Together we can do so much February 5th , 2016: Alone we can do so little; Together we can do so much -Helen Keller February 5th , 2016: One Day in the Life of BCBSM’s CQI Program - Four CQIs Addressing Quality of Care for Michigan Residents

February 5th Meeting of the Michigan Bariatric Surgery Collaborative (MBSC) Launched: 2005 Participants (sites): 38 of 40 hospitals Participants: 66 bariatric surgeons Data collection: ~62,000 surgeries to date 95% of all bariatric surgeries in Michigan CQI Specifics 155 attendees 49 surgeons, 74% of MBSC surgeons 37 of 38 hospitals Topics: Preventing blood clots Understanding/reducing ED visits Tool to assist patients in choosing type of bariatric surgery February 5, 2016 Meeting Improvements are inception to present for all CQIs To date, an estimated 3,464 patients avoided an unnecessary procedure (IVC filter); yearly, 433 Michigan patients are impacted 490 patients did not experience a readmission; that’s ~61 patients per year Select Improvements to Date

February 5th Meeting of the Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) Launched: 2012 Participants (sites): 59 of 61 hospitals Participants: 430 orthopedic surgeons and trauma-orthopedic surgeons Data collection: ~100,000 cases to date 93% of all knee and hip replacements in Michigan CQI Specifics 185 attendees 55 physicians (representing their practices and hospitals) 58 of 59 facilities Topics: Improving readmission rates Addressing patient factors pre-surgery to improve outcomes Most effective way to capture patient reported outcomes February 5, 2016 Meeting An estimated 5,200 patients avoided blood transfusions; 2,400 in 2014 2,500 patients avoided a nursing home stay post-surgery Select Improvements to Date Total spend on knee and hip replacements is projected to be over $7 billion annually in the US

February 5th Meeting of the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) Launched: 2009 Participants (sites): 6 anticoagulation facilities* Participants: 35 physicians, nurses, and pharmacists Data collection: ~25,000 cases to date 5% of all anticoagulation cases in Michigan CQI Specifics *Represent various types of delivery in hospitals and freestanding clinics 26 attendees 7 physicians 6 of 6 facilities Topics: Blood clots – choice of drug when there is a clot Understanding/reducing ED visits Efficacy of new oral anticoagulant drugs February 5, 2016 Meeting 48,000 patients did not receive unnecessary testing (International Normalized Ratio testing) 8,200 visitors from all 50 states were educated on anticoagulation guidelines via the MAQI2 toolkit The mobile app version of the toolkit has been downloaded ~1,000 times Select Improvements to Date Blood clot prevention and treatment is one of AHRQ’s top 10 issues impacting patient safety

February 5th Meeting of the Michigan Spine Surgery Improvement Collaborative (MSSIC) Launched: 2013 Participants (sites): 27 of 36 hospitals Participants: 156 neurosurgeons and orthopedic surgeons Data collection: ~36,000 cases to date 80% of all spine surgeries in Michigan CQI Specifics 91 attendees 25 physicians (representing larger practices and hospitals) 27 of 27 facilities Topics: Dependency on drugs for pain pre & post-surgery Infection at the surgical site How to avoid adverse events (harm to a patient as a result of care) February 5, 2016 Meeting Total spend on spine surgery is projected to be approximately $13 billion annually in the US This is a new CQI. Due to the type of data collected, as well as factors such as length of treatment, timing rules, and tracking of patient outcomes, it takes time for the dataset to mature and become robust enough for analyses to occur and quantitative results to be realized. Select Improvements to Date

So Much Can be Accomplished in One Day… Over 450 people, including 136 physicians, representing more than 60 hospitals, came together to work together to improve health care quality. These 4 CQIs are a sample of a larger portfolio of over 20 statewide initiatives with hospitals and physicians. These programs have saved Michigan $793 million, the Blues $284 million and have quantified improvements (e.g. Complications reduced or avoided, as well as deaths averted).   In just one day, 450+ professionals dedicated to making care better for Michigan patients convened to discuss best practices and commit to taking action across the continuum of pre-op, intra-op, and post-op care by: Reducing and effectively treating blood clots – one of the top issues impacting patient safety Reducing visits to the emergency room Improving care by reducing complications; determining the best medications; helping patients choose the best surgery; and helping patients improve their health to be better prepared for surgery Savings are for 5 of the longest standing CQIs over a 6-year period. MSSIC - New Hudson MAQI2 - Commerce MBSC - Plymouth MARCQI - Livonia If this can happen in a day, imagine the impact in a week…in a month…in a year… in several years… The CQIs are a win for those who seek care, those who provide care, and those who pay for care.