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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. The current plan is to expand the program to include urgent care and emergency medicine physicians, as well as physical therapists, in 2023.

Is this something new?

MIBAC is nearing the end of the 2nd 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. On October 1, 2022 Quality Improvement activities are being launched.

What are the components of the MIBAC 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.

  • Training
  • Quality Improvement

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.

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.

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 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 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 the MIBAC  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-December 31, 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 at any time (with varying incentive dates based on date of commitment), with a statement of interest via an email to the Coordinating Center (dwalker3@hfhs.org). Based on feedback from our Clinical Champions and PO leadership, training will be available through 12/31/2022. Training is available for all PCPs serving the adult population and affiliated with a PGIP PO, chiropractors contracted with BCBSM, and APPs within Michigan. This training is available on this website under the “Training” link. CME / CE is available for eligible participants.

POs and independent chiropractors who train in 2022 may 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)

Enrollment in PatientIQ, the Patient-Reported Outcome platform (registry) selected by MIBAC, is available to anyone who took the MIBAC training in 2021, or immediately after completion of the training in 2022. 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 opportunities will be offered starting in September of each year, with enrollment criteria completion by June.

  • For Physician Organizations (POs): commitments are complete for the first round (September 1, 2022-March 1, 2023 launch). Starting in December of 2022, we will begin to recruit for a September 1, 2023 Quality Improvement launch. Please check back for details. You can email us at mibac@hfhs.org with any questions.
  • For Independent Chiropractors: commitment dates vary. Please email us at mibac@hfhs.org with questions.

Where?

Is MIBAC just for selected parts of Michigan?

MIBAC will involve Physician Organizations (POs) and individual chiropractors from throughout the state. There are currently 21 POs and more than 100 chiropractors engaged in MIBAC activities. More than 800 practitioners in our state were trained in 2021, including approximately 400 Independent Chiropractors.

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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