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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: [email protected]
Questions?
Contact Information
John Syrjamaki, MPHManager, Data Analytics
Michigan Value Collaborative (MVC)Phone: 734-764-4945
Email: [email protected]
