Over the past several years, the Michigan Value Collaborative (MVC) has partnered with clinical quality collaboratives across the state to better understand how improvements in care delivery translate into value—for patients, providers, and payers alike. By pairing robust clinical data with claims-based cost and utilization data, these partnerships allow us to move beyond reporting improvement to quantifying its real-world impact.
The MVC Coordinating Center is excited to announce the completion of two new impact and value assessments conducted in partnership with the Michigan Spine Surgery Improvement Collaborative (MSSIC). These analyses examined statewide improvements in postoperative urinary retention (POUR) complications and surgical site infections (SSI) following spine surgery.
Although focused on different complications, both assessments followed a shared framework: pairing MSSIC’s clinically abstracted registry data with MVC’s claims-based episode data to quantify the impact of declining complication rates on episode-level spending and utilization.
Background and Approach
MSSIC has led statewide efforts to reduce preventable surgical complications following spine surgery through surgeon engagement, performance feedback, alignment of incentive-based measures, and implementation of evidence-informed practice changes. Over time, MSSIC-participating hospitals demonstrated measurable declines in both urinary retention and surgical site infections.
To assess the value implications of these improvements, MSSIC provided MVC with a dataset of lumbar and cervical spine patients that included the presence or absence of complications as abstracted from medical records. Spine patients were matched to MVC’s analytic tables and spine cohort for Medicare Fee-For-Service (FFS), Medicaid, Blue Cross Blue Shield of Michigan (BCBSM) Commercial, BCBSM Medicare Advantage (MA), Blue Care Network (BCN) Commercial, and BCN MA claims. MVC then evaluated the matched population for readmission status and price-standardized facility payments associated with POUR and SSI. MVC and MSSIC used the rates of adverse events pre- and post-QI to estimate the number of events averted. MVC payment data was then used to calculate cost savings from averted events.
Postoperative Urinary Retention (POUR)
While postoperative urinary retention may not always be perceived as a high-cost complication, the analysis demonstrated that it is associated with meaningful differences in episode spending and utilization. Episodes involving POUR were linked to higher total payments and greater downstream healthcare use compared to episodes without urinary retention.
The analysis conducted revealed that there were statistically significant reductions in the rates of POUR and readmissions between 2016-2024 from which to estimate cost savings. Specific to POUR, MVC and MSSIC estimated there were 5,197 POUR events averted. Using the MVC-based estimate of 21.7% of POUR events also involving readmission, MVC and MSSIC estimated there were 1,128 readmissions averted.
To estimate cost savings from averted POUR events, MVC completed a comparative analysis of diagnosis-related group (DRG) and post-discharge payments among lumbar and cervical spine patients with no POUR compared to those with POUR events. The results of the analysis of higher inpatient DRG payments (Figure 1) show that the weighted average DRG payments for patients without POUR were $25,743.40; the weighted average payments for those with POUR was $27,603.20, a difference of $1,859.80 per patient. Looking at post-discharge payments (Figure 2), MVC found that the average payment for a patient without POUR was $1,691. The weighted average payment for those with POUR (21.7% with readmission and 78.3% without readmission) was $12,684.65, a difference of $10,993.65 between patients with and without POUR.
Figure 1. Calculation of Additional Inpatient Diagnosis-Related Group (DRG) Payments Based on Complications and Comorbidities (CC) by POUR Status
Figure 2. Calculation of Post-Discharge Price-Standardized Payments Associated with POUR
This amounted to an estimated total direct cost savings to payors of $66,799,380 from POUR rate reductions. On this finding, Senior MSSIC QI Lead Kari Jarabek, BSN, RN, said, “The analyses here show how decreasing rates of what some may consider to be a ‘minor complication’ of surgery can have profound consequences in terms of cost savings for patients, employers, and other payers.”
View the complete summary of the December 2025 MSSIC urinary retention assessment on MVC’s CQI collaboration page [LINK].
Surgical Site Infections (SSI)
The association between surgical site infections and higher costs is well established, and the MVC–MSSIC assessment reinforces this relationship within Michigan hospitals. Episodes complicated by SSI were associated with significantly higher total episode payments and increased post-discharge utilization.
The analysis revealed statistically significant reductions in the rates of SSI and readmissions from the 2019 baseline year to the 2020-2024 post-intervention period. MVC and MSSIC estimated 301 SSI events were averted. Using the MVC-based estimate of 62.6% of SSI events also involving readmission, MVC and MSSIC estimated that 188 readmissions were averted.
To estimate cost savings from averted SSI events, MVC completed a comparative analysis of diagnosis-related group (DRG) and post-discharge payments among patients with no SSI compared to those with SSI events. The results of the analysis of higher inpatient DRG payments (Figure 3) showed that weighted average DRG payments for patients without SSI were $25,823; the weighted average payments for those with SSI was $26,483, a difference of $660 per patient. Looking at post-discharge payments (Figure 4), MVC found that the average payment for a patient without SSI was $1,801. The weighted average payment for those with SSI (62.6% with readmission and 37.4% without readmission) was $23,274, a difference of $21,473 between patients with SSI and those without. This amounted to an estimated total direct cost savings to payors of $6,662,033 from SSI rate reductions.
Figure 3. Calculation of Additional Inpatient Diagnosis-Related Group (DRG) Payments Based on Complications and Comorbidities (CC) by SSI Status
Figure 4. Calculation of Post-Discharge Outpatient Payments Associated with SSI
View the complete summary of the December 2025 MSSIC SSI assessment on MVC’s CQI collaboration page [LINK].
Advancing Value Through Collaboration
Taken together, these two assessments demonstrated that MSSIC efforts delivered significant net savings for its BCBSM sponsor and healthcare providers in Michigan, and that targeted practice changes—such as early ambulation and updates to existing protocols to reflect best practices—not only improved patient recovery but also contributed to improved value at the episode level.
These two assessments also demonstrated a consistent pattern: fewer complications were associated with lower episode spending and reduced downstream utilization. By linking clinical registry data with claims-based cost analysis, MVC and MSSIC were able to move beyond reporting improvements in complications to quantifying its broader impact.
As MVC continues its partnerships with the BCBSM Value Partnership CQIs, this work provides a replicable model for understanding how collaborative clinical improvement translates into measurable value for patients and the healthcare system.