proportion of patients (Varban et al., 2022). Using its rich administrative claims data sources, MVC helped analyze pre-surgery and post-surgery receipt of diabetes medications, which was used to estimate the overall impact across Michigan and its estimated cost savings due to a decrease in post-surgery diabetes medication prescription fills.

The most impressive finding of the analysis was a significant decrease in the percentage of bariatric surgery patients who filled any diabetes prescription post-surgery (Figure 1), with over 50% of patients who previously used diabetes prescriptions taking no medications within 120 days post-surgery. This amounted to an annual cost savings of about $4,133 per patient. Five years post-surgery, the continued estimated cost savings from reduced reliance on prescriptions ($20,665) surpassed the average price-standardized total episode cost of bariatric surgery ($14,832). These results provide evidence of statewide clinical outcome improvement and cost savings for Type 2 diabetes following bariatric surgery. A summary of this return-on-investment analysis was developed and publicized by MBSC and MVC in August 2022.

Figure 1.

This analysis was also evidence of the opportunities for cross-collaboration and information sharing in obesity care—between primary care providers, chronic disease management care teams, and bariatric surgeons; between collaborative quality initiatives with varying clinical, value-based, and socioeconomic focuses; and between providers, their patient, and their patient’s families. Obesity is a clinical diagnosis with extensive social complexities and implications for one’s physical and mental health. Improving support and care for those in seek of treatment requires intentional, innovative collaboration.

The complete recording of Dr. Varban’s recent MVC Health in Action workgroup presentation and the discussion that followed are available on MVC’s YouTube channel. Those with questions about any of the above-mentioned materials or analyses are welcome to contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu. MVC’s next workgroup takes place on Tues., Jan. 24, from 11 a.m. - 12 p.m., featuring a guest presentation by Karla Stoermer Grossman, MSA, BSN, RN, AE-C, Clinical Site Coordinator at the Inspiring Health Advances in Lung Care (INHALE) Collaborative Quality Initiative. Register to join us and hear about INHALE’s approach to improving outcomes for patients with asthma and chronic obstructive pulmonary disease.

15 Sep 2022
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MVC and Members Promote Sepsis Awareness Month

MVC and Members Promote Sepsis Awareness Month

September 15, 2022 | 0 Comments | , , ,

Throughout the month of September, providers and advocacy groups are calling attention to the prevalence and signs of sepsis, the body’s life-threatening response to infection. It is the leading cause of death in U.S. hospitals, taking the life of a patient every two minutes and affecting an estimated 49 million people every year worldwide. Despite this, at least one in every three adults has never heard of sepsis. That is why in 2011 the Sepsis Alliance officially designated September as Sepsis Awareness Month.

To support its member hospitals in improving their outcomes related to sepsis, MVC collaborated with the Michigan Hospital Medicine Safety Consortium (HMS) in 2019 to develop a sepsis episode definition for its registry. MVC then began distributing sepsis push reports in 2020 with regular refreshes each year. Hospitals received their latest sepsis reports in April, which showcased wide variation across the Collaborative for measures such as total episode payments and 90-day readmission rates (see Figure 1). In addition, hospitals received details on their inpatient mortality and discharge to hospice rates compared to their geographic region and the Collaborative as a whole (see Figure 2). More information about this report was detailed in a previous MVC blog post.

Figure 1.

Figure 2.

MVC also began hosting a sepsis workgroup in June 2019 to help facilitate idea and practice sharing among Collaborative members. MVC has continued to host sepsis workgroups since then, with the most recent workgroup taking place last week on September 8. That workgroup honored Sepsis Awareness Month with a member panel featuring guest speakers from several health systems in Michigan. Attendees learned about current sepsis initiatives underway at hospitals throughout the state as well as insights on the impact of COVID-19, sepsis screening, sepsis bundle compliance, transitions of care, and other related topics. Those unable to attend can view the complete recording of this panel and discussion here.

One area of focus for this year’s Sepsis Awareness Month is a Sepsis Alliance tool to help providers remember the signs and symptoms. Their acronym approach asks providers to remember, “It’s about T-I-M-E,” with the word “time” representing temperature, infection, mental decline, and extremely ill (see Figure 3).

Figure 3.

This resource and many others have been created, collated, and packaged by the Sepsis Alliance in their yearly Sepsis Awareness Month Toolkit. Hospitals and providers are encouraged to utilize these resources to help educate their staff and patients. The hope is that through public education we can raise awareness of the signs and symptoms of sepsis so people in our communities know when to seek emergency care. Together, we can help save lives and limbs from sepsis. Learn more at sepsisawarenessmonth.org. To contact the MVC Coordinating Center about your sepsis reports, future workgroup speakers, or other questions, please email michiganvaluecollaborative@gmail.com.

16 Dec 2021
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MVC Shares National Action Plan with COPD Workgroup Attendees

December 16, 2021 | 0 Comments | , ,

The Michigan Value Collaborative (MVC) held a bi-monthly virtual workgroup recently on chronic obstructive pulmonary disease (COPD), a condition that accounts for the majority of deaths from chronic lower respiratory diseases and is continuously a leading cause of death in the United States. Notably, COPD is nearly two times as prevalent in rural areas as it is in urban areas; therefore, MVC members in rural areas may be dealing with significant inequities within their patient populations. The workgroup presentation and discussion focused on the COPD National Action Plan (CNAP). To the Coordinating Center’s surprise, many workgroup participants had not previously heard of the CNAP, making this event a great opportunity for practice sharing and discussion among members.

Overcoming barriers to prevention, early diagnosis, treatment, and management of COPD is necessary to improve quality of life and reduce mortality. To address these barriers, the U.S. Congress; National Heart, Lung, and Blood Institute; and Centers for Disease Control and Prevention convened a town hall where they asked federal and nonfederal partners to develop an action plan. These partners were tasked with identifying the efforts needed to change the course of COPD. The result was the development of the COPD National Action Plan (CNAP), which was released in 2017 and updated in 2019. It consists of five goals, which were outlined and discussed during the workgroup (see Figure 1).

Figure 1. Slide from COPD Workgroup Presentation

Goal 1 calls for promoting more public awareness and understanding of COPD, especially among patients and their caregivers. Key opportunities include patient and caregiver education that is sustainable and culturally appropriate, technological support mechanisms, and connecting patients and caregivers to local and state resources.

Goal 2 focuses on increasing the skills and education of healthcare providers so they are better equipped to provide comprehensive care. This goal is supported by the development and dissemination of patient-centric, clinical practice guidelines for care delivery, the use of technological support mechanisms, and consideration of home-based pulmonary rehabilitation programs. It’s important to note that studies have found no statistically or clinically significant differences for health-related quality of life and exercise capacity among patients who have completed home-based vs. outpatient-based pulmonary rehabilitation.

Goal 3 encourages increased data collection, analysis, and sharing to create a better understanding of disease patterns. Opportunities within this goal include supporting pharmaceutical and clinical COPD research; identifying and delivering comprehensive, evidence-based, culturally appropriate interventions; and disseminating findings to a variety of audiences (from patients to national policymakers).

Goal 4 aims to increase and sustain COPD research to improve understanding of the disease and its diagnosis and treatment. It’s vital that clinicians, researchers, and health policy experts foster research across the COPD continuum (prevention, diagnosis, treatment, management). Workgroup attendees agreed that there are opportunities to improve equity among COPD patients through more data on diagnosed and undiagnosed COPD in disadvantaged patients. Another vital component of this goal is supporting and sustaining pharmaceutical research for COPD medications since none of the existing medications for COPD have been shown to reduce the progressive decline in lung function.

Goal 5 calls for federal and nonfederal partners to collaborate to meet the objectives of the CNAP and translate its recommendations into research and action. Workgroup attendees highlighted the importance of implementing CNAP equitably among both urban and rural regions and implementing COPD strategies at all health policy levels (national, state, local). Such opportunities could improve access to cost-effective and affordable COPD support services and expand support for and access to pulmonary rehabilitation services (including home-based PR), thus reducing health inequities among COPD patients.

Each of the five CNAP goals is equally important and vital in reducing COPD health disparities. Although many of the MVC workgroup participants had not heard of the CNAP before, they were interested in sharing its goals and opportunities with others in their healthcare organization. If you would like to learn more about this patient-centered national action plan, you can read the full published report here. If your organization has addressed the CNAP goals or implemented any of the discussed opportunities, the MVC Coordinating Center would like to hear about the successes, challenges, and lessons learned. If you would like to share this information or present at an upcoming MVC workgroup, please email MVC at michiganvaluecollaborative@gmail.com.