A report released by the Center for Healthcare Research & Transformation (CHRT) on the use of health care services in Michigan shows a high degree of variation in the use of certain tests and procedures — including back surgery, Cesarean section, hysterectomy and angioplasty — among different regions throughout the state.
The “Thumb”/Saginaw area had among the highest use rates for all procedures studied. The use of medication for pediatric attention-deficit/hyperactivity disorder (ADHD) also varied widely from region to region, with the Grosse Pointe, Grand Haven and Kalamazoo areas having the highest reported rates in the study.
“CHRTBook: Health Care Variation in Michigan” compares the state’s Blue Cross commercially insured population to the Medicare population, and looks at changes within the commercial population in overall use and geographic variation over the past 10 years. It was modeled after the groundbreaking Dartmouth Atlas of Health Care study.
“Geographic variation has been well-documented nationally and was a significant topic of discussion during the debate on health reform,” says Marianne Udow Phillips, director of CHRT, which is a partnership between U-M and Blue Cross Blue Shield of Michigan. “Developing a better understanding of variation in the use of health care services could support state and national efforts to improve quality and contain costs in the health care system.”
The report depicts an improving picture in some key areas, showing notable reductions in overall use for some procedures often considered to be “over-utilized.”
Highlights of the report include:
• Blue Cross Blue Shield of Michigan use trends are better than national trends for high-cost interventional cardiac procedures. This may indicate that more heart patients are being successfully treated with medical options over interventional options.
• In the Blue Cross Blue Shield of Michigan commercial population, hospital admission rates for conditions where all or part of the hospitalization could have been prevented (known as “ambulatory care sensitive conditions”) significantly decreased from an average of 71 admissions per 10,000 members in 1997, to an average of 36 admissions per 10,000 members in 2008.
• The data show a direct correlation between diagnostic and interventional procedures. For example, areas with high rates of CT scans for low back pain also had high rates of back surgery.
• Michigan, like the rest of the nation, is seeing a significant, unexplained increase in C-section rates. Every area in the state has increased its C-section rates in the last 10 years.
“This study shows that we can make a difference on health care cost and quality through innovations such as the cardiovascular collaborative initiative,” says Dr. Thomas Simmer, senior vice president and chief medical officer, Blue Cross Blue Shield of Michigan. “We’ll use the information in the report to further these collaborations for continuous improvement.”
