The Michigan Value Collaborative

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

Tag: SNF (page 1 of 3)

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, contact Pamela James,  the Project Manager at or contact the MVC Coordinating Center through Abeer Yassine ( ) or Deb Evans (

BCBSM Collaborative Helps Improve Joint Replacement Initiatives and Patient Outcomes in Michigan

Rochelle Igrisan

Rochelle Igrisan, MBA, MSN, RN is MARCQI’s Senior Project Manager.

Established in 2012, The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI), essentially focuses on hip and knee procedures, such as joint replacements and revisions of those procedures. MARCQI currently works with 60 member hospitals using clinical data to track the progress of these hospitals in improving patient outcomes related to joint surgery. Several of the quality initiatives initiated by MARCQI and utilized at participating hospitals have proven to be valuable and successful at improving patient outcomes while also reducing costs.

Optimize Use of Blood Transfusions Post Joint Replacement

By disseminating data on usage, sharing and promoting the American Red Cross (ARC) Guidelines for blood transfusions, and reviewing best practices regarding the standard for blood transfusions after joint replacement surgery MARCQI recognized the use of transfusions as an area to address among their member hospitals. The ARC guidelines suggest:

  1. Providing blood transfusions post joint replacement (unilateral) if the patient’s hemoglobin level is less than eight; and
  2. Only transfusing one unit of blood at a time and then testing the patient’s hemoglobin levels again to assess further treatment.

Following implementation of these guidelines, MARCQI member hospitals the use of blood transfusions after joint replacement decreased from 9.8% to 2.6%. This best practice has not only helped improve patient care by providing an appropriate and necessary amount of care for the patient, but has also helped reduce costs for hospitals. It has also reduced blood utilization throughout the state of Michigan allowing this precious commodity to be available for other occasions.

Improving Patient Care and Self-Management Post Joint Replacement

A second initiative MARCQI participants worked on has been geared towards decreasing the inappropriate use of skilled nursing facilities after joint replacement surgery. The majority of joint replacement patients have better post-operative outcomes if they are sent home. Thus, hospitals provided patients with guidance on how to better self-manage their condition post joint replacement. Prior to implementation of this quality initiative, about 33 to 50 percent of patients went to a nursing home following joint replacement surgery. However, after working on this initiative, only about 15 percent of patients are sent to nursing homes post joint replacement.

Other initiatives MARCQI is working on are better understanding of pain management post joint replacement, and reducing surgical site infections in post joint replacement candidates. Overall, the different quality initiatives that MARCQI has worked on has helped improve patient outcomes and save hospitals millions of dollars. In 2014-2015, MARCQI member hospitals saw a shared cost savings of $3,453,424. This cost savings goes hand in hand with helping improve patient experience and quality of care related to joint replacement surgery.

To promote hospital and CQI collaboration, MVC and MARCQI work on a Joint Replacement Workgroup together. If you are interested in learning more about MARCQI or the Joint Replacement Workgroup, please contact Deby (, Abeer ( or Rochelle Igrisan from MARCQI (

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