for Medicare & Medicaid Services, Veterans Affairs,
the state of Michigan, and other sources. The institute
devoted $123 million to health services research in fiscal year 2015. One of the IHPI’s most important projects at present focuses on the evaluation of the state’s
Medicaid expansion program, known as the Healthy
Michigan Plan, which provides coverage to 625,292
Major contributors to the work of the IHPI are participants in the BCBSM CQI. The BCBSM CQI comprises
70 Michigan hospitals; 92 percent of eligible hospitals
in the state participate in at least one of the program’s
20-plus CQIs, including the Michigan Surgical Quality Collaborative (MSQC). The MSQC is affiliated
with the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®)
and was established under the leadership of Darrell
A. “Skip” Campbell, Jr., MD, FACS, chief medical officer and Henry King Ransom Professor of Surgery,
department of surgery, U-M Health System. Many
other surgeons in the U-M are vital in the MSQC,
including Mark R. Hemmila, MD, FACS, professor
of surgery, section of general surgery, Trauma Burn
Research Laboratory; Justin B. Dimick, MD, MPH,
FACS, George G. Zuidema Professor of Surgery,
chief, division of minimally invasive surgery, director, Center for Healthcare Outcomes and Policy, and
associate chair, strategy and finance; and Michael J.
Englesbe, MD, FACS, associate professor of surgery,
section of transplantation surgery.
The participants in the BCBSM CQI are referred
to as Value Partners for their efforts to improve the
quality/costs of the health care services they provide.
According to David A. Share, MD, senior vice-president,
and Tom Leyden, MBA, director, BCBSM Value Part-
nerships, the most common and costly areas are sur-
gical and medical care.
Participating hospitals and providers collect, share,
and analyze data through clinical registries, then
design and implement changes to improve outcomes
and reduce spending for complex, technical areas of
care. CQI registries allow for a more robust analysis of
the link between processes and outcomes than can be
achieved by examining one group or institution alone.
This innovative and highly regarded program
helps providers to self-assess and optimize their care
by identifying opportunities to develop best practices
or more closely align health care procedures with best
practices. As a result, participants are experiencing
improved quality and lower costs for certain high-cost,
high-volume, high-complexity procedures.
David C. Miller, MD, MPH, FACS, director, MVC,
and associate professor, urology; and James M.
Dupree, MD, MPH, FACS, co-director, MVC, and
assistant professor, urology, described the MVC’s
efforts. A partnership between Michigan hospitals
and the BCBSM/Blue Care Network (BCBSM/BCN),
the MVC builds on the MSQC’s legacy and seeks to
improve health care quality across the state through
rigorous performance feedback, empirical identification of best practices, and collaborative learning. The
MVC hosts semi-annual meetings where representatives from participating hospitals discuss performance
data, analyses of best practices, and collective strategies for improving quality and efficiency.
At present, the MVC uses BCBSM claims data to
assess hospital performance. Measures are based on
utilization and payments for different services, as well
as Medicare fee-for-service data. Hospitals receive
risk-adjusted measures of 30- and/or 90-day episode
EXECUTIVE DIRECTOR’S REPORT
As the nation seeks to implement a patient-centered health care
system that emphasizes quality, safety, and cost controls, it will
become increasingly necessary for surgeons and their institutions
to participate in collaborative quality improvement activities.