Quality Improvement Projects in Michigan Helping Bend the Health Care Cost Curve

If you are concerned about what’s going on with the escalating cost of health care in this country, you should feel good about the work going on right here in Michigan.

Four programs BCBSM sponsors with Michigan hospitals have saved a combined $232.8 million over three years, lowering complication rates for Michigan patients and literally saving lives.

The Collaborative Quality Initiatives, as we call them, target health care quality, patient safety and improved outcomes. They cover some of the most commonly performed and costly areas of medical care: general surgery, cardiac and thoracic surgery, angioplasty, and bariatric surgery.

Widespread Benefits

The savings benefit more than just people who carry Blue Cross insurance. About two-thirds of the savings was spread across patients with Medicare, Medicaid or non-BCBSM private insurance and the uninsured.

We started these initiatives in 1997 when we joined five hospitals to study variation in angioplasty procedures and treatment. The initiative resulted in drastically fewer emergency bypass surgeries and other complications and saved $15.2 million in an early analysis (this program saw the largest savings — $102 million — from 2008 through 2010).

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BlueWorks Award Highlights Progress in Improving Health Care Quality, Lowering Costs for All Michigan Residents

Two surgical initiatives developed by Blue Cross Blue Shield of Michigan and Blue Care Network have been recognized as tops among 48 programs run by Blues plans nationwide, providing further validation of BCBSM’s efforts to improve health care quality, patient safety and outcomes.

Together, the two collaborative quality initiatives have removed an estimated $100 million in costs from the health care system in Michigan, including from non-Blues plans.

The 2011 BlueWorks Award was announced last week by the Blue Cross and Blue Shield Association and the Harvard Medical School Department of Health Care Policy. The award recognizes Blues-sponsored programs that improve health care safety, quality, accessibility and affordability while engaging providers, consumers and communities.

It’s the second consecutive year that BCBSM has received the prestigious BlueWorks Award. In 2010, BCBSM was recognized for its Patient-Centered Medical Home program, which emphasizes the roles of primary care and increased patient involvement to improve health outcomes and lower costs.

The BCBSA and Harvard Medical School recognized the Michigan Blues for two statewide initiatives aimed at improving quality and patient outcomes in surgical procedures:

  • The Michigan Surgical Quality Collaborative, which collects and analyzes procedural and outcome data to improve the quality of care for patients undergoing general and vascular surgery, which is commonly performed at hospitals across Michigan. Rates for surgical morbidity are lower under this program and dropped more quickly than at other hospitals in the National Surgical Quality Improvement Program, after which the program is modeled.
  • The Michigan Bariatric Surgery Collaborative Quality Initiative, which analyzes and shares patient data and outcomes from a clinical registry database. Among other goals, this CQI aims to reduce both emergency room visits and the use of pre-operative Inferior Vena Cava filter placements to improve care for patients who undergo bariatric surgery. This initiative has served as a guide for other regional collaborative efforts and can be easily replicated to improve patient care in other clinical areas.

Early data suggest that the Michigan Surgical Quality Collaborative led to $85.9 million in cost savings statewide in 2009 and 2010. That figure includes procedures covered by all commercial insurers — including the Blues — as well as self-payers, Medicare and Medicaid.

An analysis of the Michigan Bariatric Surgery CQI suggests that the program has saved Michigan $14.6 million between 2008 and 2010.

All told, Blue Cross Blue Shield of Michigan and Blue Care Network sponsor 10 collaborative quality initiatives with Michigan hospitals. Another two are planned for launch in early 2012: one on arthroplasty (hip and knee replacement surgery) and the other on intensity modulated radiation therapy, which is used to treat breast and lung cancer.

Photo by Army Medicine.