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MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

MVC Workgroup Planned to Support Members Focused on Cardiac Rehabilitation Rates

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

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

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

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

Figure 1.

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

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

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Healthy Weight Awareness Month Inspires Workgroup Collaboration

Healthy Weight Awareness Month Inspires Workgroup Collaboration

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.

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MVC and Members Promote Sepsis Awareness Month

MVC and Members Promote Sepsis Awareness Month

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.

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MVC Shares National Action Plan with COPD Workgroup Attendees

MVC Shares National Action Plan with COPD Workgroup Attendees

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.