What happens when hospitals that might seem like statewide competitors team up instead?

Hitinder Gurm, M.D., said, after 25 years, it's clear that statewide cardiovascular collaborative BMC2, formally known as the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, has made all of the providers better. Member hospitals share their data, best practices and lessons learned with each other to improve patient care and reduce health care costs.

"It's been a great source of partnership and collaboration, with all of us focusing on quality and transparency," said Gurm, a professor of internal medicine and chief clinical officer at University of Michigan Health's adult hospitals. Gurm, an interventional cardiologist at U-M Health's Frankel Cardiovascular Center, also serves as BMC2 program director.

Here, Gurm notes some of the most exciting achievements in the 25 years since the consortium began.

A statewide culture of collaboration

Although BMC2 started as a registry of percutaneous coronary intervention at five hospitals back in the '90s, it's expanded to include all non-federal hospitals in the state conducting PCI procedures to unblock arteries, and more than 85% of hospitals conducting qualifying vascular interventions. The hospitals track outcomes for PCI, vascular surgical procedures and, most recently, transcatheter aortic valve replacement, or TAVR, via the Michigan TAVR registry in collaboration with the Michigan Society of Thoracic and Cardiovascular Surgeons.

"There's something to be said about the entire state working together," Gurm said. In practice, that looks like 350 interventional cardiologists and 225 vascular specialists all on the same team as their 700,000-plus patients.

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For the last few years, the collaborative has been conducting peer review of blinded cases to find ideas that every provider might be able to take with them.

"There's really no such thing as the perfect health care system, and what we realized was each hospital is doing important work that can help others," Gurm said. "I've learned from colleagues at the big hospitals and colleagues at the smaller community hospitals. There's no sense of competition, because everybody wants to do the best for our patients, not just our own patients but also patients elsewhere around Michigan and beyond."

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Practice-altering insight on reducing contrast in kidney injury

The incidence of many complications in Michigan has declined substantially and the state now performs much better than the country overall on many process measures. One area where the collaborative has generated new knowledge that shaped the care of patients globally is the field of contrast-induced kidney injury.

The incidence of kidney injury, common after an interventional procedure, was reduced by 25.5%, Gurm said, thanks to best practices generated from BMC2 data. The collaborative developed a suite of kidney-injury prevention resources including a pre-procedure risk assessment tool and policies on pre-procedure hydration and new approaches to safe contrast dose control. Quarterly BMC2 reports were also modified to show kidney injury rates, risk assessment results, and hydration status.

"This approach has been adopted in many hospitals in the U.S.," Gurm said. BMC2 members published their findings in the journal JACC: Cardiovascular Interventions in 2018.

Better best practice adherence in vascular surgery

The connection with other providers that happens at regular meetings, and a monetary incentive to participate in the quality improvement database, is already improving care for people getting vascular surgery at BMC2-affiliated hospitals.

A 2021 study in the Journal of Vascular Surgery found "significant improvements in adherence to 'best practice' guidelines across a large, heterogenous group of hospitals" participating in the collaborative, the authors wrote.

"It's inspiring to see measures including appropriate prescribing of statins at hospital discharge, reduction in unnecessary blood transfusions, lower perioperative myocardial infarctions, correct approaches to intraoperative antibiotics and others now beyond the professional society average here in Michigan with BMC2," said Peter Henke, M.D., head of vascular surgery at the U-M Health Frankel Cardiovascular Center and the vascular surgery program director at BMC2.

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Looking forward

Gurm says the next 25 years will include more patient participation, especially the voices from BMC2's new patient advisory board. His goal is for the patient advocates to help guide the direction of future quality improvement efforts.

In addition, the team plans to add a focus on what happens after a patient leaves the hospital. They'll consider how best to optimize the long-term cardiovascular care of patients, including improving risk factor control, reducing the likelihood of future heart attacks and strokes, and promoting a return to an active lifestyle. 

Disclosure: Blue Cross Blue Shield of Michigan funds BMC2 as one of its collaborative quality initiatives, and the BMC2 Coordinating Center is housed at U-M.

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