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Improving cardiac rehabilitation statewide
February is American Heart Month, which commemorates the more than 600,000 Americans who die from heart disease each year and raises awareness about strategies to support heart health.
One of these strategies is cardiac rehabilitation. CR is a medically-supervised program that combines exercise, education, peer support and counseling to help patients recovering from a cardiac event, disease or procedure.
Benefits of CR
Evidence shows that CR saves both lives and money. A 2016 meta-analysis* estimated that for every 37 coronary heart disease patients who attend CR, an average of one life is saved. Additionally, a study of percutaneous coronary intervention patients between 2015 and 2019 conducted by the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, and the Michigan Value Collaborative, or MVC, found that CR resulted in an estimated 86 saved lives, 145 avoided readmissions and approximately $1.8 million in savings.
CR utilization today
Despite this, CR remains heavily underutilized. Today, only one in three eligible Michiganders participates in a single CR session — a rate well below the Million Hearts* nationwide goal of 70%. Reports also show wide variability in CR utilization rates between Michigan hospitals (Figure 1).
Figure 1. Sample figure from the October 2022 Michigan Cardiac Rehabilitation Network cardiac rehab report (click to enlarge)
Collaborative response
In response, the Michigan Cardiac Rehabilitation Network, or MiCR, was established to equitably increase participation in CR for all eligible individuals in Michigan.
“We are really excited to combine the strengths of BMC2 and MVC with the tremendous passion for cardiac rehabilitation demonstrated by health care providers and personnel across the state in an effort to improve the care of thousands of patients every year,” said Devraj Sukul, M.D., M.S. Dr. Sukul is the co-director of MiCR, associate director of BMC2 for percutaneous coronary intervention and an interventional cardiologist at Michigan Medicine.
MiCR goals
The MiCR team established new, statewide goals to improve CR utilization and quality. They are working on number of efforts to meet these goals:
- Incentive measures: The MVC component of the Blue Cross Hospital Pay-for-Performance Program now includes a CR-related measure. Hospitals being scored on this measure will receive more points if their CR utilization rate improves over time or is greater relative to their peers. MVC aims to coordinate with participating sites and their respective BMC2 or Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative colleagues to help maximize quality improvement efforts.
- Stakeholder meetings: The MiCR team will host virtual and in-person meetings throughout the year. At MiCR’s first official meeting in October 2022, speakers discussed cultivating buy-in from clinicians and administrators, navigating challenges with insurance coverage and improving patient and provider engagement for CR.
- Best practices toolkit: The MiCR best practices toolkit outlines CR quality improvement strategies. MiCR contributors hope to support the implementation of these strategies at partnering hospitals.
- Patient and provider tools: MiCR is working with the Healthy Behavior Optimization for Michigan team to develop patient and provider-facing tools for improved CR enrollment.
- Increased awareness: “Physician endorsement and referral play a critical role in a patient’s decision to enroll in cardiac rehab,” explained Mike Thompson, Ph.D., co-director of MiCR, co-director of MVC and assistant professor in the Department of Cardiac Surgery at Michigan Medicine. “Improving awareness of its benefits among patients and physicians will save lives, improve health and improve the sustainability of healthcare in Michigan.”
The MiCR team anticipates these efforts and tools will help hospitals remove barriers to participation and increase patients’ commitment to full CR participation.
*Blue Cross doesn’t own or control this website.
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