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Establishing and Running Quality Collaboratives: The Michigan Experience
Key Points
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Healthcare quality is high, and costs are low in Michigan.
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The Continuous Quality Improvement (CQI) platform is a statewide learning health system that informs a physician-led, value-based reimbursement scheme.
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The quality agenda in Michigan is outsourced to the physician community and bolstered by a robust value-based scheme that is informed by high-quality registry data that is actionable.
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Financial incentives are important drivers of quality improvement but rarely motivate clinicians to practice change.
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It is unclear whether the CQIs can have success using their quality improvement methods to address gaps in health equity and poor health behaviors, but that is the next challenge.
Approximately 20 years ago, healthcare purchasers in Michigan engaged with the state's dominant private payer to make the strategic decision to invest in a portfolio of collaboratives. This created a statewide learning health system known as the Continuous Quality Improvement Collaboratives (CQIs). The goal of the collaborative work is to drive value and improve health care for patients, clinicians, payers, and purchasers.
The CQIs were born out of efforts to improve perioperative care but have grown to more than 20 specialty or disease-based CQIs. Quality of care is high in Michigan, and costs are the lowest in the United States. As a result, many health systems, payers, and regional healthcare organizations have asked the CQI portfolio to share the framework. In this context, we identify the key domains for developing a successful CQI program within a region.
Funding of the Collaborative Portfolio
Doing CQI work requires a significant investment. In Michigan, the CQI platform is funded by many tens of millions of dollars because detailed and continuous CQI work requires dedicated, full-time, expert support in clinical implementation, statistics, change management, and administration. The collaborative coordinating centers boast a staff of more than 200 full-time employees that dedicate their efforts to improve the value of care in the state of Michigan. This has been a good investment for the large statewide private payer.
The most common question asked by stakeholders outside of the state of Michigan is, “How is all of this paid for?” In short, reimbursement for hospitals and physicians over the past 20 years in Michigan has been held relatively flat with an increasing proportion of payment put at “risk” via value-based reimbursement and pay-for-performance endeavors. This large resource pool of clinical dollars from the statewide private payer funds the infrastructure, including the CQIs, to engage clinical stakeholders, drive change, and measure performance.
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