From Registry Report to Bedside: Leveraging Your Quality Data

Mike Englesbe University of Michigan Mike Englesbe - Disclosures

 Funding Sources: CMS NIH BCBSM HHS - Michigan

 Equity Partner- Prenovo LLC. 37 McLaren – Macomb 1 Allegiance Health 38 McLaren – Northern Michigan 2 Alpena Regional Medical Center 39 McLaren – Oakland 3 Beaumont Hospital – Dearborn 40 McLaren – Port Huron 4 Beaumont Hospital – Farmington Hills 41 Memorial Healthcare – Owosso 5 Beaumont Hospital – Grosse Pointe 42 Mercy Health Hackley 6 Beaumont Hospital – Royal Oak 43 Mercy Health Partners 7 Beaumont Hospital – Taylor 44 Mercy Health Saint Mary's 8 Beaumont Hospital – Trenton 45 Metro Health Hospital 9 Beaumont Hospital – Troy 46 MidMichigan Medical Center – Clare 10 Beaumont Hospital – Wayne 47 MidMichigan Medical Center – Gratiot 11 Borgess Medical Center 48 MidMichigan Medical Center – Midland 12 Bronson Battle Creek Hospital 49 Munson HealthCare Cadillac Hospital 13 Bronson Methodist Hospital 50 Munson HealthCare Grayling Hospital 14 Covenant HealthCare 51 Munson Medical Center 15 Crittenton Hospital Medical Center 52 Oaklawn Hospital 16 Detroit Receiving Hospital 53 ProMedica Bixby Hospital 17 Dickinson County Healthcare System 54 ProMedica Monroe Regional Hospital 18 Garden City Hospital 55 Providence Hospital – Southfield 19 Genesys Regional Medical Center 56 Sinai-Grace Hospital 20 Harper University Hospital 57 Sparrow Carson Hospital 21 Henry Ford Hospital 58 Sparrow Hospital 22 Henry Ford Macomb Hospital 59 Spectrum Health Big Rapids Hospital 23 Henry Ford West Bloomfield Hospital 60 Spectrum Health Butterworth Hospital 24 Henry Ford Wyandotte Hospital 61 Spectrum Health United Hospital 25 Hillsdale Hospital 62 St. John Hospital and Medical Center 26 Holland Hospital 63 St. John Macomb Oakland Hospital 27 Hurley Medical Center 64 St. John River District Hospital 28 Huron Medical Center 65 St. Joseph Mercy Ann Arbor 29 Huron Valley Sinai Hospital 66 St. Joseph Mercy Chelsea 30 Lake Huron Medical Center 67 St. Joseph Mercy Livingston 31 Lakeland HealthCare 68 St. Joseph Mercy Oakland 32 McLaren – Bay Region 69 St. Mary Mercy Hospital, Livonia 33 McLaren – Central Michigan 70 St. Mary’s of Michigan 34 McLaren – Flint 71 University of Michigan Health System 35 McLaren – Greater Lansing 72 UP Health System – Marquette 36 McLaren – Lapeer Region 73 West Branch Regional Medical Center Partnering with BCBSM/BCN MSQC Operations

73 surgeon champions

73 hospitals

2,500 surgeons,1800 gynecologists

1,000 anesthesiologists

Monthly surgeon conference calls, newsletter

Quarterly meetings for 10 years

300-400 surgeons, anesthesiologists and nurses per mtg Fixing problems, Collaborating and Innovating in care delivery Fix specific problems

Collaboration

Innovation

6 Focus

Collaborate

Innovate How to prevent SSI in Michigan

The Problem: Surgical site Evidence Based Initiatives in 73 Infection hospitals  Pre op shower  CHG skin prep  Glycemic control  Normothermia  Short duration surgery  Appropriate IV antibiotics  Oral antibiotics with bowel prep  Laparoscopic approach  Weight based dosing  Wound protector Site Visits to Best Performing Hospitals

Trends Elective Colectomy Michigan Urological Surgery Improvement Collaborative (MUSIC)

– AuSable Urology – Lansing Institute of Urology – Bay Area Urology Associates – Marquette General Urology – Cadillac Urology Practice – Michigan Institute of Urology – Capital Urological Associates – Michigan State Urology – Cascades Urology – Michigan Urological Clinic – Center for Urology – MidMichigan Physicians Group - Urology – Comprehensive Medical Center – Northern Michigan Urology • Affiliates in Urology – Pinson Urology Center • Arnkoff, MD, and Weigler, DO, PC – Sherwood Medical Center, PC • Comprehensive Urology – Spectrum Health Medical Group – • Grosse Pointe Urology Urology • Comprehensive North – Tri City Urology • Michigan Urological Institute – University of Michigan, Department of Urology • Oakland County Urologists – Urologic Consultants, PC • Urology Associates of Port Huron – Urology Associates of Battle Creek – David L. Harold, MD, PC – Urology Associates of Grand Rapids – Detroit Medical Center – Urology – Urology Surgeons, PC – Edward Barton, MD, PC – Wayne State University Physicians – Henry Ford Health System – Vattikuti Urology Institute Group – Urology – West Shore Medical Center – IHA – Urology – West Shore Urology – Kent Kirby, MD, PC – Western Michigan Urological Associates – Lakeshore Urology, PLC – Lakeside Urology Why MUSIC Exists:

Making Michigan #1 in Prostate Cancer Care The MUSIC solution Variation in post-prostate biopsy admission rates Nearly 50% reduction in hospitalization rates

1.5%

1.16% P = 0.0011

1.0%

0.66%

0.5% n = 65 n = 65n = 60 n = 23 n n= =25 25

0.0% Pre-Intervention Post-Intervention (5,158 biopsies) (10,988 biopsies)

Womble et al, J Urology, 2015 Avoidance of Low Value CT Scans

100% 100%

80% 80%

60% 60%

40% 40%

20% 20% 10% target

0% 0% 0 10 20 30 40 50 0 5 10 15 20 25 30 35 Practice Practice Patient reported outcomes

 20 participating practices

 1800+ patients

 Electronic data collection

 Tablets for clinic questionnaire capture and education Patients with good urinary function after prostatectomy

75%

50%

25% CurrentCurrent GoalGoal CurrentCurrent GoalGoal 3 Month 6 Month The challenge of treatment variation

Use of Active Surveillance among men with low-risk prostate cancer

100%

50%

0% 0 5 10 15 20 25 30 35 40 45 50 Urologist Appropriateness Are we making patients better???

How often is the uterus “normal” after hysterectomy in Michigan hospitals

Michigan Scorecard Propublica Scorecard

Partnering with hospitals and CQIs to drive higher value care Engagement is the key

 Visits to participating sites

 Solicited ideas for initial priorities

 Created work groups for ongoing feedback and guidance

 Promote vigorous participation at collaborative- wide meetings Build culture and collective pride

“I was talking to one of the urologists after the meeting, and you all make us proud to be urologists in Michigan. You are continuing to make it fun and are positively influencing our practices for the benefit of our patients. ”

MUSIC Urologist, Feb 2015 Fixing problems, Collaborating and Innovating in care delivery Innovation - Surgery Coaching • - 35 DO PEOPLE TRAIN??

1100 patients

85% agree to participate

91% compliant with program

MSHOP outcomes CMS Innovation Program year 1 Serving Michigan 6% 21% Opioid naive Used opioids patients become chronic opioid preoperatively users

$2.5 Billion