Providing decision makers with evidence: A Q&A with CHRT’s health policy team lead

December 13, 2023
Nancy Baum, systemic and policy analysis team lead

CHRT’s health policy team evaluates laws, regulations and policies, as well as decisions and actions of leaders in public health, healthcare payers and providers, for their impact on population health. The team analyzes and recommends evidence-based policies designed to improve the health of people and communities, and responds to the needs and interests of a broad range of stakeholders. 

We sat down with Nancy Baum, the team director, to learn more about the team’s work.

Describe some of the challenges the health policy team addresses. 

One of our main goals is to help decision makers use evidence in their decisions. That’s a common theme of our particular team’s work, and it’s also most of what we do at CHRT. For our team, sometimes that means gathering information on what’s been published, what programs are in place, or what similar organizations or states are doing on a specific topic. Sometimes it means bringing people together to learn from each other, as we do in our two fellowship programs. We also have a project with partners at MSU to help educate Michigan legislators on health topics.

The decision makers we support could be legislators, but they don’t have to be. We’re also working with people who run programs, hospitals, or other health organizations. We want to get evidence into the hands of all decision makers who have an impact on health.

What’s one of the big projects in the team’s portfolio now?

One of the big pieces of work we’ve focused on for many years now is work we do with the Department of Health and Human Services for their long-term services and supports (LTSS) programming.

People with disabilities need supportive services that are very expensive. For the most part, Medicare doesn’t cover long-term services and supports. In most states, Medicaid does, but for the generally only people with a low income qualify for Medicaid coverage and services. So we have a system where there’s a great deal of demand, but the services are very expensive. And there are serious workforce problems meeting that demand because the pay for direct care workers is very low.

Michigan, like most states, has put together some important and effective programs for people who need these long-term services and supports. But many more people want them than qualify for them, and it is very important that these services are of high quality. So we work with the state to assess these problems, gather stakeholder input, and recommend some solutions.

Do you have any projects in the behavioral health space?

Our team works on a variety of projects related to behavioral health. For many years, we have had a shortage of behavioral health providers to meet demand in Washtenaw County. Without access to the care they need, people can develop acute behavioral health needs and present at the emergency department. Emergency departments are crowded and people with acute needs then have to wait a long time for appropriate services.

One of the really exciting projects we’re working on right now is called ADAPT (A Dynamic Approach to Psychiatric Treatment Systems). We’re working with modelers at the University of North Carolina who are building a model of Washtenaw County’s behavioral health system. This model will allow the community to understand what the impact on treatment experience might be if they change the level of resources committed to an aspect of the system. It’s exciting because this kind of work hasn’t been done before. We’re training this model on Washtenaw County data, but other communities will also be able to use it that have similar behavioral health systems and problems.

Do you work with other teams?

Absolutely. Our team is working closely with CHRT’s health and social equity team to find opportunities for community paramedics to deliver services to people in their homes, which helps keep people out of the hospital. For example, what often happens is that someone is discharged from the hospital but they have to do wound care at home. If they are not comfortable doing that then they might call emergency servicest, and historically paramedics had to transport them to the hospital. But someone who just needs a bandage change doesn’t necessarily need to be transported to the hospital, so delivering care to them in their home is more appropriate. These new programs allow community paramedics to deliver those and many other types of services in the home without transporting to a hospital.

Describe some of the processes the team uses.

Our team works to gather data. Sometimes we’re gathering primary data and analyzing it. Sometimes we’re exploring secondary data, aggregating existing evidence and knowledge, or conducting landscape analyses to see if there are best practices elsewhere that can be leveraged. We also do a lot of writing. We write reports, issue briefs, one-pagers and other materials to communicate what we learn.

We also run the two fellowship programs – a policy fellowship and a public health fellowship –  which let people meet colleagues, learn from one another and from experts in the field, and find opportunities to elevate the impact of their work.

Relationships are an important part of all of our work. The better relationships we have with decision makers, the better the opportunity we have to support them.

What do you want readers to know about the team’s mission, vision, values or services?  

We’re always thinking about how the policy or system we’re analyzing impacts various people and groups. When we’re talking about addressing social determinants of health, the big picture question is: does everybody have the resources they need and a real opportunity to improve their health? Or are there inequities where programs are helping certain populations the way they need help but not others?

Identifying places we can be more equitable is very important to everybody on our team, and really everybody here at CHRT. Providing decision makers with data on inequities can empower and enable leaders and organizations to take actions to help everyone improve their health.