Imagine you have incapacitating hip pain from degenerative joint disease. You undergo pre-operative testing, a hip replacement surgery, transfer to an inpatient rehabilitation hospital and then get physical therapy services at home. Your cousin went through the same surgery a year ago, and both of you had good outcomes.
But instead of going to the inpatient rehabilitation hospital as part of the care, your cousin went straight home from the hospital and had a visiting nurse and physical therapist help her start her rehabilitation.
The costs for these kinds of “episodes of care” — defined as care received for a particular condition before, during and after hospitalization — are a major contributor to the high costs of health care, and they vary widely among hospitals. For example, experts say there’s a nearly $20,000 difference in costs of performing cardiac bypass surgery among 27 hospitals in Michigan.
These variations are the subject of a new initiative sponsored by Blue Cross and Blue Care Network to help Michigan hospitals understand their utilization patterns and how they relate to costs and patient outcomes.
The Michigan Value Collaborative will be coordinated by the University of Michigan Health System using claims data from the Blues. It will examine costs and utilization patterns across 20 common conditions, including:
- Heart attacks
- Congestive heart failure
- Cardiac surgery
- Hip replacement
- Colon surgery
The analysis will include data compiled from all hospitals in Michigan. Individual hospitals will see their own data alongside data from other hospitals that are not identified.
The idea is to help hospitals understand which services they perform add value and which do not so doctors and hospitals can focus on providing high-value care.
“We often don’t know which services and procedures are the most efficient and effective for patients,” said Dr. David Share, senior vice president of Value Partnerships at BCBSM. “By participating in the Michigan Value Collaborative, hospitals can use our claims data to compare themselves to their peers, learn about what works to yield the best outcomes at the lowest cost and accelerate the adoption of practices that yield the highest value.”
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