Continuing with MISHC: Value and Return on Investment

Blue Cross Blue Shield of Michigan (BCBSM) remains fully committed to MISHC, providing funding to support clinical data abstraction and reporting resources as well as provider value-based reimbursement (VBR) rewards, that remain in place – subject to applicable program requirements.

This support helps sites offset the resources needed for data abstraction, performance measurement, and quality improvement work.

The MISHC Coordinating Center provides infrastructure and expertise that would be difficult and costly for individual programs to reproduce independently. Participating sites continue to receive support through:

• Performance and outcomes reports
• Data-quality review and audits
• Quality-improvement initiatives
• Statewide benchmarking and collaborative learning
• Identification and sharing of best practices
• Support for coordinators, clinical teams, and site leaders
• Guidance as federal requirements and evidence-development models evolve

This centralized infrastructure helps sites turn data into action.

Procedural success alone does not fully describe the value of structural heart care. Patient-reported outcome measures – particularly the Kansas City Cardiomyopathy Questionnaire (KCCQ) – help determine whether treatment improves symptoms, functional status, and quality of life.

Maintaining meaningful patient-centered measures allows sites to answer a fundamental question: Are our treatments helping patients feel and function better?

These data support patient-centered care, shared decision-making, quality improvement, and a fuller understanding of outcomes.

The Transcatheter Valve Therapy (TVT) Registry and MISHC serve complementary purposes. The TVT Registry provides national benchmarking, while MISHC helps Michigan sites interpret results, identify local opportunities, learn from one another, and implement improvements.

Continued participation supports:

• Evidence-based, heart team collaborations across interventional cardiology, cardiac surgery, and quality leaders 
• Invitations to MISHC meetings featuring national speakers and educational opportunities, including learning about cutting-edge procedure types and variables from national leaders
• Comparison with statewide and national performance
• Early identification of variation and emerging trends
• Tracking clinical and patient-reported outcomes
• Monitoring of operator procedural volumes
• Evaluation of improvement efforts
• Sharing effective practices among Michigan programs

Without a collaborative framework, a site may still collect data but have fewer resources for understanding what the data means and how to act on it.

Although CMS may no longer require a single national registry for every TAVR indication, sites continue to face important clinical, payer, and program requirements. These include:

• TVT Registry participation requirements for mitral transcatheter edge-to-edge repair
• Multidisciplinary Heart Team evaluation and documentation
• Operator volume tracking
• Quality-improvement requirements
• Coverage with Evidence Development studies for certain indications
• Public-reporting transparency considerations
• Value-based reimbursement requirements

MISHC helps sites maintain the data capabilities and workflows needed to respond to these requirements. Participation also positions sites to adapt more efficiently as CMS finalizes evidence-development and coverage expectations.

MISHC strongly supports the Heart Team as a foundational component of every TAVR program. The collaboration reinforces comprehensive evaluation, appropriate treatment selection, shared decision-making, and consistent documentation.

This supports both regulatory readiness and clinical quality by helping to ensure that treatment decisions reflect each patient’s risks, goals, life expectancy, anatomy, and available surgical and transcatheter options.

Participation connects programs across Michigan so they can solve common problems collectively rather than independently. MISHC provides a trusted structure through which sites can:

• Learn from peers
• Compare approaches
• Develop shared standards
• Identify high-performing practices
• Address statewide opportunities
• Respond collectively to policy changes
• Shape the future of structural heart quality measurement

This results in a learning network that increases the value of each site’s data and experience.

MISHC recognizes that data collection requires significant effort from coordinators, abstractors, clinicians, and program leaders. MISHC is working with senior leaders from the TVT Registry and BCBSM to explore sustainable models that: 

• Preserve national and statewide benchmarking
• Maintain patient-centered outcomes
• Support participating coordinators and programs
• Capture the information needed to drive measurable improvement

Site representatives are encouraged to help shape this work so that the next phase of MISHC delivers high value while using staff time responsibly.