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MVC Shares New COPD Report with Physician Organizations

MVC Shares New COPD Report with Physician Organizations

This week the Michigan Value Collaborative (MVC) introduced a new push report for its physician organization (PO) members focused on chronic obstructive pulmonary disease (COPD), providing a tailored version for each of MVC’s 40 PO members. This new push report was created in response to member interest in improving the quality of care for chronic diseases. It utilized 30-day claims-based COPD episodes from Medicare Fee-For-Service, Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial, and BCBSM Medicare Advantage with index admissions from 1/1/19 to 6/30/21.

One feature the MVC Coordinating Center is excited to highlight is the inclusion of 30-day readmission rates by major comorbidity categories for COPD. Rates were assessed for a PO’s attributed COPD patients overall as well as for attributed patients with congestive heart failure, diabetes, and vascular disease (see Figure 1). These comorbidities are assessed using diagnosis codes on claims in the six months prior to the patient’s index hospitalization.

Figure 1.

Also featured in this report were 90-day rates of pulmonary rehabilitation utilization following COPD index hospitalizations. This is the first time MVC has included a measure of pulmonary rehabilitation utilization in a collaborative-wide report, and the Coordinating Center hopes that this metric will encourage increased use of this important program across Michigan. Across all COPD episodes in the report, the collaborative-wide rate of pulmonary rehabilitation for PO-attributed patients was 2.7% (see Figure 2).

Figure 2.

Due to the low collaborative-wide rate, the Coordinating Center assessed 90-day utilization of pulmonary rehabilitation rather than 30-day utilization. However, the American Thoracic Society recommends the initialization of pulmonary rehabilitation within three weeks following hospitalization. Click here to learn more about American Thoracic Society recommendations for pulmonary rehabilitation and other care following COPD hospitalization.

Each PO’s complete report also includes figures illustrating average price-standardized risk-adjusted 30-day total episode payments, average index hospitalization length of stay, trends in readmission rates, rates and payments of post-acute care utilization, rates of outpatient follow-up, and patient population demographics. A patient population snapshot table details several demographic variables, including a variable based on data from the Economic Innovation Group’s Distressed Communities Index (DCI). It identifies the proportion of patients living in an “at-risk” or “distressed” zip code across all payers (see Figure 3). The DCI is derived from the U.S. Census Bureau’s Business Patterns and American Community Survey.

Figure 3.

A second table provides information on index hospital locations of care for the PO’s attributed patients, comparing the percent of patients treated at each site as well as each index hospital’s average 30-day total episode payment.

The COPD PO report is also being shared with members of the newly established lung care Collaborative Quality Initiative, commonly referred to as INHALE (Inspiring Health Advances in Lung Care). INHALE focuses on patients with asthma and COPD. They disseminate strategies to improve outcomes in these patient populations and reduce the costs associated with asthma/COPD care.

MVC also partnered with a fellow Collaborative Quality Initiative to provide POs with a provider resource that may be relevant to their work with COPD patients. The Healthy Behavior Optimization for Michigan (HBOM) team provided its Quit Smoking Resource Guide to send alongside MVC’s report. HBOM aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful. Read more about HBOM’s materials and efforts on the HBOM website or in MVC’s May spotlight blog.

If you have any suggestions on how these reports can be improved or the data made more actionable, the Coordinating Center would love to hear from you. MVC is also seeking feedback on how collaborative members are using this information in their quality improvement projects. Please reach out at Michigan-Value-Collaborative@med.umich.edu.


New Report on Colectomy Distributed to Member POs

The Michigan Value Collaborative introduced its first colectomy physician organization (PO) report this week. A colectomy is the surgical removal of a section of the large intestine (colon) or bowel and is performed to treat diseases of the bowel (i.e., Crohn’s disease, ulcerative colitis, and colon cancer).

The report incorporated administrative claims of attributed members from 1/1/19 – 12/31/20 for Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial and BCBSM Medicare Advantage, and 1/1/19 – 9/30/20 for Medicare Fee-for-Service. Reports were created for all POs that currently participate in MVC and had at least 11 colectomies per year in both 2019 and 2020.

There were significant differences in the anticipated clinical course and the likelihood of complications between elective (planned) and emergent colectomy. Therefore, MVC provided a stratified summary of planned versus emergent colectomies (Figure 1), and some metrics in the report were stratified by planned and emergent status to highlight when there was an emergency department revenue code on the episode. For example, there were notable differences in post-acute care utilization between planned and emergent colectomies (Figures 2 & 3).

Figure 1. PO A Colectomy Report Table

Figure 2. PO A Risk-Adjusted Payments: Planned Colectomies

Figure 3. PO A Risk-Adjusted Payments: Emergent Colectomies

In an effort to provide valuable data to MVC POs, the Coordinating Center continually meets with key stakeholders, BCBSM, and PO members to drive MVC PO report development. The contents of this report were developed based on that feedback. For example, this report allowed POs to individually compare their organization to new comparison groups.

The comparison groups in the new colectomy report include:

  • All MVC POs
  • EMPLOYED VS. INDEPENDENT POs: As defined in the BCBSM Physician Group Incentive Program (PGIP) 2021 physician list, POs with greater than 50% of their aligned providers employed by a health system are considered employed, and those with less than 50% are considered independent.
  • PO SIZE: These groups were based on the number of attributed members at each PO (Figure 4). Member POs would see the PO size comparison group in which they belong so they can compare their performance to other POs of a similar size.

Figure 4. PO Size Grouping

Other components included in the report were a list of the top 10 facilities where a PO’s attributed patients had a colectomy performed, the five most common comorbidities among attributed colectomy patients, median length of stay, 30-day risk-adjusted total episode payment, 30-day readmission rate, and the utilization rate for post-acute care services (emergency department, skilled nursing facility, and home health). General findings included that diabetes was the most common comorbidity across all colectomies (planned and emergent) performed at POs and was frequently one of the top two comorbidities for individual POs. In addition, home health services had the greatest variation in post-acute care utilization (see Figure 5).

Figure 5. PO A Home Health Utilization Rate

By understanding the needs of MVC PO members regarding present and future patient care improvement activities, MVC will be better able to improve future PO reports. If you are interested in sharing feedback about these new PO reports, have any specific PO analytic requests, are undergoing new PO improvement initiatives, and/or would like more information about MVC, please reach out to the Coordinating Center at michiganvaluecollaborative@gmail.com.