Frequently Asked Questions / More Information
MIBAC is a statewide quality improvement collaborative or CQI focused on improving outcomes for patients being treated for low back pain. The initial participants will include “first-contact” providers for patients with low back pain – primary care physicians (MDs/DOs) and chiropractors. It is the newest of the CQIs supported by Blue Cross Blue Shield of Michigan (BCBSM).
The over-arching goals of MIBAC are to improve processes of care and outcomes for patients with low back pain in “first-contact” settings, and to reduce the number of patients who develop chronic back pain. Within this broad set of goals, collaborative participants will identify priority targets for quality improvement, interact with each other to identify potential “best practices”, and participate in specific quality improvement initiatives.
MIBAC is the newest in the portfolio of CQI programs supported by BCBSM. The CQI programs share some basic features: a set of participating organizations (either hospitals or Physician Organizations (POs) and individual clinician participants; collection of patient-specific data for a central registry that supports comparative performance reporting and identification of “best practices”; regular interaction among participants to review data and plan QI activities; monitoring of progress over time on QI for selected metrics; and a Coordinating Center to provide the organizing and support functions for the collaborative.
MIBAC will address the problem of inefficient and widely-varying care practices, and unsatisfactory outcomes, for patients with low back pain. Low back pain can be frustrating for both patients and providers. There is often no single cause for the pain that can be “fixed” with one simple approach to treatment. The result is frequent unnecessary imaging studies and referrals, use of unproven therapies, over-use of opioids, and dissatisfied patients who never do get effective pain relief.
The initial goal of MIBAC is to give “first-contact” clinicians an effective set of tools and protocols with which to deal more effectively with patients with low back pain, through the training programs being offered by MIBAC. Past experience with these programs suggests that significant improvements in patterns of care (e.g., inappropriate use of imaging) will occur. MIBAC’s QI activities will be derived from their own registry data that show which approaches yield the best outcomes with the greatest efficiency, and then use the collaborative structure to spread those practices across the state.
MIBAC goals are to:
Participation in MIBAC is voluntary, but participants can be involved at three different levels of participation, each incentivized. The first level is a one-time provider training. Once trained, providers may then participate in the next levels which involve of data collection and quality initiatives.
Level I: Online training for primary care physicians (PCPs) and chiropractors (or in-person when feasible; two (2) hours for PCPs, twelve (12) hours for chiropractors) offer a framework for treating low back pain, treatment protocols and a “toolbox” of resources. This is evidence-based and will be CME/CE accredited.
Level II: Collection of patient-reported outcomes (PRO) data, with the primary data collection method being a smartphone. Level 2 participants will explore several possible uses of the PRO data, including feedback to clinicians on an individual patient basis for use in direct clinical care, and analysis of patterns in PRO data for purposes of structured quality improvement.
Level III: Abstraction and input of clinical data to the patient registry; collection of PRO data for the registry; ongoing analysis of registry data to identify “best practices” and opportunities for improvement; collaboration on statewide and local quality initiatives to improve care. This set of activities is the essence of CQI model.
The training involves educating providers on back pain pathway-based care This pathway takes established components of excellent clinical practices and retools them so each first-contact provider knows precisely when to provide such care components in the continuum of care to achieve the right patient -right treatment – right dose goal. This pathway has been vetted and tested as effective, resulting in better patient care.
The training programs from Spine Care Partners have been used in a variety of settings, in several different states (i.e. New York, Massachusetts, and Rhode Island), and have consistently had high levels of participant satisfaction and strong evidence of success in defined measures of appropriate care patterns (e.g. use of imaging, rate of surgical referrals, etc.). This program has been successfully implemented through Excellus Blue Cross and Blue Shield (Upstate New York).
All PGIP POs’ primary care practitioners (MDs and DOs) and chiropractors are invited to participate in the initial training and support activities. The practice-associated Advanced Practice Providers (NPs and PAs) will be eligible to participate in the training, although there is currently no reward mechanism in PGIP for their training. Chiropractors not in PGIP are also eligible to participate in MIBAC, if they are current BCBSM providers.
Participation in the registry, data analysis and organized QI initiative activities (Level 3) will be on a volunteer basis. We anticipate that the larger practices with EMR systems, greater patient volumes, and some form of QI infrastructure will be best able to participate in the registry and organized QI parts of MIBAC.
The role of the PO will vary at each level of participation. The first step for Level 1 is for an interested PO to agree in principle to participation by responding with a signed Commitment Letter. We expect POs to encourage and recruit most of their PCPs and chiropractors to complete the Level 1 training program. Participation in Levels 2 and 3 will depend on capabilities and interests of the POs and its member clinicians. We are currently in the process of determining the complete set requirements and incentives for participation in level 2 or 3. Only POs that commit to level 1 training will be eligible for the additional levels. Participation in advanced levels won’t commence till the 2nd half of 2021.
Practitioners will first complete the evidence-based MIBAC training (Level 1), then become part of a “MIBAC Provider Network”. Once training is completed, they may then be eligible to participate in advanced Level 2 and Level 3. Please see the specific details of what’s involved in each level below:
Level 1. Practitioners have an opportunity to collaborate with others in the MIBAC Provider Network (MPN) through online communication functions like message boards, chat rooms, webinars, and other functions that the MPN members may suggest or request. This allows for a free exchange of ideas and experiences — a key part of MIBAC.
Level 2. Practitioners will encourage their patients to use a smartphone (or other methods as needed and supported by MIBAC) to regularly report on outcomes such as pain relief, functional status, ability to work or activities of daily living, and satisfaction with care. Participants may receive status reports on these outcomes — at the individual patient level for either clinical action or inserting in patient medical records, or at the practice level showing patterns (averages, trends) if sufficient patient volumes available to support meaningful analysis.
Level 3. Practitioners will have clinical data collected from their back pain patients entered into a central registry (by a paid abstractor) and PRO data added to that registry. MIBAC data analysts will analyze care patterns and outcomes data and provide regular feedback on those patterns of care. The exciting opportunity is that such robust registry data will allow Level 3 practitioners to develop and prioritize structured Quality Improvement (QI) initiatives on both local and statewide levels.
MIBAC’s Coordinating Center is housed at Henry Ford Health System. The Coordinating Center is responsible for daily administrative activities related to ensuring active and engaged participation. They also support consortium participants in setting and directing the QI agenda for improving patient care processes and outcomes. The training programs are being implemented with the support of Spine Care Partners, who developed the evidence-based pathway training curriculum and achieved highly successful results.
The main reason is to improve patient care and outcomes for low back pain — a very common and expensive condition for which there is great variation in care patterns that often do not result in pain reduction. Effective treatment for acute pain is crucial to prevent progression to chronic pain. MIBAC provides a proven-effective pathway for effectively addressing acute pain. Beyond that, participation in MIBAC should help with improving performance on standardized metrics related to low back pain and cost of care that are used by private and public payors in pay-for-performance programs.
Based on our 25+ years of experience in Michigan with collaborative quality improvement programs, clinicians find CQI’s engaging, rewarding, and satisfying as a way of becoming better at what they do — as well as improve their patient outcomes!
More efficient and effective care, and better outcomes (e.g., less pain, quicker return to work and daily activity, and improved functional status) are the “center of the bulls-eye” goals for MIBAC.
The SCP training modules provide very useful tools and treatment protocols for management of low back pain. Participants receive CE or CME credits for participation, at no cost to the practice or the PO. Improved scores on metrics of patient satisfaction, utilization, cost, and process of care quality mean better performance in PGIP, MIPS, and other payor-based pay-for-performance programs.
Discussions are underway to link participation and performance success in MIBAC to enhanced reimbursement through their PGIP rewards program, Value-Based Reimbursement (VBR).
An introductory webinar describing MIBAC was offered to POs and independent clinicians in February and another is planned for March 2021. Online training sessions were open starting March 1, 2021.
The MIBAC coordinating center is reaching out to POs that participated in the February informational sessions to complete a commitment letter. This will also be posted on the PO Collaboration site. Please stay tuned to further details from our Coordinating Center staff, who’ll work with PO leadership to discuss further participation opportunities.
As a PO, once you have expressed interest in participating by signing the Commitment Letter, you will receive a registration link for PCPs (MDs/DOs) and chiropractors to register for the training. Please share the registration link with all your Practice Units and eligible clinicians.
As a PGIP PO-affiliated PCP, you will have access to the registration link. Any PCP who is interested in participating in MIBAC can register to access on-line training materials provided by Spine Care Partners.
The training sessions are available now as on-line programs. We are flexible – training can begin shortly after we receive a formal commitment from the PO to participate. Depending on the specific needs of POs and their affiliated practices, training can be offered in a defined short time frame as a “batch” or can be spread out to accommodate the schedules of individual practices and clinicians.
Later in the year if COVID restrictions ease to allow in-person trainings, such sessions could be scheduled for relatively large groups at a specific place and time throughout the state.
MIBAC will involve POs and individual practices representing the entire state.
No travel is required for on-line training sessions, unless POs want to gather groups of clinicians in a single location and do the online training as a group. If it becomes possible to do in-person training later in 2021, training sessions would be offered at a specific place and time (to be negotiated with participating POs or groups of independent practices), so some travel might be required. In any event, the travel would be local and probably not involve an overnight stay.
Sponsored by Blue Cross and Blue Care Network, Collaborative Quality Initiatives and Collaborative Process initiatives bring together Michigan physicians and hospital partners to address some of the most common and costly areas of surgical and medical care. These initiatives rely on comprehensive clinical registries that include data on patient risk factors, processes of care, and outcomes of care. Collection and analysis of procedural and outcomes data allows the participants to implement changes in practice, based on the knowledge acquired from the consortium. These changes in practices lead to increased efficiencies, improved outcomes, and enhanced value.
There are 18 Collaborative Quality and Collaborative Process Initiatives that contribute to Blue Cross Blue Shield of Michigan achieving a lower growth in medical cost trends than the national average. This savings helps hold down health care costs for our Blues customers statewide. For more information about the BCBSM CQI Program, please contact [email protected].
Value Partnerships is a collection of clinically-oriented initiatives among Michigan physicians, hospitals and Blue Cross that are improving clinical quality, reducing complications, controlling cost trends, eliminating errors, and improving health outcomes throughout Michigan.
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