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    MUSIC: How statewide initiative is improving care, outcomes

    Khurshid R. Ghani, MDKhurshid R. Ghani, MD David C. Miller, MD, MPHDavid C. Miller, MD, MPH

    Today’s health care landscape places much emphasis on outcomes, quality improvement, and value, and urology practices must adapt to the changing paradigm in order to survive. But how? The state of Michigan has a possible solution in the form of the Michigan Urological Surgery Improvement Collaborative (MUSIC). In this interview, Khurshid R. Ghani, MD, and David C. Miller, MD, MPH, of the University of Michigan, Ann Arbor, discuss the origins of MUSIC, what it’s done for prostate cancer care in Michigan, and how a similar model could be rolled out nationally. Dr. Ghani is co-director of MUSIC and assistant professor of urology and Dr. Miller is director of MUSIC and professor of urology at the University of Michigan, Ann Arbor. They were interviewed by Urology Times Editorial Consultant Stephen Y. ­Nakada, MD, the Uehling Professor and founding chairman of urology at the University of Wisconsin, Madison.


    Please provide an overview of MUSIC.

    Dr. Ghani: MUSIC is what’s called a “collaborative quality initiative.” The state of Michigan has around 20 of these initiatives, and they are all funded by Blue Cross Blue Shield of Michigan. Blue Cross Blue Shield has a special division called the Value Partnerships program that oversees these initiatives throughout many specialties; MUSIC is focused on urologic surgery and, right now, specifically prostate cancer care.

    Related - Quality improvement: Why residents should get involved

    MUSIC is a consortium of 43 practices in the state of Michigan, both academic and community practices, totaling around 250 urologists. That’s approximately 90% of the urologists in the state. It was set up in 2011 by Dr. Miller and Dr. Jim Montie with funding from Blue Cross Blue Shield of Michigan. It’s basically a group of urologists who are working together with the common goal to improve patient care. I’ve been involved in it for the last 2 years as a co-director. It’s a unique group. It’s a privilege to work there.


    Dr. Miller, what inspired you and Dr. Montie to do this?

    Dr. Miller: For me, there were a couple of factors. I was doing a lot of outcomes research during my residency and fellowship, and it was becoming clear to me that this was an area where it was very easy to find problems with care delivery, but there was not as much emphasis on finding solutions to those problems. This collaborative quality initiative model had emerged in Michigan, where some work was already being done in general surgery and cardiology. Clinicians in those specialties were collaborating, with support from Blue Cross Blue Shield of Michigan, and really tackling some of the big challenges in the field.

    Dr. Montie, who was the chair of the urology department at the time, and I were envious that urologists weren’t involved. We thought, we have common conditions that are important to patients and the opportunity to tackle some of these problems ourselves. We decided to go to Blue Cross Blue Shield of Michigan and pitch the same model in urology as a way to work on some of the big problems in the field and they said, not surprisingly, “While that’s great that you’re interested, so is everybody else. Show us that urologists can work together to do this.”

    That was the genesis of the initial Urological Surgery Quality Collaborative (USQC) that was really a “coalition of the willing” of some practices both in and outside of the state of Michigan that had urologists who had trained at the University of Michigan. We started collecting data together on imaging for early-stage prostate cancer, and we showed that we were able to reduce utilization in patients where the tests were less likely to be beneficial.

    Much like an NIH grant, we then had preliminary data that we were able to take back to colleagues at Blue Cross Blue Shield of Michigan and say, “Look, we worked together on this. We achieved a beneficial change in practice patterns,” and that prompted them to say, “OK, let’s launch in the state of Michigan.”

    When we started, we had no idea whether any urologists in the state would be interested. But after Blue Cross Blue Shield of Michigan approved MUSIC, they put out a request for participants, and at that point about six or seven more practices in the state came forward without us even having approached them directly. That showed, I think, that urologists were ready to participate in something like this to be proactive in terms of defining the quality of care we provide instead of being reactive as we have been on some occasions in the past.

    That was the launching point, and from there we spent a lot of time building relationships. Drs. Montie, Ghani, and I have driven to almost every practice in the state of Michigan to meet with urologists in their environment to understand what their priorities are and to emphasize the point that this is about making Michigan the best place in the world for prostate cancer care. It’s not about an academic emphasis or defining one center as better than the other. That’s one of our fundamental principles and has been an important catalyst for our growth and sustainability.

    Next: Why would anyone not participate?

    Stephen Y. Nakada, MD
    Stephen Y. Nakada, MD, a Urology Times editorial consultant, is professor and chairman of urology at the University of Wisconsin, Madison.


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