MIBAC Key Questions for Potential Participants

What is the Michigan Back Collaborative (MIBAC)?

MIBAC is a statewide quality improvement collaborative focused on better care for low back pain by “first-contact” clinicians – primary care physicians and chiropractors.

Is this something new?

Yes – MIBAC was first discussed in the spring and summer of 2020 and will begin work with the first wave of participants in the first half of 2021.

What happens in MIBAC?

The first level of participation in MIBAC is on-line (or in-person when feasible) training for primary care physicians and chiropractors – two hours for PCPs and twelve hours for chiropractors. After that, for volunteer practices, collaborative quality improvement involves contributing data to a central patient registry, identifying “best practices” and opportunities for improvement from that registry, and working together on both state-wide and locally-focused quality improvement initiatives.

What do participating Physician Organizations (POs) or practices have to do?

The first step is to agree in principle to participation, and to encourage all affiliated PCPs and chiropractors to participate in the training program. Then, 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.

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). The training programs are being provided by Spine Care Partners, a group with extensive experience in successful provider training in New York and several other states.

Who can participate in MIBAC?

All Physician Organizations (POs) that are part of the BCBSM PGIP program are invited to participate in the initial training and support activities. There will be a phased roll-out of the additional collaborative quality improvement activities so that 10-12 POs will be asked to join in each of the collaborative’s first four years. Independent PCPs or chiropractors not affiliated with a PO can also participate in the training immediately, and in the other activities depending on practice structure and capabilities.

Would all practices within a Physician Organization be involved?

Participation in MIBAC is voluntary at both the PO level and practice 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. Participation in the registry, data analysis and organized QI initiative 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 parts of MIBAC.

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 (e.g., inappropriate use of imaging) will occur. Beyond that, the collaborative QI 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 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 training programs from 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 strong, tangible evidence of success in defined measures of appropriate care patterns (e.g., use of imaging, rate of surgical referrals). The collaborative QI activities follow the pattern of approximately 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 SCP training modules provide very useful tools and treatment protocols for management of low back pain. Participants receive CE or CME credits for participation, at no cost to the practice or the PO. 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.

Discussions are ongoing with BCBSM to link participation and success in MIBAC to enhanced reimbursement through the Value-Based Reimbursement (VBR) aspect of PGIP. Discussions are also ongoing about ways to provide reimbursement for administrative costs at the PO level for organizing and supporting participation in MIBAC.

When is MIBAC getting started?

The formal agreements to establish MIBAC were signed in January of 2021. An introductory webinar describing MIBAC will be offered to POs and independent clinicians in February and March of 2021. Interested organizational and individual participants will be identified immediately afterward, with the first step of participation – on-line training materials provided by Spine Care Partners – beginning as soon as possible after that.

When would my organization or practice have to make a commitment to participation?

An initial expression of interest following the introductory webinar is the first step; a formal agreement to participate should be completed by the end of March of 2021. Coordinating Center staff will work with PO leadership to discuss participation opportunities in greater detail.

When would the training sessions begin?

The training programs already exist, and will presumably be done on an on-line rather than in-person basis as long as COVID remains a problem. Training can begin within 3-4 weeks after a formal agreement to participate. Depending on the specific needs of POs and their affiliated practices, training can be offered in a defined short time frame as a “batch”, or can be spread out to accommodate the schedules of individual practices and clinicians. Later in the year if it is possible to do in-person training sessions, those would be scheduled for relatively large groups at a specific place and time.

When I click on the link in the “Provider Portal” on the main web page, either nothing happens or I get an error message.  What’s going on?

Many health care organizations have special security protections built into either the web browser functions or the e-mail system.  This is to protect confidential patient or organizational information, or to prevent employees from using organizational resources for social media or other personal purposes.  These protections can block access to the Provider Portal in some organizations.  If this happens to you, the first step is to contact your IT staff and ask for an exception to whatever rule or function is blocking access.   If this doesn’t solve the problem, contact the Coordinating Center at 33-874-2722 or at MIBAC@hfhs.org.