The Michigan Value Collaborative

Helping Michigan hospitals achieve their best possible patient outcomes at the lowest reasonable cost

Tag: AMI (page 1 of 2)

Transitions of Care Enhanced by I-MPACT, a BCBSM CQI

Pam James

Pam James, MS is the I-MPACT Program Manager

The Integrated Michigan Patient Centered Alliance in Care Transitions Collaborative (I-MPACT) is a Blue Cross Blue Shield Value Partnership collaborative quality initiative (CQI) which was established in 2015 and formally launched with an inaugural kick-off for cohort one in April 2016. This CQI has several aspects that make its approach to quality improvement unique. Hospitals and physician organizations (PO) are required to partner with each other to better coordinate care and ultimately improve patient outcomes and experiences; that partnership is called a “cluster”. Another unique feature of I-MPACT is the incorporation of patient or caregiver advisors on each cluster team. These patient advisors are an integral part of the team and, to encourage continued participation and ensure the patient’s voice is heard, the clusters have to provide information to I-MPACT how the patients are integrated into and utilized on any projects or initiatives. Lastly, each cluster is evaluated as one entity for the Pay for Performance Index (P4P) to encourage collaboration, equity and inclusion between them. The entire cluster, both hospitals and POs, can earn additional dollars based on their cluster’s score on the P4P.

The ultimate goal for I-MPACT is to help improve care transitions for patients. I-MPACT strives to accomplish this goal by focusing on three key areas:

  1. Increasing the frequency with which patients are seen by a provider within 7 days of discharge,
  2. Working on reducing readmissions,
  3. Working on reducing Emergency Department visits.

I-MPACT currently has 20 hospital and PO clusters which are divided into 4 groups or cohorts. Data extraction centers around key documents in the care transition process including the discharge summary, patient summary/after visit summary and the admitting history and physical. The goal is to understand more about processes and communication during the care transition and gain a better understanding of where gaps and challenges are occurring.

I-MPACT focuses on five specific patient populations which were strategically chosen to align with other collaboratives and Center for Medicare & Medicaid Services (CMS) initiatives. The five conditions are:

  1. Acute Myocardial Infarction (AMI),
  2. Congestive Heart Failure (CHF),
  3. Pneumonia,
  4. Chronic Obstructive Pulmonary Disease (COPD),
  5. Patients transitioning from hospital to a skilled nursing facility (SNF).

I-MPACT helps their members understand the care transition process, especially from a patient perspective by performing an on-site observation of a patient’s discharge process and mapping the data gathered in a document called “the patient journey”.

Upon joining I-MPACT each new cluster, along with their patient advisors, attend a day long kick off where they work through mapping out a transition process, identifying gaps and challenges in their organizations’ care transitions and brain storming interventions aimed at addressing those gaps and challenges.

If you would like more information about I-MPACT check out their website at http://www.impactcqi.org/, contact Pamela James,  the Project Manager at  I-MPACTCC@med.umich.edu or contact the MVC Coordinating Center through Abeer Yassine (abeery@med.umich.edu ) or Deb Evans (debevans@med.umich.edu)

Value and quality improvement with multipronged strategies

John Hollingsworth

John Hollingsworth M.D. is a urologist at Michigan Medicine and the Director of Population Based Measures for MVC

Members of the MVC Data Coordinating Center recently published findings from a study evaluating whether a hospital’s participation in voluntary value-based reforms was associated with greater improvement under Medicare’s Hospital Readmission Reduction Program (HRRP).

The authors analyzed data from Hospital Compare on readmissions for over 2800 hospitals between 2008 and 2015. They assessed hospital participation in Meaningful Use (MU) of Electronic Health Records, the Bundled Payment for Care Initiative (BPCI), and Medicare’s Pioneer and Shared Savings accountable care organization (ACO) programs.

They found that at nonparticipating hospitals, the association between the HRRP and 30-day readmissions was -0.76 percentage points for patients hospitalized with acute myocardial infarction (AMI). Participation in MU alone was associated with an additional change in 30-day readmissions of -0.78 percentage points for AMI. Participation in ACO programs alone was associated with an additional change in 30-day readmission of -.094 percentage points for AMI. Participation in multiple reforms led to even greater improvement  (-1.27 percentage points for AMI).

Collectively, these findings support Medicare’s multipronged strategy for improving hospital quality and value.

The article summarizes these results appeared in the April 10th issue of JAMA Internal Medicine (available at: http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2617280).

 

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