1. Understanding Patient Impact and Perspective MOQC, MiBOQI, and Pathways Tri-annual Meeting 1/22/2016 Jackie Rau, MHSA, CQI Project Lead Collaborative Quality Initiatives, Value Partnerships, Blue Cross Blue Shield The information contained herein is the proprietary information of BCBSM. Any use or disclosure of such information without the prior consent of BCBSM is prohibited. 1

2. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Presentation Objectives Explain why BCBSM supports patient perspective and involvement Demonstrate how BCBSM is sharing patient impact stories Show examples of how CQIs support the patient perspective 2

3. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 3 Explain why BCBSM supports patient perspective and involvement

4. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. BCBSM values patient perspective 4 Facilitates understanding Positive Motivator Improved care delivery Focus on patient input Demonstrate benefit of CQIs

5. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 5 Demonstrate how BCBSM is sharing patient impact stories

6. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. How BCBSM is illustrating patient impact 6 The Present: We demonstrate impact via cost savings & percent reductions in complications, procedures, etc. The Problem: This data isn’t intuitive to many people. The Future: Also illustrate the number of patients impacted.

7. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 7 How BCBSM is illustrating patient impact Take information and rates tracked through the registry Transform them into a story about the patients (problem, solution, impact, and results

8. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Michigan Oncology Quality Consortium (MOQC)- Smoking Cessation Smoking cigarettes is harmful, and this is especially the case with cancer patients. A 2014 Surgeon General’s report found that patients who have cancer and smoke have an increased all-cause mortality and cancer-specific mortality, and additionally have and increased risk for contracting a second type of cancer (e.g. such as lung cancer). Therefore, lowering smoking rates is a high priority in this population. MOQC found that while smoking status was almost always included in a patient’s chart, only 44% of patients who smoked were advised to quit or referred to counseling. MOQC committed to changing clinical culture and practice patterns to ensure that every patient being treated for cancer who uses tobacco is identified and offered help. Since April 2013, 2093 patients were referred to the free Michigan Tobacco Quitline. 30% of these patients have remained tobacco free for at least 12 months. These patients have benefitted because: –Cancer treatments, including chemotherapy, radiation, and surgery are more effective after a patient has quit smoking. –Patients also have access to free nicotine replacement therapy (patch, gum, or lozenges) from the Quitline. 2093 patients referred to the Quitline since 2013

9. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. When a patient is found to have a mass or other abnormality in his or her breast, there are multiple ways to obtain a sample from the mass to determine if it is cancer. There are two ways to do this: –An Open Surgical Biopsy (OSB), where the majority of the mass, which can be a large amount of tissue, is removed from the breast. –A Core Needle Biopsy (CNB), where a smaller sample or samples of tissue is taken from the mass in the breast with a hollow needle specifically to try to diagnose the problem rather than to remove the mass CNB is the preferred way to sample the mass, because it is accurate and safe, can be performed without anesthesia, and results in the patient having fewer overall surgeries. However, both methods are still used. Due to the work done by MiBOQI to reduce OSB through educating providers and providing feedback on rates of use, 398 patients have received a Core Needle Biopsy instead of an Open Surgical Biopsy from 2011-2013. –These patients spent less time away from work, saved on direct financial costs, and could be confident that they received a safe and accurate procedure. Michigan Breast Oncology Quality Initiative (MiBOQI) – Open Surgical Biopsy 398 fewer patients received an open surgical biopsy from 2011-2013

10. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. 10 Show examples of how CQIs support the patient perspective

11. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. CQIs and Patient Involvement 11 Many collaboratives include patients and family members; some have more recently and others for quite some time!

12. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Addressing Concerns about Involving Patients There have been no concerns expressed to the CQIs who currently include patient team members. Potential areas of concern: –Finding appropriate patient and family participants –Creating a team culture that is open and inclusive of these perspectives –Being able to speak freely at meetings 12

13. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Identifying a Patient Team Member 13 Clinical Champions Participating Hospitals Patient/Family/Caregiver Councils

14. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Diversity in Patient Team Members 14 Geographic Location Socioeconomic Status Disease Specific Factors Race and Gender Course of Treatment Severity of Disease

15. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. How Have Patient Team Members Changed the Collaborative? 15 Better understanding and appreciation for patient perspective Input from patients have advanced quality improvement priorities Serve as a reminder of the importance of the work Gain new insights on care delivery Keeps the work patient focused

16. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. A Physician’s Perspective 16 “Having a patient voice at the meetings helps to keep a firm proxy during debates. No one can really argue with what the patient representative has to say. We are all here for patients, so this voice is in many ways the most important one in the room.” - Dr. David Miller, MUSIC Project Director

17. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. The Patient’s Voice 17 “An individual may be doing something a specific way and may not realize that a minor change could have a significant impact on the result. It is a great challenge and a very noble effort to make outcomes for patients better. It becomes a coaching process with all benefiting. Thanks for having me part of this interesting process.”

18. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Question for the Audience Would you be amenable to bringing in patient team members as CQI participants? 18 Yes No Maybe

19. Blue Cross Blue Shield of Michigan is a nonprofit corporation and independent licensee of the Blue Cross and Blue Shield Association. Acknowledgements Thank you to Susan Linsell from MUSIC, Julie Wietzke from HMS, and Lakshmi Halaysamani from I-MPACT for their input on patient team members and for sharing the experiences that their CQIs have had. 19