BCBSM, BCN, hospitals statewide produce $597M in savings


By pooling resources and working collaboratively, Michigan Blues and hospitals throughout the state are participating in health quality initiatives that the company believes have brought millions of dollars in savings to the medical table in Michigan.

Blue Cross Blue Shield of Michigan announced recently that five collaborative quality-improvement programs involving 75 hospitals, BCBSM and Blue Care Network resulted in $597 million in health care savings from 2008-2012, as well as improved outcomes for patients.

The five programs include: Michigan Surgical Quality Collaborative; Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative; BCBSM Cardiovascular Consortium, which comprises two separate initiatives; and Michigan Bariatric Surgery Collaborative.

Dr. David Share, BCBSM senior vice president of value partnerships, said the purpose of the initiatives is to create a neutral ground where hospitals can collaborate on assessing and improving quality by sharing detailed clinical data on all of the cases that occurred in their institutions.

“Instead of leaving the research methods in the laboratory, what we have done is brought expert clinicians from all over the state together from all their hospitals and enabled them, by putting resources in their hands, to apply what we call ‘comparative effectiveness’ research,” said Share. “It’s applying scientific methods that are at a very sophisticated level to continuously examine real life practice on an ongoing basis, and enabling them with those methods has empowered them to self-optimize care.”

Known as Collaborative Quality Initiatives under the oversight of the umbrella program Value Partnerships established in 2006, the programs are designed to address various areas of surgical and medical care to improve patient outcomes, reduce mortality rates and lower the rate of complications.

Participating hospitals collect, share and assess data to learn which practices and procedures can improve patient safety, enhance clinical quality and increase efficiency. Some of West Michigan hospitals involved in the CQIs include: Borgess Medical Center, Bronson Battle Creek Health System, Holland Hospital, Metro Health Hospital, Mercy Health Saint Mary’s and Spectrum Health Butterworth Hospital.

The Michigan Surgical Quality Collaborative, focused on improving quality of general and vascular surgery, had a statewide savings of $230.3 million during the five years and reduced surgical site infections by 20.33 percent from 2008 to 2013. The collaborative effort through Michigan Society of Thoracic and Cardiovascular Surgeons totaled $78.2 million in savings from 2009 until 2012. The two cardiovascular consortium programs collectively saved $260.9 million otherwise used in angioplasty procedures or treatment for patients undergoing vascular procedures. 

The Michigan Bariatric Surgery Collaborative experienced $27.8 million in savings, and is a good example of how the programs are a community-based collaboration catalyzing change, according to Share.

Studying a procedure used for bariatric patients that involves an inferior vena cava filter, the collaborative discovered the device — meant to prevent blood clots from moving toward the heart, lungs or brain — caused more expensive and severe problems rather than actually reducing them.

“Because these folks were using their own data, they were talking to each other regularly in consortium meetings, and they were really excited about the findings. They owned it. They felt a sense of ownership of this learning, and within nine months they had reduced the use of these filters by 90 percent across the state of Michigan,” said Share. “That led to a reduction in death rate and saved millions of dollars a year — and it was all because of being in a consortium, pooling data and seeing a pattern emerge.”

Initial planning for the CQI models began in 1996 for a program focused on cardiac angioplasty, a procedure that involves using a catheter to open up arteries to prevent heart attacks. Between 1997 and 2001, the first cardiovascular consortium developed a data registry, collected baseline data, and identified opportunities for improvements based on new insights, according to Share.

“By the end of those four years, the death rate for angioplasty in the hospitals that participated was down by 25 percent and a major contributor was the rate of kidney failure after angioplasty was decreased by close to 60 percent,” said Share. “Kidney failure requires kidney dialysis, which is extremely expensive and complicated. We were able to prove very conclusively that this model works. Then we began to actively develop new collaborative quality initiatives so we now have 20 in total, and 15 of those are hospital-based.”

With each initiative focused on different areas of complex hospital-based care, Share said the impact of cost savings and improved practices seen in the very first project dating back to 1997 has been sustained and improved upon over time. 

“Others have achieved to a lesser extent, just because of their relative newness, similar accomplishments at decreasing complications, decreasing mortality and increasing efficiency,” said Share in reference to the other 10 hospital-based CQIs. “Michigan hospitals perform generally better on quality measures and outcome measures than other parts of the country. By everybody joining forces to collaborate on this learning and to support one another and continuous improvement, what we see is the level of quality and outcomes rises across the state of Michigan.”

Covering a range of care, the remaining hospital-based CQIs include programs such as: Anesthesiology Performance Improvement and Reporting Exchange, Hospital Medicine Safety, Michigan Radiation Oncology Quality Consortium, Perioperative Outcomes Quality Initiative, Michigan Breast Oncology Quality Initiative, Michigan Spine Surgery Improvement Collaborative and Michigan Value Collaborative. 

Daniel J. Loepp, president and chief executive officer of BCBSM, said the initiatives are rapidly improving the health care environment across the state and have positioned Michigan as a national leader in transforming health care through collaboration.

“This model enables competitors to work together as partners in large-scale efforts that reduce complications, improve patient outcomes, and significantly decrease unnecessary health care costs,” said Loepp in the press release. 

Share said the programs are expected to continue in the future.

“We have been able to show, even after a decade, the mature CQIs continue to uncover new knowledge, lead to eliminating practices that don’t work, adopting practices that do and lead to better outcomes,” said Share. 

“Since we keep showing in a very rapidly changing technology that the method continues to optimize performance, we expect to continue to support these programs and to establish a modest number of new ones in areas of care that have not yet been addressed."

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