Blue Cross launches 2 new CQIs: MIBAC, MCT2D

You may have first read about these new Collaborative Quality Initiatives in the September-October issue of Hospital and Physician Update. The following article contains some updated statistics and other information.

Blue Cross Blue Shield of Michigan has launched two new Collaborative Quality Initiatives — the Michigan Back Collaborative, or MIBAC, and the Michigan Collaborative for Type 2 Diabetes, or MCT2D. These CQIs are expected to improve outcomes for two widespread conditions — low back pain and Type 2 diabetes.

This brings the total number of CQIs in our program portfolio to 19.

Faris Ahmad, M.D., medical director with Value Partnerships, believes these newest CQIs will make a big difference in the health and well-being of residents throughout Michigan.

“The CQI portfolio is of great interest to Blue Cross and a source of pride,” Ahmad said. “Working together with our hospital and physician partners, we continue to find new avenues to explore that can positively affect the outcomes of care for many different areas.”

Michigan Back Collaborative

Low back pain is one of the most common and expensive conditions for which patients seek care. Currently, care pathways for treating low back pain vary widely. They’re often inefficient and costly, resulting in unsatisfactory outcomes for patients. Many patients don’t improve with either conservative therapy (exercise, medication, physical therapy) or more expensive forms of treatment (injections, surgery).

Patients whose acute back pain isn’t effectively managed may begin to experience chronic low back pain, which is associated with disability and potential opioid dependence. That’s one reason effective treatment of patients in the acute phase is crucial.

“We commonly see unnecessary imaging studies and referrals, use of unproven therapies, overuse of opioids and lack of effective pain relief,” Ahmad said.

MIBAC is using a spine care pathway developed in part by Excellus BlueCross BlueShield in New York, which has been proven effective, resulting in significant improvement in care patterns, better outcomes and lower costs for patients with low back pain. The pathway is helping the CQI accomplish one of its main goals — identifying the cause of low back pain in “first contact” settings to offer less invasive treatment and help avoid unnecessary referrals and imaging.

Participation in MIBAC currently includes primary care doctors (M.D.s and D.O.s) affiliated with physician organizations that participate in the Physician Group Incentive Program, along with chiropractors, regardless of PGIP participation. Eventually, the program will be opened to other practitioners involved in treating low back pain.

“The Michigan Association of Chiropractors has engaged their providers around this CQI, and we’ve received a good response from primary care doctors as well,” Ahmad said. “We anticipate that by reducing exposure to unnecessary imaging and treatment, we can improve outcomes and the member experience.”

The CQI has three levels of participation, the first being online training for primary care physicians and chiropractors. Once trained, providers may then participate in the subsequent levels, which involve data collection and quality initiatives. The collaborative held introductory webinars in February and March, with online training beginning in March. 

To date, more than 550 primary care physicians and chiropractors have completed the online training. Participation in the advanced levels is scheduled to begin late this year. 

Henry Ford Medical Group is leading the MIBAC CQI and serving as the coordinating center. Its role includes:

• Implementing training in an evidence-based pathway training curriculum that has achieved good results
• Supporting statewide activities to ensure active and engaged participation and helping participants create and direct quality improvement of care processes and outcomes

Michigan Collaborative for Type 2 Diabetes

Type 2 diabetes is one of the most prevalent, costly and disabling diseases in the U.S. According to the Centers for Disease Control and Prevention, approximately 10% of adults, or about 778,000 Michigan residents, report having a diabetes diagnosis. The data suggests that about 20% of those who have Type 2 diabetes don’t even know it. Adding these undiagnosed cases to the total brings the number of adults in Michigan with Type 2 diabetes closer to 1 million.

This results in health care costs of $327 billion in the U.S., or $1 of every $7 spent on health care, with Michigan costs totaling approximately $7.2 billion. In addition, diabetes can lead to kidney failure, heart disease, stroke and peripheral vascular disease.

“Approximately 1,000 Michiganders are diagnosed with Type 2 diabetes every week,” Ahmad said. “That’s 52,000 newly diagnosed every year. Statistics like these underscore the urgency of implementing a CQI to address the issue of diabetes.”

Currently, there are 25 physician organizations and more than 700 primary care physicians participating in MCT2D. The first meeting of Blue Cross and participants took place Sept. 24.

The goal of MCT2D is to prevent, slow and reverse disease progression of Type 2 diabetes. Rather than simply focusing on controlling blood sugar, MCT2D will work to support providers in their efforts to deliver high-quality behavioral and medical treatment to prevent, slow or reverse the course of the disease. To help accomplish this, the collaborative is employing three newly emerging, evidence-based strategies that can lead to improved outcomes for patients with Type 2 diabetes, including reversal of the disease:

• Supporting the evolving care models for diabetes by including new treatments, such as the use of GLP1 receptor agonists and SGLT2 inhibitors. These medications are proven to improve glucose control, decrease adverse cardiovascular events, slow the progression of chronic kidney disease and support weight loss. Currently only 13% of people with Type 2 diabetes have been prescribed GLP1 receptor agonists and only 8% have been prescribed SGLT2 inhibitors.
• Supporting lower carbohydrate diet interventions.
• Expanding the use of continuous glucose monitoring, or CGM, devices.

“The use of CGM devices promotes patient engagement, provides real-time feedback, and costs less than many other interventions,” Ahmad noted.

Michigan Medicine is leading the MCT2D CQI and serving as the coordinating center. The CQI is currently partnering with Physician Group Incentive Program physician organizations to recruit primary care doctors and specialists (endocrinologists and nephrologists) who have a significant number of patients with Type 2 diabetes. MCT2D will be working closing with our POs to roll out this effort and engage providers, using the CQI model of collaboration, data reporting and sharing of best practices.  

For more information about MIBAC or MCT2D, email CQIprograms@bcbsm.com. For more information about Value Partnerships and other CQIs, visit valuepartnerships.com.