The state of Michigan is home to the largest group of continuous quality improvement (CQI) collaboratives in the United States. In response to a charge from health care consumers and several large employers to improve the value of care, the state’s dominant private payer made the strategic decision to invest in a portfolio of collaboratives to create a statewide learning health system. These programs acknowledge that patients, clinicians, hospitals, and payers all want the same thing—high-value care.
In Michigan, the physician community sets a quality improvement agenda, which ultimately informs value-based reimbursement and pay-for-performance programs. These initiatives are pragmatic and evidence-based. Performance benchmarks and criteria for hospital and provider participation are set by the collaboratives and clinical community. This model acknowledges that effective quality improvement respects the tribal nature of medicine. Said another way, orthopedic surgeons will listen most to other orthopedic surgeons about how to improve orthopedic surgery.
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