09 Sep 2026
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MVC August Workgroups Highlight Preop Testing Reduction with RITE-Size and QI to Improve Outcomes for ICH Stroke Patients

MVC August Workgroups Highlight Preop Testing Reduction with RITE-Size and QI to Improve Outcomes for ICH Stroke Patients

September 9, 2026 | Comments Closed | , , , , ,

In August, the Michigan Value Collaborative (MVC) hosted two virtual workgroup presentations, a preoperative testing workgroup focused on Henry Ford Health Genesys’ preoperative testing reduction initiative and a health in action workgroup presentation by DMC Detroit Receiving Hospital on their intracranial hemorrhage quality initiative. The MVC Coordinating Center hosts workgroup presentations once or twice per month, covering a variety of topics including cardiac rehab, post-discharge follow-up, sepsis, rural health, preoperative testing, and health in action.

Preoperative Testing Workgroup: Henry Ford Health Genesys

During this month's preoperative testing workgroup, Henry Ford Health’s (HFH) Brooke Wagner, RN, BSN, Clinical Quality Facilitator II, SCQR, and Megan Wadowski, RN, BSN, Principal Quality Consultant, shared how HFH Genesys achieved significant improvement in reducing unnecessary preoperative testing prior to low-risk surgical procedures (e.g., inguinal hernia, lumpectomy, and cholecystectomy) by participating in the RITE-Size initiative.

HFH Genesys became involved in RITE-Size following outreach from the Michigan Surgical Quality Collaborative (MSQC), who indicated the HFH Genesys was eligible to participate in the RITE-Size initiative. HFH Genesys saw this as an opportunity for improvement and met with the RITE-size team for an initial site visit and kick-off meeting.

RITE-Size Coaching & Implementation Strategies

After initial discussions, the RITE-size and HFH Genesys teams identified two areas for improvement: 1) ordering practices and 2) provider workflows. The desired outcome/goal was to reduce unnecessary preoperative testing to better align with evidence-based (EBP) system-wide practices at HFH.

Wagner shared that HFH Genesys was able to pull together a multi-disciplinary team to meet with the RITE-size team, including clinical quality staff, the surgeon champion, chief of staff, and nurse manager for preadmission testing. Their team met and reviewed organizational data and workflows, discussed barriers, and considered ideas for long-term sustainability. By sharing perspectives from providers, nursing, anesthesia, and leadership, they were able to develop action plans and strategies to support continued improvement.

As the HFH Genesys team participated in regular coaching sessions throughout the project with the RITE-size team, they were able to increase awareness and give team members the opportunity to ask questions. Throughout the project, they were able to track fallouts, review trends, and maintain continuous process improvement.

Leveraging MVC Data

Part of the process of educating and increasing awareness among team members included sharing data from a MVC custom report completed earlier this year on HFH Genesys’ historical preoperative testing rates from 2023 – 2025 (partial data). Through this report, they discovered that despite changing from open surgery to robotic hernia surgery in early 2024, historical preoperative testing practices persisted (Figure 1). The team was able to develop an action plan and education for surgical providers where they presented evidence-based best practices for preoperative testing in relation to robotic hernia repairs and quickly saw a reduction in testing rates by the second half of the year.

Figure 1. Preoperative Testing Rates for Outpatient Laparoscopic Cholecystectomy, Inguinal Hernia Repair, and Lumpectomy in the 30 Days Prior to Admission at Henry Ford Genesys, 2023-2025 by Half-Year, All Payers

Line chart compares preoperative testing rates for Your Hospital and MVC GACH All across 2023 Q1–2 through 2025 Q1–2*. Blue hospital rates fluctuate from 36.8% to 30.6%, peaking at 39.7% in 2024 Q1–2, while orange comparison rates steadily decline from 39.0% to 34.6%.

*Reflects BCBSM/BCN claims through June 30, 2025, and Medicare FFS through March 31, 2025. Michigan Medicaid was provided through Dec. 31, 2024.

In addition to the clinical metrics HFH Genesys utilized, the custom report MVC provided included data for non-medical drivers of health that gave greater insight into their patient populations being treated for these low-risk procedures. Data tables helped HFH Genesys identify a large portion of patients undergoing low-risk hernia repair as patients living in zip codes with multiple barriers to care.

Identifying these barriers allowed HFH Genesys to restructure and simplify discharge instructions to better meet the needs of the patient population by incorporating patient-centered language and clear guidance on setting up follow-up appointments.

Process Change Efforts

By reviewing MVC and MSQC data together, HFH Genesys was able to identify multiple opportunities for improvement. After evaluating existing preoperative testing order sets, they found the original set was outdated and no longer aligned with evidence-based practice recommendations. By updating the electronic medical record (EMR) system, HFH Genesys was able to make a comprehensive update to the order set and preoperative testing policy for their teams.

This updated policy was then implemented across the organization and shared through trainings for providers and associated staff on appropriate testing guidelines and the revised preoperative testing workflows. To maintain continuous improvement through this process, the HFH Genesys team also established ongoing communication with surgical teams to reinforce adherence to the updated processes, which included orientations for new nursing or physician staff. Sharing the policy during the orientation allowed new staff to ask questions, and for the site to provide in-depth explanations on the effectiveness of the preoperative testing policy.

Barriers, Opportunities, and Next Steps

Wagner shared that though they have accomplished improvements in their preoperative testing process, there are barriers the organization continues to experience that may impact 100% adherence to the new policy. Those barriers range from unpredictable staffing fluctuations, administrative associate turnover, and variability in practice patterns among providers.

Despite ongoing setbacks, HFH Genesys looks forward to the future and opportunities ahead. By implementing Epic EMR in November of this year, they will provide enhanced clinical decision support for staff with the updated preoperative testing process coded into the EMR while creating standardized order sets for providers to easily use. These updates will further support adherence to the policy and provide a strong foundation for continued improvement. HFH Genesys will continue to provide communication and collaboration opportunities with providers and leadership on the “why” of the preoperative testing process change. This will be supported by ongoing monitoring and feedback processes to ensure sustained improvement through the Epic EMR implementation in November.

MVC Preoperative Testing Workgroup: Aug. 11, 2026

Health in Action Workgroup: DMC Detroit Receiving Hospital

During the August health in action workgroup, DMC Detroit Receiving Hospital’s Maryam Hakemi-King, MSN, AGNP, Stroke Program Lead Nurse Practitioner, presented on DMC Detroit Receiving Hospital’s participation in the American Heart Association’s (AHA) Intracranial Hemorrhage (ICH) Initiative, which focuses on advancing care and improving outcomes for patients with ICH.

ICH Stroke Facts & AHA ICH Initiative

Hakemi-King led the presentation by defining essential facts about hemorrhagic strokes to lay a foundation for the “why” of DMC Detroit Receiving’s participation, including:

  1. Hemorrhagic strokes account for approximately 13% of all strokes; but despite being less common, they are responsible for more than 40% of stroke-related deaths
  2. ICH is associated with a high early mortality rate of 30 – 40%
  3. Recent studies have shown a nationwide increase in ICH incidence among young and middle-aged adults
  4. There has been significant improvement in the care of ischemic stroke over the years, but similar progress has not been seen in the care of ICH patients.

As a result, AHA is actively partnering with 15 sites across the nation to participate in a two-year initiative to improve care and outcomes for ICH patients. The chosen sites are led by physician champions of the initiative and are focused on implementing national models of effective ICH care, including using procedures such as minimally invasive parafascicular surgery (MIPS) and aligning with ICH metrics and measures through AHA’s stroke focused Get with the Guidelines (GWTG) program. DMC teams are working to identify successful models of care through process mapping activities and continuously evaluating ongoing quality improvement initiatives. Participating sites like DMC are focusing on areas such as:

  • ICH patient triage process
  • Patient selection criteria for MIPS procedure
  • Surgical timing and post-operative care
  • Staff training and education
  • Evaluating outcomes

Sites discuss and review strengths and barriers to care while investigating all opportunities within each of these domains.

DMC Detroit Receiving Hospital Stroke Program

DMC Detroit Receiving Hospital has a comprehensive stroke center and program, which has seen a 43% increase in ICH admission cases from 2023 to 2025. The stroke center offers comprehensive, around-the-clock care supported by neurointensivists, specially trained neurosurgeons, and close collaboration with the ED, neurology, Neuro ICU, and neurosurgery teams. Its coordinated approach includes a dedicated stroke activation and paging system, a designated PACU holding area, 24/7 minimally invasive brain interventions for eligible patients, and AI-assisted identification of intracerebral hemorrhage (ICH). Structured documentation, quality audits, and monthly case reviews further support continuous improvement and high-quality patient care.

DMC Detroit Receiving worked to integrate the ICH methodology into their program by implementing specific metrics and measures, conducting a more in-depth analysis of patients receiving surgical intervention and their level of functioning at discharge, development of specific ICH consult note documentation and code ICH activation process, and continuing research while developing a new framework for ICH management (Figure 2).

Figure 2. DMC Detroit Receiving Hospital’s Integration of the ICH Initiative into Clinical Practice

Infographic outlines integration of ICH Initiative into clinical practice at Detroit Receiving Hospital. Four color-coded stages cover ICH-specific metrics and measures, more in-depth patient analysis, documentation and implementation of specific Code ICH Activation process, and research for new framework for ICH management.

ICH Initiative

Hakemi-King expressed how incorporating the AHA ICH initiative’s metrics and measures are an important focus for DMC Detroit Receiving. As they work to align with the national initiative, several ICH metrics and measures are being tracked, such as timing of patients being taken from arrival to the ED to imaging, taking the patient’s blood pressure in less than 120 minutes of arrival at the ED, and ensuring the ICH severity score is completed less than 6 hours before an intervention (Figure 3).

Figure 3. ICH Metrics and Measures

Slide showing ICH Metrics and Measures: door to Imaging in less than 25 minutes, door to anticoagulant reversal in less than 60 minutes, door to first blood pressure medication administration in less than 60 minutes, door to blood pressure goal less than 120 minutes, door to ICH severity score less than 6 hours or prior to intervention

These established care timeframes help ensure patients receive appropriate care on time. By structuring the patient’s care pathway from imaging to medication administration and blood pressure management, the stroke team prepares the patient to have a more successful discharge process.

The ICH quality initiatives currently in progress include tracking patient door to neuro intensive care unit (NICU) bed timing; tracking and identifying ICH presenting symptoms, which can be different than typical stroke symptoms; introducing early physical, occupational, and speech therapy interventions within the first 24 hours of admission (patient progress reported at monthly meeting); and completing a Pre-Morbid Modified Rankin Score (mRS) on patients at admission, discharge, and 90-days post-admission.

DMC Detroit Receiving Hospital is also in the process of implementing their Code ICH protocol. Code ICH is like other traditional Code Stroke processes but is specifically developed to focus on ICH patient care and is activated upon positive identification of a brain bleed on imaging. According to Hakemi-King, the introduction of the new protocol at their site has so far seen an increased rate of identification of ICH patients upon admission, a significant reduction in time from door to NICU bed, and improvement in care coordination and efficiency for these patients. Hakemi-King also shared that their site has just submitted their abstract on this research project to AHA for the 2027 International Stroke Conference and will be able to highlight more specific outcomes once the research timeframe has concluded.

Next Steps

Overall, Hakemi-King said the initiative is strengthening care for patients at Detroit Receiving with intracerebral hemorrhage (ICH) across the continuum—from improving ED workflows through Code ICH to conducting 90-day follow-up calls that assess functional outcomes and recovery interventions. The program focuses specifically on patients presenting through the ED, with strong frontline engagement supported by hands-on leadership, staff education, and regular review of performance gaps. Although exact patient volumes are not yet available, recent data suggest a relatively young population with a roughly even male-to-female distribution. For smaller hospitals preparing patients for transfer to a comprehensive stroke program, Hakemi-King emphasized two critical priorities: promptly managing systolic blood pressure to the recommended range and, when possible, initiating anticoagulant reversal before transfer.

MVC Health in Action Workgroup: Aug. 27, 2026

MVC welcomes workgroup presenters from across Michigan to share their expertise, success stories, initiatives, and solution-focused ideas with MVC members. Please reach out to the Coordinating Center by email if you are interested in being a workgroup presenter or submit a presentation proposal here.

10 Jun 2026
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CQI Spotlight: Michigan Radiation Oncology Quality Consortium

CQI Spotlight: Michigan Radiation Oncology Quality Consortium

June 10, 2026 | Comments Closed | , , , , , , , ,

Cancer treatment is complex, and for many patients, radiation therapy is a critical part of their care journey. Yet the delivery of radiation therapy—how much is given, how often, and with what level of precision—can vary widely across providers, with meaningful implications for outcomes, side effects, and overall patient experience.

The Michigan Radiation Oncology Quality Consortium (MROQC) was founded in 2011 in partnership with Blue Cross Blue Shield of Michigan (BCBSM) to better understand and reduce variation in radiation therapy practices across Michigan - specifically related to the use of advanced technologies such as 3D conformal radiation therapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in breast and lung cancer treatment. The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement in Michigan. MVC is excited to continue highlighting the innovative contributions of individual CQIs like MROQC and the ways in which MVC’s data support high-value care initiatives across the portfolio.

At the time of MROQC’s founding, there was growing interest in understanding how these technologies were being used across institutions and ensuring that newer, more complex approaches were being applied appropriately and consistently. By bringing radiation oncology providers together in a statewide collaborative, MROQC created a platform to compare treatment patterns, share best practices, and evaluate how different approaches affected patient outcomes. Over time, the work of MROQC expanded beyond treatment utilization to focus on broader quality improvement and value-based care initiatives. Today, the consortium supports multiple disease-site quality initiatives, collects patient-reported outcomes, and collaborates with clinicians and health system partners to improve the safety, effectiveness, and patient-centeredness of radiation therapy across Michigan.

Services and Benefits to MROQC Members

One of the most unique aspects of MROQC is its strong culture of collaboration across institutions that would traditionally be competitors. Radiation oncologists, medical physicists, nurses, dosimetrists, radiation therapists, abstractors, and administrators from across Michigan work together to analyze data, identify opportunities for improvement, and implement changes that benefit patients statewide. It is through this collaborative infrastructure that MROQC supports radiation oncology providers, hospitals, and care teams across Michigan.

Members benefit from:

  • Participation in statewide quality improvement initiatives across multiple disease sites
  • Access to real-time performance dashboards and benchmarking data
  • Collaborative working groups where clinicians share best practices and develop new quality measures
  • Educational opportunities and training resources
  • Support for research, publications, and national presentations
  • Participation in innovative incentive programs such as the BCBSM Gold Card program, which reduces prior authorization burden for high-performing facilities.

Through this collaborative model, the MROQC Coordinating Center team (Figure 1) enables clinicians and institutions to learn from each other, implement best practices more quickly, and continuously improve patient care. This has allowed Michigan to become a national leader in radiation oncology quality improvement, demonstrating how data-driven partnerships between member providers and payers can improve outcomes, reduce costs, and enhance patient experience.

Figure 1. MROQC Coordinating Center Team

Photo of 23 MROQC team members standing outside in front of a building

MROQC’s Key Initiatives and Achievements

Several initiatives highlight how MROQC’s collaborative model has been translated into meaningful improvements for patients and providers across Michigan.

Expanding use of shorter, evidence-based radiation treatments

MROQC has helped increase the adoption of hypofractionated radiation therapy, which delivers effective treatment in fewer sessions. For example, the use of accelerated whole breast radiation therapy has increased by more than 60% statewide, reducing treatment burden for patients while maintaining excellent outcomes.

Similarly, initiatives promoting shorter treatment courses for bone metastases have helped 78% of MROQC patients receive effective pain relief with fewer visits to the clinic, improving quality of life while reducing healthcare costs.

Improving treatment safety by reducing radiation exposure to critical organs

Through collaborative treatment planning initiatives, MROQC members have worked to reduce radiation exposure to organs such as the heart and esophagus during cancer treatment. These efforts have helped lower the risk of treatment-related complications and improve the safety of radiation therapy across the state.

Reducing administrative burden through the Gold Card program

In partnership with BCBSM, MROQC helped develop and implement the Gold Card program in 2017, which allows high-performing radiation oncology facilities to receive automatic prior authorization approval for radiation therapy treatments. This program rewards facilities that consistently meet quality improvement criteria and has significantly reduced administrative burden while allowing clinicians to begin treatment more quickly for patients.

Together, these successes demonstrate how statewide collaboration and real-world data can drive improvements in patient outcomes, treatment efficiency, and value-based care (Figure 2).

Figure 2. MROQC Performance: The Right Treatment at the Right Time

Infographic presents key statistics on radiation treatment effectiveness and advancements for breast, lung, bone metastases, and prostate patients from 2015 to 2024. Uses blue icons and bold percentages to highlight milestones such as 16K breast patients receiving targeted radiation, 89% lung patients avoiding esophagus radiation, 78% bone metastases patients benefiting from treatment reducing time and improving quality of life, and over 1K prostate patients receiving high precision radiation.

MROQC’s current initiatives focus on advancing high-value radiation therapy while strengthening the data infrastructure needed to support statewide quality improvement. Across its disease-site working groups - breast, lung, prostate, and metastatic cancer - MROQC continues to promote initiatives that improve treatment quality, reduce variation in care, and support evidence-based practice. Current efforts include improving treatment planning standards, expanding the use of shorter radiation therapy courses when appropriate, and monitoring treatment safety measures that reduce toxicity and improve patient outcomes.

MROQC is also expanding its quality improvement work to include brain metastases, building on the success of the existing metastases working group. This effort will help better understand treatment patterns and outcomes for patients receiving radiation therapy for brain metastases and identify opportunities to standardize and improve care.

For prostate cancer, MROQC partners with the Michigan Urological Surgery Improvement Collaborative (MUSIC) to better understand care across the full patient journey - from diagnosis through treatment. This collaboration allows the teams to link data across specialties and identify opportunities to improve coordination and outcomes for prostate cancer patients across Michigan.

Together, these initiatives ensure that MROQC continues to support clinicians across Michigan with the data, collaboration, and infrastructure needed to improve radiation therapy care for patients statewide.

Graphic quote from Lori Pierce, MD, highlighting MROQC as a unique radiation oncology-based collaborative quality initiative. The text emphasizes MROQC's role in setting standards for radiation-associated healthcare outcomes and efficient use of healthcare dollars in treating breast, lung, prostate cancers, and metastatic disease.

Addressing Non-Medical Drivers of Health Outcome Variation

Another important focus area is improving access to care for all Michigan cancer patients. MROQC is addressing variation in care through both data collection and targeted quality improvement efforts. The consortium collects data on demographic and social factors that may influence access to care or treatment outcomes. These data allow the collaborative to identify patterns of variation across facilities and patient populations and develop targeted interventions to address those outcome gaps. In addition, MROQC established the M-EQUAL committee, which focuses specifically on improving access to high-quality cancer care. The committee works to expand non-medical drivers of care data collection, is aiming to develop barriers-to-care quality measures and provides education and resources to member institutions to improve access and outcomes for all patients. Ultimately, MROQC’s efforts to leverage statewide data with collaborative learning translate into tangible benefits for patients: shorter and more convenient treatment courses, fewer complications, and more consistent care regardless of where they are treated.

Looking Ahead: Strengthening Data Infrastructure and Member Engagement

MVC and MROQC are currently partnering to explore a new data opportunity using claims-based analysis. This effort is looking to evaluate whether reduced fraction palliative radiotherapy for painful bone metastases among MROQC-participating sites results in lower overall healthcare utilization compared to episodes of care attributed to non-MROQC sites.

MROQC knows from experience that quality improvement requires more than collecting data - it requires building trust among clinicians, ensuring data accuracy, and creating opportunities for teams to learn from one another. Over the years, MROQC has seen how powerful a collaborative model can be when clinicians across institutions come together around shared goals. That is why the MROQC Coordinating Center continues to strengthen member engagement and is investing heavily in data infrastructure and reporting tools to support the collaborative with trustworthy, accurate data. These efforts include improving dashboards and reporting capabilities for participating facilities and preparing for a transition to a more scalable data platform to support future growth, analytics, and research. Visit the MROQC website to learn more about its team, offerings, and successes.

25 Mar 2026
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CQI Spotlight: Michigan Oncology Quality Consortium

CQI Spotlight: Michigan Oncology Quality Consortium

March 25, 2026 | Comments Closed | , , , , ,

Cancer care is not defined by treatments alone—it is measured by the experiences, quality of life, and outcomes of the people navigating the disease. Across Michigan, patients with cancer face complex clinical decisions alongside challenges that extend beyond the clinic, from treatment side effects to barriers in accessing supportive services. Through statewide collaboration, shared data, and a commitment to improving care delivery, the Michigan Oncology Quality Consortium (MOQC) is working to ensure that patients and their caregivers receive more consistent, compassionate, and high-value cancer care.

Established in 2009, MOQC was tasked with addressing oncology data that showcased significant variation in care outcomes as well as significantly higher costs compared to other areas of healthcare. One of 21 Collaborative Quality Initiatives (CQIs) sponsored by the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships Program, MOQC’s aim is to improve access, value, and quality of care for all invasive cancers.

In addition to establishing cross-cutting measures that apply to all disease groups within oncology, MOQC’s work expanded to acknowledge and address the impact of non-medical drivers of health on patient outcomes, intentionally creating space for more patient, caregiver, and frontline voices to shape meaningful change and guide the evolution of cancer care in Michigan.

Services and Benefits for MOQC Members

MOQC provides access to resources and tools, quality improvement initiatives, partnerships, funding, and support that its membership of 54 oncology practices would not otherwise have available. Through collaborative-wide and regional meetings, MOQC fosters member networking, ongoing education on best practices and emerging topics, new publications, and collaboration opportunities. MOQC also meets with oncology practices individually to review their performance measures. For those needing additional support in any area, MOQC conducts root cause analyses in collaboration with the healthcare team and provides resources and consultation on their processes and progress.

Members also benefit from access to the Patient and Caregiver Oncology Quality Council (POQC), a robust and highly engaged patient advocacy group currently comprised of 30 members (Figure 1). POQC gives teams the opportunity to learn directly from the lived experiences of patients and caregivers and brings forward barriers to care that may not be visible in data alone. POQC also contributes to decision-making about quality measures and initiatives through their work on MOQC’s Measures and Steering Committees. Their voices help member practices stay connected to the heart of what they do as they work to help guide MOQC’s efforts toward fair, effective, and compassionate health outcomes across the state (Figure 2).

Figure 1. Patient and Caregiver Oncology Quality Council (POQC)

group photo

Figure 2. POQC Member Quote

A text-based graphic features a testimonial quote from a POQC member expressing gratitude for volunteer opportunities and the rewarding experience of being a valued patient voice for cancer care.

MOQC members also have the opportunity to establish integrated clinical pharmacist positions providing direct patient care through the Pharmacists Oncology Excellence Program in Michigan (POEM). This program, which has been in place for five years, encompasses 12 pharmacists who support 113 physicians across 28 practices. POEM has been associated with a variety of positive patient care outcomes and clinic time savings relating to clinical care activities.

MOQC’s Key Initiatives and Achievements

Through MOQC’s targeted initiatives, oncology care and outcomes are improving across Michigan. The Palliative Care and Hospice initiative aims to increase time enrolled in hospice to maximize benefits and quality of life for patients and caregivers. By creating tools for how and when to talk to cancer patients about palliative and hospice care (Figure 3), MOQC practices have seen hospice care enrollment improve from 44% in 2017 to 66% in 2024. In the words of a member physician,

“There is so much to help us do better at survival in cancer, and so many more new treatments out there, but the one thing that is often overlooked is – is it the right thing to do for the patient? So I was thrilled to see that MOQC is focusing on hospice. It’s so under looked in oncology these days.”

Figure 3. MOQC Hospice Conversation Guide for Physicians

An informational flyer titled "Hospice Conversations: Words That Make It Easier for Patients and Their Loved Ones" provides guidance on improving communication during hospice care.

A complimentary initiative, expanding palliative care access through a partnership with the Center to Advance Palliative Care (CAPC), provides training curriculum to advance practice providers (APPs) regarding primary palliative care, with intentional recruitment in areas of the state that have little-to-no palliative care currently. Those who complete the curriculum attain a certificate from CAPC and integrate primary palliative care into their ongoing care of patients and caregivers.

Patient quality of life is an important consideration in cancer care. To address nausea, a common side effect of chemotherapy that significantly impacts patients’ quality of life, MOQC launched a Chemotherapy-Induced Nausea and Vomiting (CINV) – Antiemetics initiative in 2020. The initiative works to increase prescribing of olanzapine to manage treatment-related nausea. Since the initiative began, prescribing of olanzapine has increased from 10% to the notable achievement of 60% in 2024, helping more patients have better treatment experiences. To help evaluate the impact of this effort, MOQC reached out to the Michigan Value Collaborative (MVC) to leverage its robust claims-based data. Together, MVC and MOQC evaluated the impact and value of this initiative in a 2023 impact and value assessment, and the two teams are in the process of refreshing that analysis with newer years of claims data.

Other initiatives include implementing a statewide gynecologic oncology virtual tumor board to support multidisciplinary learning, standardize care recommendations across practices, expand access to clinical trials, and expand perspectives for clinicians caring for patients throughout Michigan. MOQC helps optimize statewide treatment of advanced non-small cell lung cancer via an oncology stewardship initiative focused on improving biomarker testing across the state and increasing education around targeted therapies.

In addition to centering patient voices through POQC and many other MOQC accomplishments, a major achievement of MOQC is the development of a comprehensive Excellence in Quality Certification program that recognizes oncology practices providing high-quality and high-value care. Eligibility criteria include a site visit to ensure safe practices regarding anticancer therapy, measure performance, medical record review, and policy review. All criteria measure policy and practice to validate that oncology care is guideline-concordant and recognizes substantial decreases in variations in care and in costs of care (Figure 4). A key component of the certification is creating an action plan to close non-medical gaps in healthcare, ensuring all cancer patients in Michigan have the same access to high quality care. Fourteen out of MOQC’s 54 practices were certified in 2024, and 23 practices pursued certification in 2025.

Figure 4. MOQC Excellence in Quality Certification Criteria

A screenshot of a certification guideline document titled "MOQC Excellence in Quality Certification," outlining required elements for certification in oncology quality.

MOQC is proud of its commitment to addressing the non-medical needs of patients and caregivers through the POQC and the Excellence in Quality Certification program. Additional ways MOQC centers this aspect of patient care is by endeavoring to provide patients with increased access to supportive services and resources, including standardizing screening for non-medical needs, integrating referrals to Michigan 2-1-1 into electronic medical records (EMR), providing meals to patients who are currently food insecure and receiving anticancer therapy (plus up to one caregiver per patient), and facilitating financial navigation training for interprofessional members of oncology care teams. Non-medical patient needs and gaps in care are also being addressed through MOQC’s stewardship initiative, which aims to improve the use of systemic anticancer therapy with the goal of enhancing patient health outcomes while reducing financial strain on patients. In addition, MOQC conducts multivariate analyses of its measures annually to find gaps in care based on demographic categories. These analyses allow MOQC to review variation among practices and collaborate individually with them as needed to close gaps.

Looking Ahead: Continuing to Drive Whole Team Collaboration

MOQC’s work offers a reminder that improving oncology care often requires thinking beyond traditional approaches. By weaving patient and caregiver experiences into the fabric of their work, MOQC is able to look for gaps in care, prompt new questions, and reshape how they understand quality. MOQC’s initiatives and learning opportunities (such as interprofessional development sessions, the statewide tumor board, the palliative care certificate program, and addressing non-medical needs) are shaped with recognition that there is a whole team involved in the patient care related to MOQC’s quality measures. MOQC invites practices to engage with quality improvement in ways that expand perspective and challenge existing healthcare power dynamics. Through this multifaceted approach, MOQC is always striving to look for a deeper partnership with all of the people most affected by the outcomes.

The BCBSM-funded CQIs play a crucial role in driving healthcare quality improvement in Michigan. MVC is excited to continue highlighting the innovative contributions of individual CQIs and the ways in which MVC’s data are supporting high-value care initiatives across the portfolio. Please reach out to MVC by email if you are interested in learning more.

 

03 Dec 2025
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November Workgroups Highlight Mobile Health and Patient Storytelling

November Workgroups Highlight Mobile Health and Patient Storytelling

December 3, 2025 | Comments Closed | , , , , , , , , , , ,

In November, MVC hosted two virtual workgroup presentations – the first, a rural health workgroup, featured Hillsdale Hospital’s mobile health unit initiative. The second, a post-discharge follow-up workgroup, continued a presentation started at MVC’s February 2025 health in action workgroup on patient journey mapping and introduced a joint patient storytelling project by Healthy Behavior Optimization for Michigan (HBOM) and Michigan Cardiac Rehab Network (MiCR). The MVC Coordinating Center hosts workgroup presentations twice per month covering a variety of topics including post-discharge follow-up, sepsis, cardiac rehab, rural health, preoperative testing and health in action.

Rural Health Workgroup – Hillsdale Hospital 

The first workgroup of the month provided a review of Hillsdale Hospital’s mobile health unit, which aims to deliver essential health services to patients living in rural communities who may otherwise struggle physically or financially to reach traditional care settings.

As Lindsey Crouch, Director of Outpatient Clinics, Home Care, and Durable Medical Equipment for Hillsdale Hospital explained, rural communities face higher health outcome variation, transportation issues, limited accessibility to primary care providers, and high unnecessary emergency department (ED) utilization (Figure 1).

Figure 1. Hillsdale County Community Health Needs Assessment (CHNA) Survey Data: Difficulty Finding or Getting Transportation to a Doctor in 2024, 2022, 2019, and 2016

vertical bar graph: Hillsdale County Community Health Needs Assessment (CHNA) Survey Data: Difficulty Finding or Getting Transportation to a Doctor in 2024, 2022, 2019, and 2016

During the Covid-19 pandemic, Hillsdale County’s health department purchased a mobile health unit in an effort to close the gap in healthcare access for their community. However, despite continued need, utilization of the mobile unit has waned in recent years.

Hillsdale Hospital aimed to revitalize the mobile health unit to:

  1. Bridge access gaps in rural areas. For many rural residents, distance to hospitals or clinics, limited transportation, and infrastructure challenges can hinder timely access to care. A mobile health unit can bring services to patients rather than requiring patients to travel long distances. This helps to reduce one significant non-medical barrier to care.
  2. Focus on preventive and ongoing care. The mobile unit’s design supports not just acute care, but preventive services — screenings, check-ups, chronic disease management — especially helpful for rural populations that may have higher chronic disease burden and less frequent access to routine care.
  3. Address gaps in health outcomes between communities. By delivering care directly to underserved communities, this model aligns with broader efforts to ensure that where a person lives does not determine whether they receive high-value, quality healthcare.

Throughout this program, Hillsdale Hospital aimed to improve health outcome variation with a goal to achieve a 15% improvement in selected chronic disease metrics (e.g., blood pressure control) while also establishing partnerships with local organizations for sustainability.

Throughout the presentation and follow-up discussion, participants addressed several key considerations related to implementing and operating the mobile health unit including:

  • Logistical planning & scheduling. Which rural towns or areas will be served? How often do visits occur? How to communicate the schedule to residents to maximize utilization?
  • Service offerings. What mix of services beyond basic triage should be included? Considerations may include screenings, chronic disease management, preventive care, and referrals when needed to ensure the mobile unit meaningfully supplements local rural healthcare capacity.
  • Coordination with local providers. What existing local hospitals, clinics, and community health organizations should be involved to ensure continuity of care? Consider these, especially follow-up and referrals, for more advanced services.
  • Addressing rural-specific challenges. What unique barriers impact your community? Consider transportation, limited staffing, and supply chain constraints.

Hillsdale Hospital’s mobile health unit embodies a vision for bringing high-value, high-quality care to rural Michigan. By lowering access barriers and delivering preventive and ongoing services directly to patients in their communities, this initiative can help improve health outcomes, reduce reliance on emergency services, and foster trust in healthcare among rural residents.

Insights from this workgroup have several practical implications for other rural hospitals and provider organizations across Michigan:

  • Expansion is possible through mobile care. Rural hospitals can leverage mobile health units as an extension of their current clinical outreach, helping to connect with populations that may rarely visit brick-and-mortar facilities.
  • Support chronic disease management. By delivery of routine care and screenings, mobile units can help stabilize chronic conditions earlier, reducing acute exacerbations and potentially reducing avoidable ED visits.
  • Enhance care coordination. Partnering with mobile health teams and community resources can help coordinate follow-up appointments, testing, and specialty referrals to create a more continuous care experience for rural patients.
  • Advance population health goals. Mobile services can function as a tool within a hospital’s broader population health strategy, align with value-based initiatives, community health needs assessments, and provide the opportunity for all people to achieve optimal health goals.
  • Gather meaningful community insights. Regular presence in rural communities can help hospitals better understand local barriers, non-medical drivers of health, and other care gaps which may inform program planning, grant proposals, and collaborative partnerships.

MVC Rural Health Workgroup: Nov. 4, 2025

Post-Discharge Follow-Up Workgroup – MVC and HBOM

The second MVC workgroup of November featured a joint presentation by MVC’s Associate Program Manager, Jana Stewart, MPH and HBOM’s Informatics Design Lead, Noa Kim, MSI. The workgroup kicked off with an overview of the rationale behind placing a greater emphasis on post-discharge follow-up – particularly how timely and effective follow-up care can reduce readmissions, improve patient outcomes, and ease transitions from inpatient to outpatient or home settings.

Next, as a continuation of the February 2025  health in action workgroup presentation on patient journey mapping, Stewart showed how mapping can be used to highlight key moments in a coronary heart failure (CHF) patient’s journey where there may be opportunities for post-discharge care coordination improvement – e.g., medication reconciliation, patient knowledge, frequent rehospitalization, low follow-up rates, and lack of social and community support.

An important strategy for combating these challenges for CHF patients is engagement in cardiac rehabilitation. And yet, patients rarely optimize this opportunity. Patient storytelling can help patients recall details, model scenarios a patient may experience in the future, and reduce the burden of information provided during a visit and may be a strategy to optimize cardiac rehab enrollment.

Under the umbrella of Michigan Cardiac Rehab (MiCR), a collaboration between the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2), MVC, and HBOM, several initiatives have been developed aimed at optimizing guideline-directed medical therapy including the development of NewBeat materials and now the Heart-to-Heart storytelling campaign (Figure 2).

Figure 2. Examples of MiCR Guideline-Directed Medical Therapy Campaigns

NewBeat materials and the Heart-to-Heart storytelling campaign

As Kim explained, the goals of the Heart-to-Heart project are to collect diverse first-person accounts of cardiac rehab in video, audio, and photo formats from patients and clinicians from across Michigan to produce a compelling, free, reusable story library for use by cardiac rehab advocates across Michigan and beyond.

For hospitals and health systems across Michigan seeking to improve post-discharge outcomes, insights from this workgroup offer the following next steps:

  1. Use journey mapping and storytelling in quality improvement. By mapping patient journeys and capturing patient experiences, providers can better identify and address systemic barriers to safe discharge and recovery.
  2. Adopt standardized discharge-to-follow-up workflows. Hospitals should ensure that discharge planning includes scheduling follow-up appointments, medication reconciliation, and clear communication of next steps before patients leave the hospital.
  3. Prioritize high-risk patients for post-discharge support. Patients with chronic illness, limited social support, or social determinants that might hinder recovery deserve extra attention during discharge planning and follow-up scheduling.
  4. Assign care coordinators or navigators. Especially for high-risk or complex patients, dedicated staff to oversee follow-up care – manage appointments, support communication, track adherence, and offer resources – may reduce readmissions and improve outcomes.
  5. Leverage post-discharge care as part of value-based care strategy. Effective follow-up after discharge supports long-term patient health, reduces avoidable costs, and aligns with goals of high-value care frameworks.

MVC Post-Discharge Follow-Up Workgroup: Nov. 20, 2025

If you are interested in pursuing a healthcare quality improvement project, MVC has data specialists available to help you navigate our data resources and create custom analytics reports to support your efforts. Please reach out to us by email [LINK] if you would like to learn more about MVC data or engagement offerings!

05 Nov 2025
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October Workgroup Highlights Food FARMacy Program for Chronic Disease Management

October Workgroup Highlights Food FARMacy Program for Chronic Disease Management

November 5, 2025 | Comments Closed | , , , , ,

In October, MVC’s health in action workgroup featured Hurley Medical Center’s Amanda Escalera-Torres, RD, Director and Nutrition Specialist for their Food FARMacy program. The presentation shared how the program helps support patients with chronic diseases by providing healthy food and nutrition education. The MVC Coordinating Center hosts workgroup presentations twice per month, covering a variety of topics including post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. 

Health in Action Workgroup: Hurley Medical Center 

Hurley Medical Center’s Food FARMacy initiative was founded in 2017 to address Genesee County’s higher food insecurity rate of 13% (compared to the state average of 11%). It was funded by several grants and the Hurley Foundation to provide support services such as grocery access and nutrition education for Hurley patients. According to a 2024 MVC member survey, programs such as this are becoming more common in health systems across the state to address non-medical drivers of health such as food insecurity, economic and housing instability, and other factors. Food insecurity and being unable to access nutritious food has been linked to an increased risk of chronic diseases such as diabetes, cardiovascular disease, and certain types of cancer (Odoms-Young, 2024).  

Patient Eligibility and Enrollment 

Escalera-Torres shared that patients are eligible to enroll in the Hurley Food FARMacy program if they are both food-insecure and have a chronic diet-related condition (Figure 1). Patients are referred to the program through avenues such as Hurley Medical Center inpatient or outpatient services, community health clinics, or primary care clinics throughout Genesee County. Once enrolled, patients receive monthly grocery support, meal kits, and nutrition classes for up to six months (Figure 2). 

Figure 1.

vertical bar chart of predicted disease prevalence for adults in low-income households 2019-2022, source: USDA Economic Research Service

Figure 2.

Food FARMacy nutrition education classes and materials

Food Distribution Process 

Each month, Hurley’s Food FARMacy program provides 300–400 patients with food access and education. Groceries are acquired through established contracts with local farmers and vendors and include locally sourced fresh fruits, vegetables, grains, meat, and more.  

Program and Participant Success 

Hurley Food FARMacy expanded their food resources by increasing their farmer and vendor contracts to 11 this past year. This provides more accessibility for food and helps boost the local Michigan economy. The program also established 12 referral partnerships across Genesee County’s community health centers and primary care providers, allowing the program to serve over 5,500 individuals in the last year. Among the population served, only 5% of those who completed six or more Food FARMacy visits in the last year had an inpatient admission (Figure 3).  

Figure 3.

Food FARMacy program and participant successes

Reducing Barriers 

Following the presentation, Escalera-Torres answered questions about the ways the program has been able to reduce barriers to access, including how food supply was managed during the off-season and how they accommodated patients with transportation limitations. Escalera-Torres explained that the program did experience some difficulty acquiring fresh produce during the off-season but recently partnered with Great Lakes Farm to Freezer to ensure availability of a robust selection of nutritious foods year-round. To address patient transportation barriers, Hurley Food FARMacy partnered with Door Dash earlier in the year for a trial run of delivering food to participants. The program was well received but ended due to lack of continued funding. Patients with transportation barriers are now able to assign a proxy to pick up their groceries, which has helped reduce accessibility barriers.  

The Food FARMacy program will continue to adapt and serve Genesee County patients providing quality food and improving nutritional awareness for chronic diet-related illnesses.  

MVC's cardiac rehabilitation workgroup for October was rescheduled for February 2026. View the complete 2026 workgroup calendar here. 

MVC welcomes workgroup presenters from across Michigan to share their expertise, success stories, initiatives, and solution-focused ideas with MVC members. Please reach out to us by email if you are interested in being a workgroup presenter or submit a presentation proposal here. 

24 Sep 2025
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Fall Collaborative-Wide Meeting Agenda, Speakers Announced

Fall Collaborative-Wide Meeting Agenda, Speakers Announced

September 24, 2025 | Comments Closed | , , ,

The MVC Coordinating Center is excited to announce the agenda for its fall collaborative-wide meeting on Fri., Oct. 10, 2025, from 10 a.m. – 3 p.m., at the Vistatech Center in Livonia, MI. This meeting’s theme is “Adapting Together in 2025 and Beyond: High-Value Care for All in a Changing Landscape.” This meeting will highlight the various ways in which MVC's members identify gaps in outcomes, adapt to ensure all patients receive the highest quality care, and establish partnerships and programs that mitigate non-medical drivers of health outcomes. Those interested in attending MVC's fall 2025 collaborative-wide meeting must register here by Thurs., Sept. 25.

MVC Director Mark Bradshaw, MSc, will kick off the day with Coordinating Center updates as well as announcements about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program. This will be followed by updates about 2026 engagement offerings presented by MVC Engagement Manager Jessica Souva, MSN, RN, C-ONQS.

MVC will then invite its first guest speakers of the day to the podium: Julia Weinert, MPH, MSHIELD Program Manager, and Brad Iott, PhD, MPH, MSHIELD Content Expert in Health Informatics and Social Care Integration. The MSHIELD team will lay the foundation for the day by discussing non-medical drivers of health and related implications for quality improvement teams, including examples of metrics that help evaluate care across all patients and interventions that can help reduce gaps in patient outcomes.

The event keynote will follow with a presentation by Gloria Rey, PA-C, MPH, Director of Post-Acute Care, Henry Ford Health. She will present on Henry Ford’s post-acute care (PAC) transition program, and the ways in which their team partners with PAC groups to ensure effective, individualized handoffs and care delivery for all patients.

Following lunch and networking, MVC Medical Director Hari Nathan, MD, PhD, will co-present with MVC Analyst Kushbu Narender Singh, MDS, MPH, for MVC’s Data in Action presentation. This data presentation will focus on MVC’s newest health outcome variation measure, including how it was developed, its use cases and benefits, a timeline for related data sharing, and unblinded data. This measure was a new addition to the MVC Component of the BCBSM P4P Program, with scoring on this measure beginning in Program Years 2026-2027.

Attendees will then transition into the afternoon breakout sessions, all led by guest hospital presenters. To showcase how members are addressing variation in outcomes, MVC invited presenters to discuss recent initiatives and successes across a range of focus areas, such as partnerships with community-based organizations, systematic approaches to referrals, and predictive analytics and assessment tools in EPIC. View a summary of all five breakout presentations here. Attendees will attend two breakout sessions before returning to the main ballroom for closing remarks and next steps.

The deadline to register for MVC’s fall 2025 collaborative-wide meeting is tomorrow, Sept. 25. We look forward to seeing you there!

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 | Comments Closed | , , , , ,

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.

26 Mar 2025
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Overcoming Non-Medical Drivers of Health: A Success Story at Marshfield Medical Center-Dickinson

Overcoming Non-Medical Drivers of Health: A Success Story at Marshfield Medical Center-Dickinson

March 26, 2025 | Comments Closed | , , ,

In recent years, the pursuit of high-quality healthcare has pushed an increasing number of organizations to consider how tailored approaches can reduce variation in health outcomes, increase the value of care, and enhance patient experiences with the healthcare system. Reflecting this growing recognition, the Michigan Value Collaborative (MVC) surveyed its members in 2024 to better understand how members were identifying gaps in care and responding to non-medical drivers of health. With questions focused on data collection, strategic planning, and programming, MVC gleaned a wealth of impactful and innovative solutions already under way in hospitals across the state.

For the majority of the surveyed hospitals, the most common focus areas for programming were enhancing provider availabilitiy (i.e., telehealth, mobile units, and nontraditional clinic hours), improving access to reliable transportation, offering financial support, and providing translated materials. Although it is common for hospitals to have strategies in place in these areas, the specific approaches are often as varied as the communities they serve.

At Marshfield Medical Center-Dickinson, for example, one way they approach gaps in preventative care within the community is through dental care programming. Recent studies have established a clear link between oral health and overall health, underscoring the importance of proper dental hygiene as a preventive measure against serious health complications. According to the Mayo Clinic, poor oral health can lead to significant conditions such as endocarditis, cardiovascular disease, pregnancy complications, and pneumonia. Consequently, effective dental hygiene education and preventive care can provide substantial health benefits that extend well beyond oral health alone.

Recognizing the multifaceted benefits of accessible oral healthcare, Marshfield has partnered with Smiles on Wheels to offer monthly dental services—including cleanings, sealants, and fluoride treatments—at their primary care clinic, regardless of insurance. This initiative has been especially beneficial for young children and parents who face financial challenges related to transportation, and helps Marshfield to more effectively ensure high-value care for all patients. It also helps families avoid future costs associated with more complex treatments that may result from a lack of preventive care. The program has received positive feedback from the patient population, with many community members expressing their gratitude for the support it provides.

Figure 1. Smiles on Wheels provides dental care services to Marshfield Medical Center-Dickinson patients during wellness care visits.

photo: Smiles on Wheels providing dental care services to Marshfield Medical Center-Dickinson patient during wellness care visit

Photo courtesy of Marshfield Medical Center-Dickinson

Dr. Alexis Cirilli Whaley, MMC-D Pediatrician said, “We are fortunate to have Smiles on Wheels offering dental care to our local children, particularly for those families needing additional support due to economic stressors. The initiative allows for increased access to dental treatment, conveniently scheduled during wellness care visits."

By partnering with Smiles on Wheels, Marshfield Medical Center-Dickinson is leveraging existing resources to create a meaningful impact. This collaboration optimizes the use of available assets and showcases an effective strategy that harnesses the strengths of community partners. Stories like that of Marshfield Medical Center-Dickinson highlight the power of community partnerships in bridging known gaps in care and making a significant difference.

If your hospital or organization has an initiative they would like to share, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu – we would love to hear from you.