Blue Cross CQI model enables rapid, statewide COVID-19 response

By: Debbie Reinheimer

Surgeons wear gowns, masks in preparation for operation

When the COVID-19 pandemic arrived in Michigan, our health care community urgently responded. As people flooded emergency departments and hospital ICUs filled up, medical professionals tried to understand how this strange new illness progressed, and how to best treat those suffering with it. COVID-19 is a “novel” coronavirus, meaning it is a new strain not previously identified in humans. So, there was no research or established best practices that providers could use to fight the earliest reported cases.

Fortunately, in Michigan, there is a longstanding model called the Collaborative Quality Initiative (CQI) that Blue Cross provider partners have used to quickly launch new efforts to collect and share critical information about COVID-19 with participating hospitals and health care facilities.

A CQI is a quality improvement model formed and funded by Blue Cross Blue Shield of Michigan, where physicians and hospitals throughout Michigan collect and share clinical data, insight and best practices. Using existing CQIs, Blue Cross and CQI coordinating centers – led by physicians at Michigan Medicine – have launched several projects to aid health care providers in responding to COVID-19 demands, and to prepare them for a post-crisis environment.

First, the Michigan Emergency Department Improvement Collaborative (MEDIC) is holding virtual town hall meetings statewide, where medical staff share information on the challenges they’re experiencing and the solutions they’re discovering related to COVID-19 in the emergency department. These video conference calls are recorded and posted on the website, so that any interested health professional can learn from them. Topics have included workforce wellness for ED staff, lessons from the front line, special considerations for pediatric patients, and how to resume regular ED operations once the coronavirus crisis flattens.

In another example, more than 35 hospitals across Michigan are contributing comprehensive, clinical data on COVID-19 patients into an extensive clinical registry, coordinated by the Michigan Hospital Medicine Safety Consortium (HMS). The registry, entitled MI-COVID19, will offer a line of sight across geographic, economic and demographic boundaries. The data will help medical professionals understand why some patients have more severe illness or worse outcomes; and what contributes to better outcomes.

Data abstractors and other staff from other CQIs including Michigan Surgical Quality Collaborative (MSQC), Michigan Bariatric Surgery Collaborative (MBSC), Michigan Spine Surgery Improvement Collaborative (MSSIC), Michigan Trauma Quality Improvement Collaborative (MTQIP), Michigan Radiation Oncology Quality Collaborative (MROQC) and Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) are lending time and expertise to the MI-COVID19 registry.

“This registry was able to be structured and launched within weeks of the onset of the pandemic, because the CQI platform was already in place and works well,” said Tom Leyden, Director II, Value Partnerships at Blue Cross Blue Shield of Michigan. “Physicians trust the Blue Cross CQI model. They know the data is valid, vetted and actionable. And they work together to create best practices that shape and improve care standards statewide.”

Finally, as the COVID-19 crisis level eases, the Michigan Value Collaborative (MVC) has developed a tool to help hospitals prepare to re-open elective surgeries. MVC examined seven years of data from its all-payer registry, looking at the hospital resources used in 17 common elective surgeries. They created a resource utilization report, showing which procedures require the most resources, including inpatient length of stay, ICU and ventilator use, blood products used, and likelihood of readmission or emergency department use within 30 days of discharge.

As hospitals prepare to re-start elective surgical procedures, the resource utilization report helps them plan for the staff, space, materials and resources that will be needed. Hospitals also can use the report to prioritize which procedures to begin first.

“Michigan’s health care system has such an advantage, because the longstanding Blue Cross CQI model enables rapid deployment of initiatives that significantly change health care practice,” said Leyden. “As a result, providers should be able to institute evidence-based practice standards for COVID-19 in the very near future.”