The Michigan Value Collaborative

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

Tag: CQI

How to integrate episode cost data with quality improvement: A story from McLaren Greater Lansing

Maya Peters is a Research Associate with the Michigan Value Collaborative.

As part of the MVC site visit team journeying across Michigan this year, one question I’ve heard from many hospitals is this: How do we integrate the clinical outcomes data from our other Blue Cross CQIs with the episode cost data provided by MVC?  Luckily, a few weeks ago we visited McLaren Greater Lansing, where we discovered a team working on a project that helps answer that question. 

Andrew Syrek, a Patient Advocate and Quality Data Specialist, and Jorgieann Stoneham, a Clinical Data Abstractor for the Michigan Surgical Quality Collaborative (MSQC), are working on a new pre-habilitation project for their colectomy patients.  This project was informed by episode cost data from MVC along with clinical outcomes data from MSQC.  I immediately thought this would be a great example for the rest of the collaborative, so I asked to speak with Andrew and Jorgieann again after our site visit.

How it began

The collaboration began last year, when Andrew discovered on the MVC registry that McLaren Lansing’s readmissions for colectomy patients were high when compared to the MVC average. He told me that he first noticed this as an improvement opportunity on the “Key Insights” report page.

The next step for Andrew was to connect with Jorgieann, because he knew that she worked with MSQC and might have some insight on these colectomy patients.  At McLaren Lansing, the quality department holds monthly meetings in which everyone touches base and shares what they’ve been working on.  These monthly meetings allowed Andrew reach out to Jorgieann directly, as he already had an idea of what she worked on.  As it turned out, Jorgieann had been looking specifically at McLaren Greater Lansing’s colectomy patients as part of her work with MSQC.

What they did

After Andrew and Jorgieann discovered their shared interest in reducing readmissions for colectomy patients, they began to put together a care improvement plan.  Andrew showed Jorgieann the readmissions data from the MVC registry, which at that point had 2012 and 2013 data. He then went into their electronic medical record, Premier, and pulled more recent reports on colectomy readmissions.  Jorgieann compared the patients that Andrew had pulled to her own data she had abstracted for MSQC, and was able to take a close look at each patient’s case to try and determine what may have led to their readmission.  Through these analyses, they were able to identify a possible driver of readmissions: A lack of education prior to and throughout each patient’s hospital stay.

To address this problem, Jorgieann came up with the idea of providing patients with a pre-habilitation kit.  These kits contain educational materials instructing patients what to do prior to surgery, as well as what to expect after their surgery.  They also receive an incentive spirometer, antibacterial soap, mouthwash and a pedometer to help each patient be as well prepared as possible for surgery.  Jorgieann said that her kits help to “empower patients to take an active role in their care” and gives them realistic goals for after surgery.

The pre-habilitation project officially began on February 1st, 2016, and Jorgieann will be doing 30 day follow-ups with each patient.  There isn’t any data to share yet, but Jorgieann and Andrew are looking forward to tracking each patient’s outcome, as well as tracking McLaren Greater Lansing’s colectomy episode cost on the MVC registry.  I will be reconnecting with them later this year.

Recommendations

Lastly, I asked Andrew and Jorgieann about what this experience had taught them, and what advice they had for others.  Andrew recommended using the MVC registry to see an overview of potential cost savings opportunities at your hospital, and then digging in deeper to these opportunities with the relevant CQI representative at your hospital.  Jorgieann added that it’s helpful to have the cost data along with the clinical outcomes data to show to surgeons; it is stronger and more believable this way.

They also stressed the importance of the monthly quality department meetings at McLaren Lansing.  For Andrew and Jorgieann, these meetings help to foster collaboration through increasing awareness of what others in your organization are working on, as well as helping to create connections across departments and projects.

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Questions or comments?  We’d love to hear from you.  You can comment on this article, or use the form at the bottom of the page.

MVC is different: How we compare to the other Blue Cross-funded CQIs

Andrea McVeigh is the Project Manager of MVC.

As the Project Manager of the Michigan Value Collaborative (MVC), one of my favorite things is on-boarding a new hospital, site coordinator or champion, and getting to know each of them. One of the most common questions I hear during this process is, “How does MVC compare to the other Blue Cross Blue Shield Michigan (BCBSM)-funded Collaborative Quality Initiatives (CQIs)?” If this isn’t asked early on, I make sure to point out the similarities and differences, because it’s important to understand how MVC fits into the Value Partnerships program at Blue Cross. In this article, I’ll first describe the differences and then the similarities between MVC and the other Blue Cross-funded CQIs.

How is MVC different from the other BCBSM-funded CQIs?

  1. MVC focuses on improving and optimizing cost-efficiency and care transitions around episodes of hospitalizations. To date, we are the only CQI that includes cost data.
  2. MVC examines a wide array of clinical conditions: We examine 25+ clinical service lines, ranging from medical conditions (like congestive heart failure and pneumonia) to surgical procedures (like heart valve replacement surgery or total hip replacement surgery). The other Blue Cross-funded CQIs are centered on a specific clinical condition.
  3. MVC uses pre-existing claims data to inform and initiate change: We use claims data to define our episodes of care. Other CQIs collect their own data from patient records. In MVC, the data are already collected and we require no chart abstraction.
  4. MVC engages hospital executives and leaders, in addition to clinicians: Other Blue Cross-funded CQIs engage mostly with clinicians. Their meetings are attended mostly by doctors, physician assistants and nurses. Because of the nature of our data and the fact that they include cost and utilization information, our meetings are attended mostly by Chief Medical Officers, Chief Executive Officers, Chief Financial officers and Directors of Quality.  

How is MVC similar to the other BCBSM-funded CQIs?

The CQIs have an obvious similarity, which is that we are all funded by BCBSM and are part of their Value Partnerships program.   But other than our funding source, what else makes us similar to each other? Well, there’s an intangible quality that we all possess, a certain “je ne sais quoi”. For the last ten years, I have been working solely on Blue Cross-funded CQIs. So I guess you could say I’ve been around for a little while. What I’ve learned in the last decade is that the Blue Cross CQIs are alike because we all possess the essential ingredients necessary for running successful statewide collaborative quality initiatives.  

  1. Our sponsor and partner, Blue Cross Blue Shield of Michigan: The support the Blues provide is exceptional. Their financial support is what makes all of this possible and without it, none of the CQIs would exist. Their support is so much more than financial, though. Their partnership, constant engagement and innovative vision keep us all humming along and pointed in the right direction. Our leader at Blue Cross, Dr. David Share (who serves as Sr. VP of Value Partnerships) was named by Crain’s Detroit Business as a Health Care Hero for the work he has done to transform Michigan’s health care system. Blue Cross’s Value Partnerships Program has won numerous national awards for their cost-savings and improvements to patient care (http://www.valuepartnerships.com/vp-award/). Since we live in Michigan, it’s easy to forget that for the rest of the country, this is not the norm. Other states don’t have payers who are as devoted to developing and continuously supporting statewide collaborative work as Blue Cross of Michigan is.  
  2. Engaged hospitals across the state. When you stop and think about what the CQIs ask of hospitals, it’s quite astounding. We more or less ask Michigan hospitals to look at data we provide them, ask themselves why they’re performing above or below the state average and, if they’re willing, open up their doors and share their best practices with their competitors. It’s this collaboration that drives improvement. Without the buy-in, participation and continued engagement from hospitals, any CQI surely would fail.
  3. Unbelievably talented Directors of the CQIs: Each of the Blue Cross-funded CQIs has a Director who, along with the rest of the Coordinating Center, leads the charge and manages the project. The type of talent to which I’m referring is more than just the necessary brainpower and discipline to get the job done; it’s the ability to earn the trust and respect of all of the hospitals across the state.

And there you have it: a quick run-down of how MVC compares to the other Blue-Cross funded CQIs. Even though MVC uses claims data and cuts across multiple specialties, we still need the same 3 essential ingredients to thrive.

Questions or comments?  We’d love to hear from you.  You can comment on this article, or use the form at the bottom of this page.