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What?

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. Additional provider types will be included in the program in the future.

Is this something new?

MIBAC is now entering its’ second full year – MIBAC was first discussed in the spring of 2020 and training was initially rolled out to our first cohort of PCPs and chiropractors in 2021.

What are the components of the MIBAC program?

The MIBAC CQI involves training and quality improvement activities.  All components are voluntary, non-dependent, with no obligation to progress to the next activity.

  • Training (Previously known as Level 1)
  • Quality Improvement (Previously known as Level 2 and Level 3)

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. PCPs are required to complete a 90-minute on-line 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.

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 variation 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.

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.

What do participating Physician Organizations (POs) or practices have to do?

The first step is to commit to participating in MIBAC, and to encourage all 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 one year or two. Then, 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. 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 in MIBAC?

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.

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), mibac@hfhs.org, or by filling out the “contact us” form below. Technical support is available by sending an email to support@mibaccqi.zohodesk.com. 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 happens in MIBAC?

In the MIBAC program, practitioners take a training module, utilize Patient Reported Outcomes via the PatientIQ platform, contribute data into our registry, attend meetings and/or watch informational webinars regarding best-practices that are derived from your efforts with the data collection activities, and apply these practices to your own patient population. *PCPs must be a PO member to participate, and must be PCPs serving the adult population, and chiropractors must be a BCBSM provider.

What comes next?

What is ahead for MIBAC:

First, and foremost, research indicates that Collaborative Quality Initiatives work. There have been successes throughout the healthcare industry for more than two decades!  Healthcare professionals have realized tangible improvements in processes and outcomes of care for their patients, as well as the added benefit of real savings passed on to employers and citizens of Michigan in general who incur the cost of medical care.

The value of participation in MIBAC that will help to create a registry which will ultimately provide useful tools and treatment recommendations for the conservative management of low back pain with the application of evidence-based knowledge.

More efficient and effective care, and better outcomes (e.g., less pain, quicker return to work and daily activity, better functional status) are the “center of the bulls-eye” goals for MIBAC. 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.

Who?

Who is organizing MIBAC?

A Coordinating Center based at Henry Ford Health in Detroit will organize the work of MIBAC; financial support for MIBAC is provided by Blue Cross Blue Shield of Michigan (BCBSM) and Blue Care Network (BCN).

Who can participate in MIBAC?

PCP Participants must be in a Physician Organization (PO) (*for the purposes of MIBAC, included PCPs are those serving the adult population). Chiropractors must be BCBSM providers. All Physician Organizations (POs) that are part of the BCBSM PGIP program are invited to participate in the initial practitioner training. There will be a phased roll-out of the additional collaborative quality improvement activities so that additional POs will be asked to join in each of the collaborative’s first four years. Independent chiropractors not affiliated with a PO but who are BCBSM providers can also participate in the training during the training period (for 2022 is April 1-November 1, 2022), and in the other activities depending on practice structure and capabilities.

Would all practices or practitioners within a Physician Organization be involved?

Participation in MIBAC is voluntary at both the PO level and practitioner level. All PCPs and chiropractors will be invited to participate in the training programs being offered. PAs and NPs who work in primary care practices and see patients with low back pain are also invited, but are currently not eligible for BCBSM-offered incentives. CME / CE is offered to all practitioners (for APPs they are ACCME credits). Participation in the registry, data analysis and organized quality improvement activities will be on a volunteer basis; typically, larger practices with EMR systems, a larger patient volume, and some form of QI infrastructure will be best able to participate in the registry and organized QI components of MIBAC.

Why?

What problems is MIBAC designed to address?

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.

What are the goals of MIBAC?

The initial goal of MIBAC, through the training programs being offered, 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. Past experience with these programs suggests that significant improvements in patterns of care will occur. Beyond that, 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.

The goals are better and more effective care patterns, better outcomes for patients, and greater satisfaction for both clinicians and patients.

Why should a PO or an independent practice want to be in MIBAC?

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 in pay-for-performance programs. 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.

What evidence is there that this approach can be successful?

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.

Why would this be good for my/our patients?

More efficient and effective care, and better outcomes (e.g., less pain, quicker return to work and daily activity, better functional status) are the “center of the bulls-eye” goals for MIBAC.

Why would this be good for my organization or practice?

The training modules provide useful tools and treatment recommendations for the conservative management of low back pain with the application of evidence-based knowledge. Eligible participants may receive CE or CME credits for participation. 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.

BCBSM is offering Value-Based Reimbursement (VBR) to link participation and success in MIBAC to enhanced reimbursement. For quality improvement activities, participants who meet eligibility criteria, VBR is being offered at the time of launch to offset the costs of implementation, practitioner support, and building the necessary infrastructure to participate successfully.

When?

When do MIBAC activities begin in 2022 for practitioners and POs new to the collaborative?

Practitioner Training

New Physician Organization (PO) commitments are welcome between now and June 1, 2022, with a statement of interest via an email to the Coordinating Center (dwalker3@hfhs.org) requested by April 15, 2022 (this is a flexible requirement, however, we are limiting the number of PO commitments for 2022, so it is highly encouraged). The next phase of training will go live on April 1, 2022 and will run through November 1, 2022, and is available for all PCPs serving the adult population and affiliated with a PGIP PO, chiropractors contracted with BCBSM, and APPs within Michigan. Training was previously known as Level 1 – however due to confusion we are working on rebranding our program labels. This training will be eligible on this website under the “Training” link beginning April 1, 2022. The practitioner training will be available on our website under “Training” from April 1 – November 1, 2022. CME / CE is available for eligible participants.

Independent chiropractors who are contracted with BCBSM are invited to begin training at any time, it will be available on our website under “Training” from April 1 – November 1, 2022

All POs and independent chiropractors who train in 2022 will be eligible for the Quality Improvement activities in 2023, and they are able to participate in the Patient Reported Outcome (PRO) platform provided by PatientIQ immediately after training, by completing the PatientIQ enrollment form under the “Members” tab.

    When can participants begin using PatientIQ for PROs?

    Patient Reported Outcomes (PatientIQ)

    Previously known as Level 2, this activity is currently open for anyone who took the MIBAC training in 2021. Please visit the “Members” tab and complete the “MIBAC / PatientIQ Registration Request” form if you are interested and a Coordinating Center representative will contact you.

    When do Quality Improvement (L3) MIBAC activities begin in 2022?

    Quality Improvement: Patient Reported Outcomes (PROs) plus contribution of clinical and demographic patient data to the MIBAC registry

    Quality Improvement is available after the first year of commitment to MIBAC. For 2022, this will include the 20 Physician Organizations (POs) engaged in 2021.

     

    • For Physician Organizations (POs): commitments are currently being sought from Cohort 1 POs – those that began training activities in 2021 – with a request for letters of interest by June 1, 2022 and a formal participation agreement signed by July 1, 2022. The letter of interest form is available to PO leadership from the Coordinating Center. Please email lmille32@hfhs.org to get a copy for your team. Enrollment may be limited if the interest is excessive to our capabilities to successfully administer these activities.
    • June 1, 2022: Letter of Interest due
    • July 1, 2022: Participation Agreement due from PO
    • July 15, 2022: PO agreements with participating practitioners due
    • For Independent Chiropractors: BCBSM practitioners not affiliated with a PO have slightly different due dates, with interest forms requested by June 15, and a formal participation agreement and plan due by July 15, 2022. For this group only, letters of interest can be filled out online here at our website. Please visit the “Members” tab and complete the “Letter of Interest” form. This is transmitted directly to the Coordinating Center, and we will reach out to you with more details, including a participation agreement. Please email mibac@hfhs.org with any questions.

    Where?

    Is MIBAC just for selected parts of Michigan?

    MIBAC will involve POs and individual chiropractors from throughout the state. In the first year, 20 POs were be engaged as “first cohort” participants, and they may be concentrated somewhat in one part of the state or another, but the collaborative seeks to involve POs and independent chiropractors from the entire state. More than 800 practitioners in our state were trained in 2021.

    Do participants have to travel to attend training sessions?

    No travel is required for on-line training sessions, unless POs want to gather groups in clinicians in a single location and do the on-line training as a group. If it becomes possible to do in-person training, 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.

    Where can I go to get more information?

    Please use the “contact us” form at the bottom of the page – we will receive your request and someone from the Coordinating Center will contact you. Alternatively, you can email us at mibac@hfhs.org. Please allow 2-3 business days to return your call, although we strive to answer on the same day.

    Testimonials

    “I thought the training was excellent. It strongly reinforced what we already know - that conservative management of low back pain leads to better results, lower cost, and helps patients learn how to self-manage this often chronic recurring problem.”

    David Parker, MD

    “I am thrilled to be involved in MIBAC because it helps to align the values of excellent patient care with provider decision and reimbursement. It’s an opportunity for providers to control their own destiny by advocating for their patient’s interests.”

    James Leonard, DC

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