Michigan Medicine / University of Michigan
The University of Michigan serves as the operational hub of Michigan’s many BCBS-funded statewide Collaborative Quality Initiatives (CQI). Their work as an impartial and competent partner helps physicians and hospitals to design the pay-for-performance environment within Michigan. How does this build trustworthiness? The focus on quality and robust resources unites institutions and physicians through a focus on increasing system reliability, which builds collaboration among BCBS of Michigan, providers, and hospitals that put the interests of patients first.
How It Works
Blue Cross and Blue Shield of Michigan funds the statewide enterprise (the CQIs) with a goal of improving high-value care for every patient in Michigan. The University of Michigan directs these efforts and functions to coordinate vision, data, and collaboration among all physicians and hospitals in the state. The University of Michigan oversees granular clinical data across 16 specialties in the state. These data are used to identify best practices and opportunities for improvement across the state. The physician community works together to implement best practices into measure improvement. The University of Michigan coordinates assessment of improvement and the attribution of BCBSM value-based reimbursement and pay for performance incentives. It also organizes the development and maintenance of a collaborative community, facilitating goodwill and a mission devoted to improving the health of every patient in Michigan.
Skills and Competencies
There are several key competencies. Trust is first and foremost. Michigan Medicine is part of the University of Michigan and is a large, integrated healthcare system that competes within the healthcare market. Despite the realities of this competitive marketplace, the CQIs have been able to flourish because hospitals and the physician community trust the CQI leadership at the University of Michigan. All hospitals and physicians trust that the University of Michigan will not use the hospital and physician-specific data for competitive advantage. The second competency is community building. Specific efforts to celebrate the unique expertise and challenges of the health care community in Michigan are mandatory to foster a community rooted in collaboration and continuous improvement.
Origins
The CQI movement in Michigan began with the observation that there were profound differences in the rates of acute renal failure following percutaneous coronary interventions (PCI) across the State. Blue Cross and Blue Shield of Michigan partnered with cardiologists at the University of Michigan to set up a PCI registry to improve care. Rates of acute renal failure following PCI rapidly improved in Michigan. This success fueled the CQI movement.
Effectiveness
There are countless examples of success related to the CQIs. For example, opioid prescribing following surgery rapidly became aligned with evidence-based practice in as short as two years, resulting in a 50% reduction in surgical prescribing in the state. In fiscal year 2020, over 100 peer reviewed publications reported CQI worked to improve care. More recently, within a few weeks, a COVID ICU collaborative was begun and over 500 ICU professionals (nurses and doctors) logged into the launch of this nascent collaborative. Clearly, the clinician community trusts that the CQI movement is focused on serving the state.
Scalability
The CQI model for improving care continues to expand. First, within Michigan, expansion of the model includes new, more complex care settings, including chronic disease management (diabetes, kidney disease, lung disease), health equity, and health behaviors. Outside of Michigan, other groups have tried to emulate the success in Michigan, including in Tennessee, South Carolina and Illinois.