1. PATIENT SAFETY ORGANIZATION Michigan Surgical Quality Collaborative http://www.msqc.org/

2. A COLLABORATIVE QUALITY INITIATIVE (CQI) Michigan Surgical Quality Collaborative Member Hospitals Coordinating Centers BCBSM/BCN Collaborative Quality Initiatives, or CQIs, are built upon a unique partnership between hospitals and physicians, the Coordinating Centers, and Blue Cross Blue Shield of Michigan/Blue Care Network.

3. Member Hospitals Contribute hospital data to the all-payer registry Share and learn from best practices Implement quality improvement (QI) to address opportunities for improvement in clinical outcomes

4. BCBSM/BCN Provide support to the Coordinating Centers Offer an incentive payment design to participating member hospitals (FTE/P4P) Create a neutral ground for hospital collaborations

5. Coordinating Centers Organize and share clinical leadership resources and knowledge of best practices Develop and execute consortium-wide quality improvement agendas based upon collaborative data Provide analytic and quality improvement support

6. Coordinating Center QI Framework Continuous Quality Improvement Data Analysis Data Reporting Develop Best Practices Data Collection

7. 3 Why is the CQI model successful? Each Collaborative owns their data A foundation in confidentiality and a culture of trust ‘All boats rise’ through the all-payer data collection Harness the power of continuous quality improvement Rapid change grounded in evidence-based medicine

8. Why is the CQI model successful? “The CQI Projects effectively put the workings of comparative effectiveness research in the hands of the provider community, in real world situations, empowering them to use sophisticated scientific methods to rigorously assess and improve care affecting the entire population making hospitals self-optimizing institutions” – David Share, MD Senior Vice President, Value Partnerships, BCBSM

9. Improving the Quality of Care in Michigan Through CQIs Health Affairs, April 2011 Vol 30(4). p.1-11 By David A. Share, Darrell A. Campbell, Nancy Birkmeyer, Richard L. Prager, Hitinder S. Gurm, Mauro Moscucci, Marianne Udow-Phillips, and John D. Birkmeyer Regional collaborations between hospitals and physicians may be more effective than either selective referral or pay- for-performance in improving the quality of health care at the population level The improvement programs target clinical conditions and procedures that are relatively common and that are associated with high costs per episode

10. What is MSQC? An established Collaborative Quality Initiative (CQI)  Under the support of Blue Cross Blue Shield of Michigan and Blue Care Network (BCBSM/BSN), MSQC has been collecting and analyzing surgical data since 2005 for the purpose of improving patient outcomes and lowering cost. A high quality, clinically collected data registry  MSQC data is collected by a dedicated Registered Nurse employed at each hospital.  All abstractors are required to complete biennial certification exams. Inter-Rater Reliability (IRR) Testing is also performed on data collected by MSQC.

12. Confidentiality and Privilege MSQC is a listed Patient Safety Organization (PSO), which provides federal protections to its data. Under the Patient Safety and Quality Improvement Act (PSQIA), all MSQC reports are considered Patient Safety Work Product (PSWP). As PSWP, these reports are considered privileged and confidential and are not subject to legal discovery. Reports will be accompanied with the following disclosure statement:

13. What is a Patient Safety Organization? Legal structure in which healthcare providers can voluntarily disclose information, learn from mistakes, and avoid them in the future. PSOs are intended to incentivize providers to more openly share patient safety events using a common platform for relevant comparison and ultimately improvements in safety and quality of care.

14. Who Can View Reports? You and your hospital  With documented permission from your surgeon champion, any member of your institution will have access to comparison reports of your hospitals performance vs. the collaborative database. Individual Surgeons  Surgeons with 30 cases or more existing in the database will be able to view their own results.  These are accessible ONLY to the surgeon identified in the reports.

15. Providing Value to Member Hospitals Dashboard Reporting  MSQC provides reliable performance feedback using clinically collected data through a real-time, risk adjusted online reporting application.  Reports include both hospital and surgeon level comparisons in a confidential and protected environment. Continuous Collaborative Learning  MSQC is a forum for hospital and surgeon networking to explore opportunities to improve surgical care.  Meeting and conferences offer Continuing Medical Education (CME) credits and MSQC is approved by the American Board of Surgeons for Part 4 Maintenance of Certification (MOC).

16. Providing Value to Member Hospitals Valid data monitoring  Our Clinical Site Support Nurses provide initial and ongoing SCQR training and certification process, definition/variable support to ensure their consistent application and perform Interrater Reliability Review of collected data.  The data analysts perform data quality checks on hospital collected data, ensuring the data collected is useful and reliable for our member hospitals. Our analysts also provide support for retrieving and analyzing data so that hospitals can make the most of our rich and complex collaborative wide data. Site-specific Quality Improvement Initiatives  Our Quality Improvement Specialists work directly with each hospital to identify opportunities for improvement. They also provide resources to assist sites in implementing Quality Improvement Initiatives (QII). Confidential Mentorship Opportunities  MSQC facilitates hospitals learning by matching high quality and performance improvement institutions with those looking to improve in a specific clinical area.

17. Results and Achievements 73 participating member hospitals in Michigan (2015) 10+ years of improving surgical care (2015) 406,116 cases abstracted (2005-2015) 232 million dollars saved state-wide (2008-2012) 3,505 fewer occurrences of morbidity (2008-2014) 28% reduction in Surgical Site Infections (2008 – 2014) 80+ published journal articles (2015-2016) 15% reduction in length of stay (2005-2008)

18. Results and Achievements

19. TO REQUEST MORE INFORMATION PLEASE CONTACT US AT MSQC PSO MSQCCustomerSupport@med.umich.edu