
Cardiovascular disease is the leading cause of death for both men and women in the United States and costs the healthcare system about $229 billion year. (1,2) In Michigan, the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, is a leader in making cardiovascular care safer and higher value when compared to the nation. This cardiovascular CQI has outperformed national rates in a number of key areas of quality improvement, including prescribing recommended medications, referral to cardiac rehabilitation, reducing hospital length of stay, blood transfusions and mortality rates.
Prescribe Medications
In patients who have had coronary angioplasty and stenting (percutaneous coronary intervention, or PCI), BMC2 data demonstrate that Michigan physicians are increasingly focused on prescribing guideline-recommended medications that reduce cholesterol and prevent blood clots and do so consistently above the national average. BMC2 hospitals also have a steady low rate of blood transfusion after PCI over time and below the national average. Similarly, among VS patients, BMC2 hospitals prescribe guideline-recommended medications at a higher rate than national counterparts.
Refer to Rehab
Additionally, BMC2 surpasses the nation when it comes to post-PCI referral to cardiac rehabilitation; a 90% referral rate in Michigan translates to over 2318,000 patients referred to cardiac rehab each year. Each of these interventions contributes
to improved long-term health outcomes and reduction in hospital readmissions.

Reduce Length of Stay

Michigan hospitals demonstrate consistent year-to-year improvement in decreasing the length of hospital stay for endovascular aneurysm repair (EVAR) patients, increasing patient satisfaction, improving outcomes, and saving costs.
MISHC hospitals have a lower overall death rate when compared with the nation since 2017, including a 64% decrease over time. MISHC hospitals also maintain a steady decreasing rate of blood transfusions with over 4000 transfusions avoided, after MISHC set a statewide goal, issued best practice protocols and quarterly data reports, and convened consortium meeting presentations and discussions.

Conclusion
The power of CQIs is evident in BMC2 performance on key measures of quality when compared to national rates and is further supported through research: a recent article by Beaulieu et al. (3) demonstrated that participation in BMC2 is a key contributor toward increased adherence to best practices, and that hospital performance improves the longer they are members. The collaboration across BMC2 overcomes the silos and barriers of traditional market and academic competition. Patients in Michigan clearly benefit from the strength of the collaborative work of BMC2 through improvements in care and outcomes.
About BMC2
BMC2 is a consortium of healthcare providers dedicated to improving quality of care and outcomes for patients with cardiovascular disease including those having coronary angioplasty and stenting (percutaneous coronary intervention, or PCI), vascular surgery (VS) for aneurysm repair, bypass surgery for peripheral arterial disease, carotid endarterectomy and stent, and transcatheter aortic and mitral valve replacement and repair procedures.
BMC2 drives quality improvement through collection and reporting of procedural variables and outcomes to individual physicians and participating hospitals, convening members at statewide meetings to share best practices, peer review of select PCI and vascular surgery procedures to improve procedural quality and appropriateness, dissemination of best practice protocols designed to increase quality and consistency of care, and incorporation of patient perspectives into quality improvement through the PCI Patient Advisory Council.
BMC2 comprises three statewide quality improvement data registries: BMC2 PCI, BMC2 Vascular Surgery, the Michigan Structural Heart Consortium (MISHC), a collaboration with the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, and the Michigan Cardiac Rehab Network in collaboration with the Michigan Value Collaborative. Over 70 hospital team, 500 physicians, and 50 facilities participate in BMC2, contributing data on 30,000 patients annually.
1. Centers for Disease Control and Prevention, National Center for Health Statistics. About Multiple Cause of Death, 1999–2020. CDC WONDER Online Database website. Atlanta, GA: Centers for Disease Control and Prevention; 2022. Accessed February 21, 2022.
2. Agency for Healthcare Research and Quality. Medical Expenditure Panel Survey (MEPS): household component summary tables: medical conditions, United States. Accessed April 8, 202
3. Beaulieu RJ, Albright J, Jeruzal E, Mansour MA, Aziz A, Mouawad NJ, Osborne NH, Henke PK. A statewide quality improvement collaborative significantly improves quality metric adherence and physician engagement in vascular surgery. J Vasc Surg. 2022 Jan;75(1):301-307. doi: 10.1016/j.jvs.2021.07.234. Epub 2021 Sep 3. PMID: 34481901.