What is the Michigan Back Collaborative?
What is the Michigan Back Collaborative (MIBAC)?MIBAC is a statewide quality improvement collaborative with an initial focus on better care for low back pain by “first-contact” clinicians – primary care physicians and chiropractors. The current plan is to expand the program to include urgent care and emergency medicine physicians, as well as physical therapists, in 2023.
What are the components of the program?The MIBAC CQI involves training and quality improvement activities.  All components are voluntary, and non-dependent, with no obligation to progress to the next activity.

Quality Improvement: MIBAC quality improvement involves the use of Patient Reported Outcomes and collection of clinical and demographic data points (registry-building activities) which will build the MIBAC Registry. Regular analysis of registry data will be conducted to show variations in practice and key quality metrics. The value of data abstraction is to identify variations in key outcomes and process variables, as well as identify potential “best practices” in clinical and administrative areas of spine care. Collaboration of participating practices will occur via meetings and site visits with top-performing practices to review data, share experiences, and present successful outcomes for patient care.

Practitioner Training: MIBAC involvement includes a training component for PCPs and Chiropractors (for the purposes of MIBAC, included PCPs are those serving the adult population). The training is focused on the biopsychosocial model of spine care management. Solutions in spine care management and techniques to foster inter-professional and doctor/patient partnerships are emphasized. For 2022, PCPs are required to complete a 90-minute online and on-demand training module. There are two options available to Chiropractors with the requirement of a 100-minute online training and/or the recommended option of a 12-hour on-line or in-person session available specifically for chiropractors. CME / CE is available for both sessions if you have not taken the training previously. Please contact us for further information.

All levels of MIBAC are voluntary, and the completion of one level does not need to occur before the PO/practice/provider enrolls in another level. Progression of levels in the MIBAC CQI will have overlapping measurement periods and incentives that are available for providers and POs throughout program commitment. The ultimate goal of the MIBAC CQI and intrinsic value for all those who participate is to provide “first-contact” clinicians with an effective set of tools with which to treat lower back pain and achieve positive outcomes for those suffering.  The value of the data collected and analyzed through this initiative will identify approaches to yield the best outcomes with the greatest efficiency, to communicate and impact patient care on a statewide basis.

Collaboration amongst providers will be coordinated through the MIBAC Coordinating Center via meetings, webinars, surveys and follow-up communications.

*PCPs must be a PO member to participate, and must be PCPs serving the adult population, and chiropractors must be a BCBSM provider.
If I am a Physician Organization representative, how do I get our group started on the program?The first step is to commit to participating in MIBAC, and to encourage affiliated PCPs and chiropractors to participate in the training program. Once a PO is committed for the training component, they can remain in this activity for several years. A subset of practices that are willing and able to participate in the registry and the collaborative QI activities will be identified and will begin that phase of the work, usually in year two or later down the road. This will require an additional participation commitment. If you are a PO and are interested in more information, please fill out the “contact us” form at the bottom of the page.
Is there a cost to participate?There is no cost to the PO, practice, or practitioner for MIBAC participation. For CME / continuing education costs, please refer to your accrediting institution for details
How can I ask questions or trouble-shoot issues with participate?What type of support is available if I have any questions or issues with participation?
Program support is available at 313-693-5180 (the MIBAC Coordinating Center), [email protected], or by filling out the “contact us” form below. Technical support is available by sending an email to [email protected] This creates a ticket which is tracked in our system to insure adequate follow-up and resolution.

During normal business hours, we can usually assist you right away. After business hours, please leave a message and we will reach out to you on the next business day
What is on the horizon for the collaborative?Ultimately, an Executive Committee will make the decisions on clinical initiatives for the collaborative. However, for the "work" of the program, including managing PO and provider relationships, arranging CME, collaborating with BCBSM to set up incentives, reviewing the program's budget and strategic plan, etc., that is done by the MIBAC Coordinating Center (CC). The CC consists of clinical leadership provided by three directors (see "our team" for more information), and an operations team consisting of program management, analytics, etc. This CC is based at Henry Ford Health in Detroit. The collaborative is funded by Blue Cross Blue Shield of Michigan (BCBSM).
Who can participate in MIBAC?
Their are different types of participation in MIBAC. For Quality Improvement, active patient enrollment is performed by PCPs and Chiropractors, along with their site teams. Additionally, the Coordinating Center (CC) meets with a variety of disciplines, including PM&R, Emergency Medicine, and Physical Therapy, for feedback on the program. Additionally, the MIBAC Steering Committee will include specialty-level clinicians such as PM&R along with Physical Therapy. Providers from these disciplines are able to take the on-demand practitioner training, however, they are not eligible for BCBSM incentives at this time.

Primary Care Physician (PCP) Participants must be in a Physician Organization (PO) and the PO must have them included in their Physician Group Incentive Plan (PGIP) list.  For the purposes of MIBAC, included PCPs are those serving the adult population. Although PCPs are not required to have a Patient-Centered Medical Home (PCMH) designation to participate, only those who do so are eligible for Value Based Reimbursement (VBR). 

Chiropractors must be BCBSM providers, and may belong to a PO but that is not a requirement. 

All Physician Organizations (POs) that are part of the BCBSM PGIP program are invited to participate in the initial practitioner training. Independent chiropractors not affiliated with a PO but who are BCBSM providers can also participate in the training and in the other activities depending on practice structure and capabilities.
Why should this be important to me?
Why is back pain so important?
Low back pain can be frustrating for both patients and clinicians. There is often no single cause for the pain that can be “fixed” with one approach to treatment. There can then be unnecessary imaging studies and referrals, use of unproven therapies, over-use of opioids, and dissatisfied patients who never do get effective relief of pain.

Back pain is the leading cause of disability worldwide.
What are the goals of the collaborative?
The goal of MIBAC is to decrease the rate of conversion from acute to chronic low back pain. Our belief (backed by research) is that the first encounter with their healthcare provider after the onset of low back pain can substantially impact the outcome. We are collecting data points in our registry from the first visit for the episode of pain, such as details on the referrals made, medications recommended, and tests conducted or ordered, along with Patient Reported Outcome (PRO) surveys completed by the patients at baseline, 1 month, 2 months, 3 months, and 6 months. 

The intent is, through thorough data analysis, to identify correlations for further investigation. (E.g., patients who are not prescribed opioids have better outcomes at 3 months). We are focusing on the PROMIS Pain Interference (PROMIS PI) which will collect "T" scores from the patient surveys, as well as the STarT Back tool at baseline to stratify the patient's level of risk into one of three categories. To collect these metrics, we are working closely with PatientIQ. 

PatientIQ has built our registry and manages the platform, assists with data analysis, performs complex reporting, troubleshoots user-challenges, and advises the MIBAC Coordinating Center in many areas of the quality improvement (QI). The collaborative quality improvement activities will use the registry data to identify approaches that seem to yield the best outcomes with the greatest efficiency, and then use the collaborative structure to spread those practices across the state.

MIBAC offers training programs designed to give “first-contact” clinicians an effective set of tools and protocols with which to deal more effectively with patients with low back pain. Past experience with these programs suggests that significant improvements in patterns of care will occur. Our current training is a 90-minute on-demand module designed and presented by the team at Spine Care Partners.

The overall goals of MIBAC are better and more effective care patterns, better outcomes for patients, and greater satisfaction for both clinicians and patients.
Why should a Physician Organization (PO), practice, or clinician want to participate?
The fundamental reason to be involved in MIBAC is better patient care and better outcomes for a common clinical condition that can be frustrating for patients and clinicians alike. Beyond that, participation in MIBAC should help with standardized performance metrics related to low back pain specifically and to population cost of care more broadly that are used by private and public payors. Based on 25+ years of experience in Michigan with collaborative quality improvement programs, clinicians find them engaging, rewarding, and satisfying as a way to become better at what they do.

Additionally, happy patients return to you, tell their other healthcare providers about the care you provided, and tell their friends. Providing the highest quality care and involving the patient in their care plan will boost patient self-efficacy and improved satisfaction. If you are being "measured" on other metrics (i.e., HEDIS or others), participation in MIBAC can be another way to improve your scores on these measures. If you bring your colleagues from your practice it can streamline how we talk to patients and reduce variations in verbiage, pathways, etc., when sharing patients.
What evidence is there that this type of program will impact outcomes?
The Collaborative Quality Initiative (CQI) program has been highly effective in improving the health of our state, by investigating, educating, and incentivizing high-quality care. Clinicians want to help their patients! When they are shown proof of efficacy for a treatment technique, medication, referral pathway, etc., they will adopt those changes to do what is best for their patients, and the CQI model guides that process, collects relevant existing research, performs pilots with participating sites, educates the state (and further), and collaborative celebrates successes.

The collaborative quality improvement activities follow the pattern of more than 20 other BCBSM-supported statewide improvement collaboratives that have consistently demonstrated tangible improvements in processes and outcomes of care, and real savings to employers and citizens of Michigan in general who incur the cost of medical care. Henry Ford Health houses the Coordinating Centers for MIBAC, MSSIC (Michigan Spine Surgery Improvement Collaborative), and MiMIND (Michigan Mental Health Innovation Network for Clinical Design), and the remainder of the Coordinating Centers are housed at Michigan Medicine / University of Michigan Health System.

The practitioner training programs provided by Spine Care Partners have been used in a variety of settings, in several different states, and have consistently had high levels of participant satisfaction and incorporate evidence-based evaluation and treatment methods for the care of acute low back pain. The collaborative quality improvement activities follow the pattern of more than 20 other BCBSM-supported statewide improvement collaboratives that have consistently demonstrated tangible improvements in processes and outcomes of care, and real savings to employers and citizens of Michigan in general who incur the cost of medical care.
How can I ask questions or trouble-shoot issues with participate?
The most effective way to get support from our team is to email us at: [email protected] 

Emailing us at the address above creates a ticket in our system and notifies all of us that someone needs assistance. Between 8:30 am - 5:00 pm Monday-Friday, A team member sees the ticket and routes it to the individual best able to respond, and it is tracked through our system from the day the email is received through the time the ticket was closed. Program support is also available at 313-693-5180 (the MIBAC Coordinating Center), [email protected], or by filling out the “contact us” form on this website. 

During normal business hours, we can usually assist you right away. After business hours, please leave a message and we will reach out to you on the next business day
Details of Participation
When do each of the MIBAC activities begin?
That is a complicated question! Clinicians in committed Physician Organizations can begin training any time (see "register for training" on our home page), as can any Blue Cross Blue Shield of Michigan participating Chiropractor. Quality Improvement participation begins at specific times of the year with some commitments due May 1st and some commitments due November 1st. Please email Diane at [email protected] for questions. Alternatively, if you return to the home page and select "Join MIBAC", you can fill out a participation form. This will either prompt the enrollment process, or we will contact you to discuss the timeline and will put you on the list for the next available enrollment date.
If I am really engaged and want to fully participate, do I need to travel?
For clinicians engaged in the training activities or in Quality Improvement activities, there is no travel required at this time (this may change at a future date). If you are nominated to the Steering Committee or Executive Committee, there will be some travel involved within the state. In 2023, we are holding meetings in New Hudson, Ann Arbor, Midland, and Grand Rapids, and members of these committees are expected to attend one in-person meeting per year. These meetings are two to three hours long, usually include a guest speaker as well as presentations from our directors, and of course a delicious dinner is provided to our guests.
As a participant, how can I get assistance or ask a question?
The most effective way to get support from our team is to email us at: [email protected] 

Emailing us at the address above creates a ticket in our system and notifies all of us that someone needs assistance. Between 8:30 am - 5:00 pm Monday-Friday, A team member sees the ticket and routes it to the individual best able to respond, and it is tracked through our system from the day the email is received through the time the ticket was closed. Program support is also available at 313-693-5180 (the MIBAC Coordinating Center), [email protected], or by filling out the “contact us” form on this website. 

During normal business hours, we can usually assist you right away. After business hours, please leave a message and we will reach out to you on the next business day
© 2023 Henry Ford Health. All Rights Reserved.