The Michigan Value Collaborative

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

Tag: Michigan (page 1 of 3)

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.

How Michigan can be the best in CHF readmissions

Deby Evans

Deb Evans is the MVC Site Engagement Manager

Last November, the Michigan Value Collaborative (MVC) launched its goal to work together to be number one in the country for CHF readmissions. MVC hospitals have shared best practices and challenges with one another through workgroups, toolkits and blogs to collaboratively meet this goal.  In addition to learning from one another, there is information to be gained in how hospitals outside of Michigan are addressing readmissions.

A report from the Commonwealth Fund titled “Reducing Hospital Readmissions: Lessons from Top-Performing Hospitals” identified quality improvement strategies implemented with measurable impacts on reducing readmissions. One of the hospitals studied is in Utah, which currently has the lowest CHF readmission rate in the nation according to CMS Hospital Compare.  According to the study, successful quality improvement strategies included incorporating evidence-based practice into daily protocols, standardizing procedures along with information gathering, providing feedback and supporting clinical decisions through electronic information systems.

Specific initiatives underway include:

Providing clinically excellent patient care with a focus on patient safety. Doing this leads to a fall in readmission rates, improvement in quality measures and savings are realized as a byproduct.

Using information technologies as tools that improve quality, integrate care and ease patient transitions.

Early involvement of case management and discharge planning.

Targeting high risk patients and ensuring frequent communication across the whole care team.

Teaching patients and families how to manage their conditions.

Maintaining a life-line with high risk patients after discharge.

Aligning the efforts of hospital and community providers to ease transitions across care settings.

The authors noted that hospital environments played a role in each facility’s ability to reduce admissions. Specifically, the success of the initiatives were influenced by policy environment, local health care markets, association with an integrated health system and the priorities set by hospital leaders.

Many of the programs implemented by the top performing hospitals are similar to initiatives discussed by the MVC CHF readmission workgroup. For more information on the workgroup or toolkit, please contact Deby (debevans@med.umich.edu ) or Abeer (abeery@med.umich.edu ).

Read the full article here http://www.emergingrnleader.com/wp-content/uploads/2012/08/1473_SilowCarroll_readmissions_synthesis_web_version2.pdf

 

 

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