The Michigan Value Collaborative

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

Tag: collaboration (page 1 of 4)

Going National with The Michigan Model of Collaborative Quality Initiatives

Scott Regenbogen

Dr. Regenbogen is the MVC Co-Director

Over the last 10-plus years, the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships have grown to include, among other programs, 17 Collaborative Quality Initiatives (CQI). The clinical focus of the CQIs ranges from cardiology to spine surgery to radiation and many others. This “Michigan Model” of collaboration, pay-for-participation, and statewide, population-based quality improvement has yielded wide-ranging improvements, as reported several years ago.

Still, the regional collaboratives model has not spread widely beyond Michigan. Last month, at the inaugural summit of the Center of Excellence for Collaborative Quality Improvement, discussion focused on the challenges of securing financial support for regional collaboratives. Several other states—including Tennessee, South Carolina, Illinois, and Pennsylvania—have multi-hospital improvement initiatives around surgical care, but on a smaller scale than in Michigan. Like Michigan’s, all of these CQIs are supported by a regional Blue Cross Blue Shield insurer. In a commentary in this week’s JAMA Surgery, the leaders of the Michigan Surgical Quality Collaborative argue that an all-payer strategy, including investment from the Centers for Medicare and Medicaid Services (CMS), is needed in order to replicate the Michigan approach to care improvement.

To date, BCBSM has been the sole third-party funding source for the CQIs. Yet, the efforts of each collaborative have been payer-naïve—the benefits accrue to all patients regardless of their insurance coverage. In the Michigan Value Collaborative, we analyze payment data for individuals insured by both BSBSM and Medicare, and will soon expand to include Medicaid beneficiaries as well. And even in states like Michigan, where BCBSM handles quite a large portion of the commercial insurance market, CMS still remains the truly dominant payer, once we consider Medicare and Medicaid in all of their various forms.

This week’s JAMA Surgery Viewpoint considers how CMS could partner with private payers in support of regional collaboratives. Such a partnership could allow Michigan to become a model for the rest of the country. Under the new requirements for MACRA, physicians may satisfy reporting requirements through Qualified Clinical Data Registries. But what if active participation in a proactive CQI became a central part of all medical care in this country, and was supported by CMS? If this degree of dissemination could be achieved, CMS could catalyze innovative care delivery improvement on a far greater scale.

Combating Surgical Site Infections in Michigan: Joint Replacement Workgroup Recap and Hospital Initiatives

Deby Evans

Deb Evans is the MVC Site Engagement Manager

The Michigan Value Collaborative (MVC) and the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) held a recent workgroup focused on surgical site infections (SSI) related to joint replacement. Hospitals met to discuss some of the root causes for these infections and initiatives they have implemented to help reduce them.

Below is one of the presented slides that exhibits the proportion of readmissions due to SSI’s for MVC/MARCQI hospitals based on MVC claims data:

Although many of the hospitals have done extensive analysis and in-depth review of pre-, intra- and post-operative joint conditions, few specific root causes for surgical site infections have been identified.  However, major focus areas for hospital-led initiatives that have been identified are:

  • Improving the general health of the patient especially in terms of reducing the body mass index (BMI);
  • Improving hemoglobin A1C for diabetics;
  • Improving albumin levels; and
  • Tobacco cessation

One hospital recently began an initiative aimed at helping patients become healthier and ultimately maintain an optimal weight for joint-replacement surgery. Referrals for the program come from surgeons prior to the surgery. The initiative includes a weight loss clinic and classes, which offers a refund of the cost of the program if the patient is successful in losing weight before surgery.

Most hospitals are following the Joint Commission recommendations from the Surgical Infection project (SIP) and the Surgical Care Improvement Project (SCIP). However, there are some differences in the identification and treatment of staphylococcus aureus carriers with some hospitals universally treating all joint replacement candidates and some only treating those identified as carriers through a nasal swab.  Although this workgroup only focused on SSIs related to elective joint replacement, it was mentioned that some hospitals are treating their trauma cases for staphylococcus aureus as well, while others are looking at this potential.

Other topics that prompted discussion among the group were wound closure and whether different types of closure affected SSI rates along with the type of dressing being used and the length of time the dressing stayed intact over the wound. There was some variety among surgeons and hospitals, however many are using a moisture-impervious silver based dressing that remains on for about seven days. Despite what may be considered a more expensive dressing being used the benefits of keeping the wound covered and out of contact with potentially infectious elements, i.e. pets, clothes, bed linen etc. outweigh these added costs.  In addition, when comparisons were made between these dressings and changing a dressing daily the difference in cost was negligible.

Finally, patient education was a major talking point during the workgroup. All hospitals agreed that having the patient’s cooperation is a significant factor in reducing SSI. Some hospitals have produced videos for patient viewing pre-operatively while others have an educational sheet that they provide to the patient before the surgery. Some discussion focused on the amount of information that the patients are expected to retain and ways hospitals are sharing reminders using booklets, pamphlets, a coach that is known to the patient or being seen by a discharge planner.

The Coordinating Center has put together a pre-, intra and post-operative check list of things to consider to potentially help reduce SSI, as well as a hygiene at home sheet for patients. These can be found in the resource tab on the registry along with information from our other workgroups.

If you have identified any specific root causes or have a new initiative aimed at reducing surgical site infections, then we would love to hear from you. Please contact Deb Evans (debevans@med.umich.edu) or Abeer Yassine (abeery@med.umich.edu) to share your story.  Preference

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