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IHI 2024 Poster: Coverage Quest - A fantasy exercise to map coverage barriers and opportunities for improvement in type 2 diabetes care
Updated: 01/09/25
Presented at the Institute for Healthcare Improvement (IHI) Forum, December 10, 2024, Orlando, Florida.
Poster Title: Coverage Quest - A fantasy exercise to map coverage barriers and opportunities for improvement in type 2 diabetes care
Authors:
Noa Kim, MSI [1], Larrea Young, MDes [1], Amy Kuehls [1], Heidi L. Diez, PharmD, BCACP [1], , Jacqueline Rau, MHSA [1], Jacob Reiss, MHSA [1], Lauren Oshman, MD, MPH [1,2]
Affiliations
[1] Michigan Collaborative for Type 2 Diabetes (MCT2D), University of Michigan, Ann Arbor
[2] Institute for Healthcare Policy and Innovation (IHPI), Ann Arbor, MI
BACKGROUND: Coverage Quest is a fantasy-themed process mapping activity for healthcare providers to identify barriers, best
practices, and opportunities for improvement in navigating insurance coverage for diabetes treatments. Process
mapping is a widely accepted method to understand complex systems and processes, and guide the
implementation of quality improvement interventions in a wide range of industries.
The Michigan Collaborative for Type 2 Diabetes (MCT2D) identified insurance coverage as a major barrier to quality
care for patients in Michigan. Coverage is complex to navigate and frustrating for clinicians, leading to a reluctance
to engage in quality improvement (QI) efforts. To address this, MCT2D created Coverage Quest, a 45-minute
activity where 300+ practice champions collaboratively mapped their coverage processes and identified
opportunities for improvement during MCT2D regional meetings in April-May 2023.
MCT2D is a state-wide quality initiative supported by Blue Cross Blue Shield of Michigan that aims to improve the
treatment of type 2 diabetes. The statewide collaborative is made up of over 1,400 physician members,
representing 355 primary care practices, 26 endocrinology practices, and 14 nephrology practices from 24 of
Michigan’s 30 physician organizations.
AIM: Engage members in a conversation about the complexities of navigating insurance coverage and identify
improvement opportunities that the collaborative can address across multiple stakeholder roles.
METHODS: Participants were given a packet of materials including a game board (figure 1), sticky notes in 3 colors, labels representing different MCT2D coverage navigation resources, instructions, and a magic wand sticker. Participants used these materials to work individually or in small groups on a 45-minute process mapping activity.
This activity included four “levels” where content was added and two designated discussion periods (figure 2).
Participants used the different colors of sticky notes to map each step of helping a patient who couldn’t pick up
their diabetes medication due to a high copay (figure 3). Barriers they might encounter and best practices they
might use during the process were also added. Finally, they identified one area they wanted to improve, and wrote
an accompanying statement of improvement. Completed coverage maps were collected for analysis (figure 4).
A thematic analysis of the barriers, best practices, and statements of improvement included in participants’
coverage maps was conducted through pair-coding by three MCT2D team members. This analysis revealed 20
opportunities for improvement that fit into three key themes: knowledge (e.g., understanding the prior
authorization submission process), process (e.g., standardized clinic workflows for insurance coverage), and
resources (e.g., cost and staff time). These opportunities for improvement were mapped into four groups
representing key stakeholders in making improvements in each opportunity area: patients, practices, quality
improvement organizations, and public and private organizations.
RESULTS: Coverage Quest was received positively and resulted in 162 detailed coverage maps that provided valuable data including 20 opportunities for improvement that have informed MCT2D’s targeted QI efforts to address coverage barriers. Since Coverage Quest, MCT2D has kicked off or expanded work in several of these opportunity areas, including:
- Developing Coverage Checker, a centralized digital coverage tool to show preferred medications, how to bypass prior authorization (prior auth), prior auth criteria, auto-generated EHR documentation, and links to formularies. prior authorization (prior auth), prior auth criteria, auto-generated EHR documentation, and links to formularies.
- Conducting practice site visits to offer hands-on support in improving prescribing workflows.
- Conducting practice site visits to offer hands-on support in improving prescribing workflows.
- Providing additional point-of-care resources, including the MCT2D app, patient worksheets, copay coupon
- Providing additional point-of-care resources, including the MCT2D app, patient worksheets, copay coupon guides, and more.
Tags: Research, Created By MCT2D
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Support for The Michigan Collaborative for Type 2 Diabetes (MCT2D) is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships program.
Although Blue Cross Blue Shield of Michigan and MCT2D work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.