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

Collaborating with all important stakeholders in fostering high-value healthcare in Michigan

Making Dollars and Sense out of MSQC Reports: A Partnership with the Michigan Value Collaborative

October 10, 2019

John Syrjamaki, MPHManager, Data Analytics

What is the Michigan Value Collaborative?

• Collaborative quality initiative– Established 2013– Funded by BCBSM

• Coalition of 87 hospitals– Hospital quality leaders– Coordinating Center at

University of Michigan

• Now involves 31 physician organizations

How does MVC work?

• Data Analytics• CQI collaborations• Peer-to-peer best

practice sharing

Pending data sources:Adjudicated data:

MVC Data Sources

• Medicare FFS: 1.9 million• BCBSM PPO: 3.5 million• Blue Care Network (BCN): 800K• BCBSM Medicare Advantage PPO: 300K• BCN Medicare Advantage HMO:100K• Michigan Medicaid (pending): 1.8 million

MVC data sources will comprise >80% of Michigan’s insured population

What does MVC measure?

Index Admission ReadmissionProfessional

ServicesPost-acute

Care

30 & 90-day episodes for 33 medical & surgical conditions

How do we define clinical episodes?

Concept • Clinically-designed cohorts• Homogenous patient groups

Goal • Face validity for front-line providers• Comparability across hospitals

Method• Clinical experts identify codes for:

− Inclusion/exclusion− Condition-specific risk adjustment

How do we estimate episode payments?

Risk-AdjustPrice

Standardize*

Individual Payments

Episode Payment

Final payments represent utilization, not actual dollars

*Prices assigned from standard CMS fee schedule

Price standardization accounts for:

1. Contractual differences between payer and hospital

2. Payer variation

3. Geographic & wage index differences

4. Inflation

Why do we price standardize?

• MVC payments ≠ actual reimbursement

Focus on Practice Pattern Variation Health Care Utilization

How does MVC risk-adjust?

• Patient characteristics• Age/Gender• Insurance Type

• Hierarchical Condition Categories (79)

• Prior 6 month spending

• Condition-specific characteristics(e.g. reoperation, valve + CABG)

MVC Levers for Improvement

Data Analytics• Online registry• Episode-based

intelligence

Hospital Engagement

• Collaborative meetings• Regional dinners• Virtual workgroups

CQI Synergy• Quality & value integration• Comprehensive claims

A Community of CQIs

Value equation

Value =Quality * Appropriateness

Cost

Value collaborations

MSQC hospitalsHig

her C

olec

tom

y Va

lue à

Colectomy Value Index(MSQC quality/MVC payments)

BMC2 appropriateness metric

MVC

read

mis

sion

rate

Fewer readmissions with higher appropriateness

A Community of CQIs

Current Value Report

Why does this matter?

• Value-based care

• Tracking patients

• Bundled payment programs

• Other incentive programs

What’s Next?

• Value report enhancements

• Patient-level matching– Clinical (MSQC) and payment (MVC) data

• Patient drill down

• Additional engagement with MVC– Next collaborative meeting: November 1st, 2019 @

Schoolcraft College in Livonia, MI– Email: michiganvaluecollaborative@gmail.com

Questions?

Contact Information

John Syrjamaki, MPHManager, Data Analytics

Michigan Value Collaborative (MVC)Phone: 734-764-4945

Email: syrjamaj@med.umich.edu