Since 2011, MROQC has been a platform for both comparative effectiveness research and quality improvement. Our work has allowed us to move the needle in a positive direction with clinically meaningful endpoints and our success in breast and lung cancers has allowed us to expand to other clinical indications (bone metastases and prostate cancer). The MROQC Coordinating Center works in partnership with our members by sharing data to develop best practices in areas of care with high variation and costs. To participate in MROQC, a site must meet the following criteria: Treat a minimum of 150 new breast, lung, and prostate cancer cases per year plus patients being treated for bone metastases (with a primary cancer of: breast, lung, prostate, melanoma or renal cell) Identify a radiation oncologist Clinical Champion to lead participation in collaborative quality improvement efforts Identify an onsite medical physicist to act as the Physics Lead. Designate a representative from Physics/Dosimetry to collect dosimetry data for patients enrolled. Identify an administrative champion to act as the Administrative Lead. Engage and/or hire appropriate Clinical Data Abstractor (CDA) support Identify and enroll all eligible patients to the MROQC projects Commit to active participation in collaborative quality improvement activities Contribute case data to the MROQC database in a timely manner Collaborate with the MROQC coordinating center and other participating sites, including sharing and learning from best practices For more detailed information on how your facility can join MROQC, please email the MROQC Program Manager, Melissa Mietzel, at hillmel@med.umich.edu

Collaborative Quality Initiatives (CQI) transform care processes, improve outcomes, save money, and enhance community well-being. What is a Collaborative Quality Initiative (CQI)? Statewide quality improvement initiatives, developed and executed by Michigan physicians and hospital partners with funding and support from BCBSM and the HMO subsidiary, Blue Care Network In most cases, a CQI project relies on a comprehensive clinical registry which includes patient risk factors, processes of care, and outcomes of care Physicians, hospitals, and health systems collaborate to measure and improve the standard of care in Michigan by focusing on reduction of errors, prevention of complications, and improvement of patient outcomes CQIs promote partnerships with physicians, physician groups and hospitals to create strong collaboration and reward systems for the transformation of health care. Want to learn more? Hospitals and physicians collect and share data to develop best practices around areas of care with high costs, high variation and scientific uncertainty (i.e. best practices not known). With the majority of hospitals collecting and sharing data, areas of opportunity can be identified – and acted upon – quicker. Locus of control remains with the providers – complete, accurate, risk adjusted, confidential, provider-owned data. Trust is the foundation of the partnership. BCBSM does not see any identified data; ownership of the data remains with the Collaborative. Cross-group/institution collaboration yields more than competition on quality: Improvement catalyzed by sharing best practices More can be learned from variation in care processes and outcomes across groups Allows more robust analyses of link between processes and outcomes of care than can be achieved by examining one group

In 2017, BCBSM/BCN developed and implemented the Gold Card Incentive Program in collaboration with MROQC. Being "Gold Carded" allows select radiation oncologists at facilities who met specific quality improvement criteria to receive auto approval for radiation therapy authorizations submitted to eviCore. This program is only unique to those sites who have membership in MROQC and that have contributed data to the MROQC’s data registry for at least two years, including at least one year’s worth of baseline data. Please see the Gold Card Incentive Program FAQs for more information. Questions for BCBSM/BCN regarding the Gold Card Program may be submitted via goldcardinginquiry@bcbsm.com

2024 MROQC FTE Funding Model (subject to change annually) Participating MROQC facilities receive an annual Participation Payment for full-time equivalent (FTE) funding based on their case volume through the generous support of BCBSM-BCN. This payment is intended to cover a portion of data abstraction costs for entering not only BCBSM cases but also those cases who are insured by other payers-including those who are government insured or even uninsured as well (projected to be approximately 84% of total cases). The 2024 MROQC FTE model is based off of a facility case volume of 187 patients FTE=number of cases at a given facility/187 Participation Payments are sent out to our member sites in July (via hospital contracting or payments to free-standing facilities). A single FTE should be expected to effectively manage 187 eligible cases, and the facility should staff the MROQC project accordingly with a Clinical Data Abstractor (CDA) to coordinate capture of clinical data and patient reported outcomes, AND a physicist or dosimetrist to report technical details of treatment planning and delivery. Support Documents FTE to Hours

The Value Partnerships Program at Blue Cross Blue Shield Michigan (BCBSM) develops and maintains quality programs to align practitioner reimbursement with quality of care standards, improved health outcomes and controlled health care costs. Practitioner reimbursement earned through these quality programs is referred to as value-based reimbursement, or VBR. The VBR Fee Schedule sets fees at greater than 100% of the Standard Fee Schedule. Recently, the Value Partnerships Program expanded their VBR opportunities to Physician Group Incentive Program (PGIP) practitioners who participate in select Collaborative Quality Initiatives (CQIs) and meet specific eligibility criteria. Eligible practitioners receive 103-110% of the standard fee schedule as part of “CQI VBR”. Currently, MROQC is one of 13 CQIs to offer participating PGIP physicians the opportunity to receive CQI VBR, based on meeting clinical targets relevant to MROQC. MROQC, in collaboration with BCBSM has developed quality and performance metrics for MROQC’s value-based reimbursement. CQI VBR Selection Process For an MROQC radiation oncologist to be eligible for CQI VBR, their site must: Meet the performance targets set by the coordinating center The radiation oncologist themselves must be a member of a PGIP physician organization for at least one year Have contributed data to the MROQC's data registry for at least two years, including at least one year’s worth of baseline data For additional information, please see our CQI VBR Fact Sheets: 2025 MROQC CQI VBR Factsheet

A collaborative is only as strong as its members. As part of membership in MROQC, BCBSM requires active participation from each member of the consortium and attendance by key members at the MROQC collaborative-meetings is an expectation and scored annually. Clinical Champion A site Clinical Champion is expected to attend all of the MROQC Collaborative Meetings held in a calendar year. When the Clinical Champion cannot attend a substitute may be allowed to represent the hospital. A substitute is allowed once a year. Ideally, the substitute is another Radiation Oncologist from that hospital that treats MROQC patients. Other Radiation Oncologists are acceptable. In certain cases (example: a small site with only 1-2 Radiation Oncologists), another physician is acceptable such as the Chief Medical Officer (CMO), the Chief of Quality, or a physician involved in Radiation Oncology cases. Residents, Physician Assistants (PA), Nurse Practitioners or non-physicians are not acceptable substitutes. For more information, please see the MROQC CC Attendance Policy Physics Lead (or designee) The site’s Physics Lead (or designee-i.e. another physicist or a dosimetrist who works on MROQC) is expected to attend all of the MROQC Collaborative Meetings in a calendar year. Clinical Data Abstractor (CDA or Designee) A MROQC CDA (or designee-i.e. another CDA or someone who works on MROQC not covering another role at a meeting) is expected to attend all of the MROQC Collaborative Meetings in a calendar year.

Blue Cross Blue Shield of Michigan (BCBSM) has a hospital incentive-based programs called pay-for-performance, or P4P. The program recognizes hospitals that excel at care quality, cost-efficiency and population health management. P4P are incentives based on participation and performance in quality and outcome measures. Scorecards transition to greater weight on performance as a CQI becomes more established. Effective in 2021, the program began paying hospitals, in aggregate, an additional 5 percent of statewide inpatient and outpatient operating payments – nearly $190 million statewide. The current P4P program year will closely follow the structure, performance measurement and incentive framework of the 2020 program year, with two exceptions: The Cost Efficiency component has been retired 5 points have been added to the HIE component Additionally, in 2020, hospitals who participate in all CQIs for which they have been recruited will be eligible for a fixed-dollar bonus paid from the unearned incentive dollars within the CQI component. All other remaining unearned dollars will be paid based on the multiplier concept. The below chart provides the potential bonus by hospital, depending on the number of CQIs in which they participate: Want to Learn More? BCBSM Slides on the Pay for Performance (P4P) Program