How a Provider-Payer Partnership is Changing Emergency Care Quality: Michigan Emergency Department Improvement Collaborative (MEDIC) by Keith Kocher, MD, MPH
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1) The Michigan Emergency Department Improvement Collaborative (MEDIC) is a provider-payer partnership funded by Blue Cross Blue Shield of Michigan to improve emergency care quality across 17 hospitals in Michigan. 2) An initial review of MEDIC data found significant gaps and variation in performance across sites for several quality measures related to head injuries, respiratory illnesses, and pulmonary embolism diagnosis. 3) MEDIC aims to close these gaps and improve outcomes through a learning collaborative that facilitates practice change via measurement, feedback, education and sharing of best practices.
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How a Provider-Payer Partnership is Changing Emergency Care Quality: Michigan Emergency Department Improvement Collaborative (MEDIC) by Keith Kocher, MD, MPH
- 1. Keith Kocher, MD MPH – MEDIC Director kkocher@med.umich.edu Barsan Research Day | 4.11.18 www.medicqi.org How a Provider-Payer Partnership Is Changing Emergency Care Quality: Michigan Emergency Department Improvement Collaborative (MEDIC) @kekocher
- 2. MEDIC Clinical Champions • Timothy Archer, MD • Rajan Arora, MD • Ben Bassin, MD • Lee Benjamin, MD • Molly Bolton, MD • Dominic Borgialli, DO MPH • Blaine Dennis, MD • Lori Dixon, MD • Mathew Font, MD • Brian Holt, DO • Seth Krupp, MD • Kelly Levasseur, DO • Robert Nolan, MD • Brian O’Neill, MD • Zach Sawaya, MD • Rob Sherwin, MD • Michelle Slezak, MD • Dave Somand, MD • Nicole Sroufe, MD MPH MEDIC Coordinating Center • Keith Kocher, MD MPH • Michele Nypaver, MD • Michelle Macy, MD MS • Jason Ham, MB BCh • Jim Pribble, MD MS • Jessica Kauffman, MSA • April Proudlock, RN • Emily White, MS • Megan Hogikyan, MPH • John Didyk, BA The Team MEDIC Partner Institutions • Beaumont – Farmington Hills • Beaumont Hospital – Royal Oak • Beaumont Hospital – Troy • Children’s Hospital of Michigan, DMC • Detroit Receiving Hospital, DMC • Henry Ford Hospital • Holland Hospital • Hurley Medical Center • Huron Valley Hospital, DMC • Lakeland Health • McLaren Northern Michigan • MidMichigan Medical Center • Munson Medical Center • St. Joseph Mercy Hospital - Ann Arbor • St. Joseph Mercy Hospital - Livingston • Sinai-Grace Hospital, DMC • University of Michigan MEDIC Site Abstractors • Shannon Beckman • Terri Bethea • Denise Coatesworth • Heather Faraone • Penny Hawkins • Wendy Herzok • Paulette Hoerauf • Christina Kolenc • Amy Mawhorter • Andrea Millard • Karen Moore • Heather Oliver-Weimer • Nancy Radovic • Irene Rasmussen • Branka Stojkovic • Kristin Watson • Rebecca Wozniak • Nancy Wu • Pamela Shea@kekocher
- 3. Disclosures • Michigan Emergency Department Improvement Collaborative (MEDIC) – Funded by Blue Cross Blue Shield of Michigan and Blue Care Network – www.medicqi.org • Agency for Healthcare Research and Quality (AHRQ) – Career development award @kekocher
- 4. • Why MEDIC? • What is MEDIC Outline @kekocher
- 6. Why MEDIC? That the following are true: 1. Opportunity • Gaps in practice performance 2. Alignment • Payer = Blue Cross Blue Shield of Michigan • Provider = Hospitals and emergency physicians 3. Community • Leadership + engagement @kekocher
- 7. Opportunity What are the high priority targets? 1. Evidence • Support from literature 2. Fair • Within the scope of the ED 3. Actionable • Discriminate between low/high performers 4. Feasible • Collect data • Meaningful measurement @kekocher
- 10. What are the high priority targets? 1. Use of head CTs for evaluation of minor head injuries • Children – PECARN rule • Adults – Canadian Head CT rule 2. Use of chest x-rays for evaluation of common respiratory illnesses (bronchiolitis, croup, asthma) • Children 3. Use of chest CTs for evaluation of suspected pulmonary embolism • Adults 4. Alternatives to hospitalization from the ED (PATH) • Children • Adults Opportunity @kekocher
- 11. 5. Measurement of weight for pediatric ED visits • Children 6. Use of head CT for evaluation of uncomplicated syncope • Adults 7. Use of head CT for evaluation of atraumatic headache • Children Opportunity @kekocher
- 12. Alignment Why would a major insurance company partner with hospitals and physicians? Recognize: 1. They don’t know the high priority performance gaps 2. They don’t know how to measure 3. They don’t have engagement @kekocher
- 13. Community • Clinical Champions + Data Abstractors + Administrators • All of You! @kekocher The Chasm
- 14. What is MEDIC? – A Nudge Practice Change Est. 2015 Learning Collaborative @kekocher
- 15. Value Partnerships http://www.valuepartnerships.com/ • Michigan Cardiovascular Consortium • Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative • Michigan Bariatric Surgery Consortium • Michigan Surgical Quality Collaborative • Michigan Anticoagulation Quality Improvement Initiative • Michigan Oncology Quality Consortium • Hospital Medicine Safety Consortium • Michigan Trauma Quality Improvement Project • Michigan Urological Surgery Improvement Collaborative • Michigan Radiation Oncology Quality Consortium • Michigan Arthroplasty Registry Collaborative for Quality Improvement • Michigan Spine Surgery Improvement Collaborative • Michigan Value Collaborative • Anesthesiology Performance Improvement and Reporting Exchange • Michigan Pharmacists Transforming Care and Quality Consortium • Michigan Emergency Department Improvement Collaborative • Integrated Michigan Patient-Centered Alliance on Care Transitions@kekocher
- 16. Collaborative Sites • 17 hospitals community & academic rural & urban pediatric & adult • 1.25 million annual ED visits • 30% of all ED visits in Michigan www.medicqi.org @kekocher
- 17. MEDIC Registry = 5,272 head CTs = 2,372 CXRs = 4,077 PE CTs
- 18. Measurement: MEDIC Baseline Performance* @kekocher Quality Initiative Performance Target Collaborative Site Range Adult Head Injury (Canadian Rule) CT Appropriateness > 90% 41.3% 25.5% – 58.2% Pediatric Head Injury (PECARN Rule) Overuse < 5% 10.0% 0% – 15.2% Intermediate Risk Utilization < 20% 23.7% 0% – 54.4% Pediatric Respiratory Illnesses CXR Utilization < 30% 36.5% 6.5% – 55.3% Adult Pulmonary Embolism CT Diagnostic Yield > 11% 8.9% 7.1% – 10.9% * Data from 6/1/16 – 12/31/17
- 22. MEDIC Clinical Champions • Timothy Archer, MD • Rajan Arora, MD • Ben Bassin, MD • Lee Benjamin, MD • Molly Bolton, MD • Dominic Borgialli, DO MPH • Blaine Dennis, MD • Lori Dixon, MD • Mathew Font, MD • Brian Holt, DO • Seth Krupp, MD • Kelly Levasseur, DO • Robert Nolan, MD • Brian O’Neill, MD • Zach Sawaya, MD • Rob Sherwin, MD • Michelle Slezak, MD • Dave Somand, MD • Nicole Sroufe, MD MPH MEDIC Coordinating Center • Keith Kocher, MD MPH • Michele Nypaver, MD • Michelle Macy, MD MS • Jason Ham, MB BCh • Jim Pribble, MD MS • Jessica Kauffman, MSA • April Proudlock, RN • Emily White, MS • Megan Hogikyan, MPH • John Didyk, BA The Team MEDIC Partner Institutions • Beaumont – Farmington Hills • Beaumont Hospital – Royal Oak • Beaumont Hospital – Troy • Children’s Hospital of Michigan, DMC • Detroit Receiving Hospital, DMC • Henry Ford Hospital • Holland Hospital • Hurley Medical Center • Huron Valley Hospital, DMC • Lakeland Health • McLaren Northern Michigan • MidMichigan Medical Center • Munson Medical Center • St. Joseph Mercy Hospital - Ann Arbor • St. Joseph Mercy Hospital - Livingston • Sinai-Grace Hospital, DMC • University of Michigan MEDIC Site Abstractors • Shannon Beckman • Terri Bethea • Denise Coatesworth • Heather Faraone • Penny Hawkins • Wendy Herzok • Paulette Hoerauf • Christina Kolenc • Amy Mawhorter • Andrea Millard • Karen Moore • Heather Oliver-Weimer • Nancy Radovic • Irene Rasmussen • Branka Stojkovic • Kristin Watson • Rebecca Wozniak • Nancy Wu • Pamela Shea@kekocher