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Providing decision makers with evidence

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Nancy Baum, systemic and policy analysis team lead
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.

Josh Traylor on contributing to state and local health policy reform efforts

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Joshua Traylor
Joshua Traylor

Joshua Traylor joined CHRT as executive director on November 1. We sat down with him to learn more about him, his background, and his plans for CHRT.

What interested you in joining CHRT as ED?

I was born and raised in Washtenaw County so when the CHRT opportunity was posted, a few people from Michigan brought it to my attention. I had been working in the national policy space for quite a while and saw this as a great opportunity to come back to my home state and contribute to state and local reform efforts. 

At the federal level, you hope you’re doing good work, you hope your work is impactful, but you don’t necessarily see the work being carried out on the ground the way you do at the state or local level. For me, CHRT was offering an opportunity to re-engage with that state and local effort and make a tangible impact. I also saw joining CHRT as an opportunity to use what I learned at the federal level to help increase CHRT’s reach and impact. I know CHRT has done a lot of good work over the years, and there’s an opportunity to take what CHRT has done and use it to inform national healthcare policy.

Was that the first time you’d heard of CHRT?

I actually started my career at CHRT as an early career fellow right out of grad school. I worked primarily on the data analytics team and cut my teeth doing claims data work, writing issue briefs, and developing recommendations for clients. I also was active in the initial phases of the Washtenaw Health Initiative (WHI). 

What parts of CHRT’s mission and work are closest to your heart?

What I really like about CHRT is how interdisciplinary the organization is. I tend to think at a systems level about how different threads interact to create the outcomes we see. CHRT is one of the few organizations that brings together policy, data analytics, program operations, research, evaluation, and communications all under one umbrella. This is important because so many of the health and social issues we face are multisectorial. Addressing them requires many different components to move together and you need interdisciplinary teams to do that work. 

What attracted me about CHRT as an early career fellow was its healthcare policy focus. When I looked around Michigan, especially the Ann Arbor area, CHRT felt like the spot to be. I wanted that opportunity to dig into the data analytics work and understand how our healthcare payers, providers, and employers make decisions. I was looking for insight into how different stakeholders impact the way healthcare works on the ground, and CHRT was absolutely perfect for that.

What other knowledge and experience will you bring to CHRT? 

After my CHRT fellowship, I went to the Center for Medicare and Medicaid Innovation. CMMI was established to test innovative health care reform ideas intended to reduce costs and improve quality. I felt it was important to understand the impact of health care payment and care delivery reform efforts on behavior and outcomes. 

I started my time at CMMI working on the State Innovation Models (SIM) team where I got to see how different states and territories grappled with health care issues, and think about the ways federal policy could enable, or impede, that work. Next I went to the Prevention and Population Health Group, where I worked on the design of the Integrated Care for Kids Model where I learned a lot about the opportunities and issues with reform efforts in the Medicaid space. 

I left CMMI to join the Healthcare Transformation Task Force (HCTTF), a DC based non-profit that brings together healthcare payers, providers, purchasers, and patient organizations interested in payment and care delivery reform efforts. I had the opportunity to work with state and national payers, health systems, and patient advocacy groups to build consensus on a range of issues including payment model design, health equity promotion principles, and multi-payer alignment strategies. The Task Force was like a graduate program on topics you don’t learn about in grad school.

How did your work in DC intersect with what’s been happening here in Michigan?

At CMMI, I was the project officer for the State Innovation Model (SIM), so I was responsible for project management on the federal side of the program and interacted with a number of states, including Michigan. I provided technical assistance where I could and liaised with our grants office at the federal level to make sure we could fund things appropriately. I also looked for opportunities to connect the SIM folks in Michigan to other states, federal initiatives, and agencies that could inform their work.

What accomplishment are you most proud of?

I’ll give you three at different places. Early in my career at CHRT, I worked on the launch of the WHI, a voluntary collaborative of local individuals and organizations dedicated to improving the health of low-income, uninsured, and under-insured populations. I was interested in the concept that you could bring together so many different community level entities under one umbrella to improve care delivery. The WHI experience was really formative in my early career.

At CMMI, my work on the Integrated Care for Kids model. We began working on that model in 2015 and continued designing it through the 2016 presidential transition, when a lot was up in the air and a number of programs wound up not making it to fruition. I’m proud to have been a part of the team to design that model and shepherd it all the way through and make sure it got out the door as a funding opportunity for states.

At the Task Force, one of the biggest projects I worked on was called Raising the Bar, a Robert Wood Johnson Foundation (RWJF)-funded initiative to develop principles and action steps to advance health equity. It involved creating principles and action steps for healthcare organizations that were interested in advancing health equity. That effort has gotten quite a bit of traction and been used in a lot of different places.

What books are on your nightstand?

Right now? Goodnight Moon. I have a four year old and a two year old. Not a lot of free time for book reading beyond that!

But I would say a book that I have recommended time and again to students, mid-career, and even late stage career folks who want to understand the US healthcare system is a book called The Healing of America by T. R. Reid. 

We often talk about the U.S. healthcare system when what we really have is a collection of several health care systems. The Healing of America is one of the most approachable descriptions I’ve seen of all these healthcare systems and how they compare to those in other countries.

What do you do in your free time?

I love motorcycling, especially long distance motorcycle trips (though I don’t ride nearly as much since becoming a parent). I’ve ridden from Michigan to California and from DC to the Dakotas. I love to explore and I like to fix things so riding and motorcycle maintenance check both of those boxes. I also really like to garden and cook. If I have a garden and a well-stocked kitchen and folks to entertain, that’s my happy space.

What are your favorite places to visit in Ann Arbor or Michigan?

I grew up just outside Ann Arbor, and I went to school in Ann Arbor for my whole education from kindergarten to graduate school. The city changed a lot over that time but a few places feel like constants to me. I love the Arb, Kerrytown, and the farmers market. As a kid, I used to go to the Ann Arbor Y with my parents on the weekends and then after that we would go to the farmers market and Kerrytown for lunch. I have tons of fond memories of that area from childhood. And I’ve always loved walking through Nickels Arcade at Christmas time when all the lights are up and it’s snowing.

I also like North Campus. It’s an area not a lot of people go to unless you are in the engineering, music, architecture or urban planning programs. I was an engineering student for my freshman and sophomore years at Michigan. I appreciated the relative solitude of North Campus. There are also a ton of interesting hidden features you would miss if you didn’t know about them. For example, there is a natural echo chamber if you stand at one spot outside Pierpont Commons. There is also a grass field behind one of the engineering buildings that’s been shaped into a three-dimensional sine wave. It was designed and created by Maya Lin, the artist who did the Vietnam War Memorial in D.C. It’s a fun place if you have kids because they can run up and down the sine waves.

What are your goals for CHRT’s next few years?

Right now I’m in the phase of understanding all the work that’s going on and meeting all the leaders and partner organizations that CHRT is working with. The interdisciplinary nature of CHRT – bringing together policy, data analytics, research, evaluation, program implementation, communications, and finance – is a real strength for the organization. Our team also has experience working on a range of key health and social policy topics and initiatives. I think the perspective and skills of the CHRT team offers us the opportunity to help shape an ambitious but attainable vision for improving the health and wellbeing of our region and the state.

To be able to do this, I want to make sure we have good sustainable funding streams in place so we can support the ongoing work and be able to pursue the passion projects that attract people to work here.

Finally, I want to elevate the lessons learned at CHRT to the federal level and to create greater interconnection between CHRT and organizations that have similar missions in other parts of the country. I see a lot of opportunities for collaboration, shared learning, even partnership on projects.

What would you like to say to the CHRT community?

I’m really looking forward to getting to know the people who currently partner with CHRT, and to identifying new opportunities and new projects. CHRT has the opportunity to be a neutral convener and do the visioning work that pulls together different perspectives. I’m looking forward to partnering with people to do that.

The important role of human-centered design in health care 

by
Kimberly Snodgrass

By: Kimberly Snodgrass, Cleoniki Kesidis

In 2023, with Medicaid renewals at the forefront of state health and human service department operations, we’re thinking a lot about how to create easy-to-use systems that allow people to demonstrate their eligibility for Medicaid. Without easy-to-use systems, many are losing Medicaid insurance for administrative or procedural reasons–even if they remain eligible.

Data shows that in Michigan, for example, one in every three individuals up for Medicaid renewal have had their coverage terminated in the first three months of renewals. Of these, 17 percent were denied coverage because they no longer qualified for Medicaid. The rest–83 percent–were denied coverage because they failed to complete the state’s renewal paperwork or weren’t able to verify their information properly. 

When individuals encounter challenges in navigating complicated systems, such as Medicaid renewals, they can be deprived of the support they deserve, potentially exacerbating their circumstances. For instance, if someone struggles to enroll in Medicaid, they might postpone important visits to their primary care physician or other preventive appointments. This frequently results in them seeking care for more severe and costly health conditions.

Human centered design: A solution.

Human centered design aims to solve challenges like these by deeply understanding the experiences of people affected by complicated systems. The design process can be applied to products, services, processes, or other things that meet real needs and help people become their healthiest selves.

If we understand people’s experiences, we can identify recurring pain points that prevent them from successfully achieving their goals. Once we understand this, we can build solutions that address these pain points. In its essence, HCD is a form of accessibility. 

Steps to take to achieve human centered design.

Civilla, a nonprofit based in Detroit, helped the Michigan Department of Health and Human Services improve and simplify their public benefits application, and shares five essential steps: 

  • Identify the challenge.
  • Figure out who’s directly impacted by the challenge. 
  • Talk to, observe, and collaborate with those people. 
  • Propose changes, see what people think about them, then test those changes to learn what works. 
  • Collaborate to implement the effective changes with a peer-led approach. 

In sum, inefficiencies are addressed collaboratively. Frontline staff work with organizational leaders, programmers, designers, and communicators. But the end users play a critical role, and evidence–about what works and what doesn’t–is essential. 

Human-centered design empowers individuals, enhances efficiency, and promotes a more inclusive and user-friendly society. Embracing this approach in the health and public health sector has the potential to create many positive changes. 

Helping organizations create successful, sustainable programs

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Melissa Riba in a black top, smiling.
Melissa Riba

CHRT’s program evaluation team works with stakeholders to design, analyze, synthesize, and report on evaluations. They aim to improve programs by assessing progress, demonstrating impact, and developing lessons learned.

We sat down with Melissa Riba, the program evaluation team lead, to learn more about the team’s projects, purpose, and intended impact.

What are some of the challenges CHRT’s program evaluation team addresses?

The program evaluation team works with organizations that have identified a problem and created an intervention or program to address it. They’re doing great work, built on their evidence and experience, and they know they’re changing people’s lives. Their challenge is demonstrating that.

Evaluation can be a challenge for organizations because it’s a very time intensive, deliberate, systematic process. It’s a lot more extensive than simply identifying data or metrics, and it needs to be incorporated into early planning of a program to do it well. Often, organizations are trying to get a program up and running quickly and they don’t have the time or resources to plan evaluation. 

That’s where we can come in as consultants. We work hand in glove with the program to demonstrate impact and make the case for the program’s value – or to identify adjustments required to make the desired impact. This is often necessary to get continued funding to sustain or expand the program, because funders want to know the program is having the desired impact. As third party evaluators, we also provide the essential objectivity of an outside perspective.

As well as demonstrating value to funders and other stakeholders, we work on continuous quality improvement. By collaborating closely with the implementation organization, we identify areas where they should make mid-course adjustments. We provide quarterly data and information so they can see if they’re on track towards their targets, and discuss solutions if they’re not.

People working in health care and combating health disparities have a great deal of expertise and passion. Everyone undertakes these programs to improve people’s lives. We partner with them to demonstrate that they are indeed having an impact or consult on program adjustments to improve impact.

What projects are in the team’s portfolio now, and what do you anticipate their impact will be?

One project that we’ve been working on for five years is an evaluation of the behavioral health primary care integration process with the state of Michigan. We’ve been looking at how to integrate care and improve information sharing to improve care for the patient. As this project is winding down, we’re seeing a lot of impact.

We’re also working on a smaller pilot program in Detroit with an early childhood education center. Providers there observed that a lot of caregivers experience health disparities or behavioral health needs like postpartum depression. They’re piloting an evidence-based peer-to-peer program with a small cohort of moms to improve wellness, reduce depression and anxiety, and support parent-child relationships. On the program evaluation team, we often work with a small pilot to show outcomes and gather lessons learned, and then help our client make the case to expand it. This project is exciting because if this program does well the organization can expand the model to other parts of the state.

The program evaluation team has a robust portfolio, and we’re working on several other projects now as well, including evaluating the Certified Community Behavioral Health Clinics (CCBHC) in Michigan.

What processes does the team use to advance projects?

We use a culturally relevant and equitable evaluation framework for our projects. I’ve been doing evaluations for more than 25 years, and one common issue is that the exercise of evaluation is not always inclusive of a vulnerable community in a culturally relevant, equitable, appropriate way. Over the last few years, we’ve been incorporating this framework into all that we do to address this issue. We look through the perspective of the people being impacted by the program and seek input and guidance from people with lived experience. 

To achieve this, we focus on methods and how we collect data. We take into account health literacy and aim to understand where people are coming from. For example, when we were working on a project to integrate care in a pediatric practice, we initially wanted parents to take a brief survey. We realized that wouldn’t be appropriate because there may be multiple children present at an appointment, or children fussing, and the parents didn’t have time for a survey. Based on collaboration and feedback, we adjusted our method and had much more success. 

It comes down to being flexible. We work very collaboratively with our partners to make sure our evaluation is grounded in the reality of the work they’re doing and the community they’re working in.

We’re also really passionate about lessons learned. People get a little scared about evaluation, like you’re being judged. But that’s not our approach. We’re focused on the successes and the challenges, and how we can learn from them.

Everyone on our team is passionate about taking the hard work that our clients do on a daily basis and demonstrating its impact. Our team is very multidisciplinary, and our work is very applied. We take on the really messy projects. Our interns often say that our work is very different from what they learned in their evaluation classes, because we’re grounded in the real world and focused on adding value without getting in the way of our clients’ important work. It’s so exciting when we can see the impact immediately.

Health and Social Equity team members include: 

Introducing CHRT’s new health and social equity team

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Sharon Kim in a black jacket smiling

In March, the Center for Health and Research Transformation (CHRT) launched a new team focused on health and social equity.

Though each of CHRT’s teams applies a health and social equity lens to their projects, CHRT desired a specific team to manage major programs under the health and social equity banner, while offering support to clients in pursuit of more complex health and social equity initiatives. 

CHRT brought programs such as MI Community Care, the Promotion of Health Equity project, the Healthy Aging at Home Network, and efforts supporting the Washtenaw Health Initiative under that health and social equity umbrella. 

We sat down with Sharon Kim, the Health and Social Equity team lead, to learn more about the team’s projects, purpose, and intended impact.

Sharon Kim

What are some of the challenges CHRT’s health and social equity team will address?

All of our programs focus on supporting the most vulnerable and underserved folks in our community, but in different ways and with different populations. 

MI Community Care (MiCC) is a good example. A coalition of Livingston and Washtenaw County community partners, MiCC is a free care coordination program that initially focused on reducing emergency department use. Now, MiCC helps participants–primarily Medicaid enrollees–meet their health and personal goals. Participants live with challenging and complex needs. MiCC participants often need support with multiple needs such as food, housing, specialized medical care, and behavioral health or substance use conditions. 

CHRT is the backbone organization for the MiCC program. Some partner organizations have become hublets, which means they take the lead with participants, coordinating all the services that that participant is going to need. Hublets are supported by additional partner agencies. All the boots-on-the-ground agencies involved came together and developed the MiCC model themselves. They developed a common consent model, they adopted common comprehensive assessment forms, they’re all using a shared IT platform to coordinate with each other and ensure closed-loop referrals. It’s part of what you see at a national level, this push toward coordinated, holistic, team-based care that’s centered around the patient.

In the U.S. we focus so much of our time and resources on medical settings, but true health care starts where we live, where we work, where we pray, and where we play. Our environment, the way we grew up and the resources available to us, drives health and wellbeing. We have been so focused in this country around providing care after someone gets sick, versus making sure that people have the things they need to be born healthy and stay healthy.

Our programs have the potential to reach and support the lives of our most vulnerable and underserved populations, but there are few mechanisms to pay for social care. We’re looking at sustainability paths from a policy perspective, and from a boots-on-the-ground perspective. But for many of our local players, it’s hard to do this work when you’re worried about keeping the lights on. And going after different funding streams increases the administrative and reporting burden.

Merging all our health and social equity programs under the same umbrella will help us make more efficient use of funding, staff, and other resources, especially for programs that serve overlapping populations and address similar needs. We expect that this will result in improved coordination of services, ensuring a more systemic approach to meeting community needs.

What projects are in the team’s portfolio now, and what do you anticipate their impact will be?

One of our largest projects, the Promotion of Health Equity (PHE) project, is really quite amazing. 

PHE is a Centers for Medicare & Medicaid Services (CMS) funded health equity project administered by the Michigan Department of Health and Human Services (MDHHS). For PHE, CHRT is facilitating a learning network and providing administrative support to six collaboratives: 

Each participating collaborative has already done significant work building a consortium of health care and social service organizations that are working together to serve their geographic regions. 

Bringing together so many regions from across the state, each with their own unique models and challenges, is a tremendous opportunity for all of us. We can address the priorities of the State of Michigan and the Michigan Department of Health and Human Services, such as the state’s social determinants of health strategy and health information technology roadmap. Both include a focus on community information exchange and the ability to integrate data across the clinical and social care settings, which is a central focus of PHE. PHE partners are leveraging the robust data sharing infrastructure they have built. This infrastructure helps to improve the ability for social care organizations to do their vitally important work. Michigan is already a national leader in regard to the sharing of clinical data, and through PHE we are moving another step forward in developing a statewide infrastructure to support data sharing between clinical and social services.

PHE brings together so many amazing partners. In addition to CHRT, core project partners include: the Michigan Health Information Network, Michigan Data Collaborative, Collaborative Quality Initiatives, MSHIELD, and the backbone organizations representing six different regions of the state.

A second project housed in the new CHRT team is a collaborative effort focused on supporting the unmet needs of older adults and their caregivers. It provides support to the aging population in Washtenaw County through a collective impact model. CHRT and its CBO partners successfully completed a CIHN pilot program. During this pilot, they created a shared administrative structure to provide individuals diagnosed with heart disease or diabetes with medically friendly home-delivered meals coupled with SDOH-focused assessments and referrals for additional services. Building on the success of the pilot program, CHRT plans to develop a “Healthy Aging at Home Network” (HAHN), formalizing the alliances developed during the pilot program and scaling up the service offerings for Michigan residents.

In the project, social care organizations come together to coordinate efforts to make sure that seniors—regardless of their economic status, race, ethnicity, or gender—have access to the things they need to age in a healthy way. 

What processes does the team use to advance projects?

As a new team, we are still developing our processes. Everything is a team effort. My role on the team is to make sure that my team has what they need to make their programs successful. I lean on their knowledge, expertise, and passion to advance equity.

The Promotion of Health Equity project is a good example of a team effort. We are bringing together six incredibly different regions with different goals. The CHRT team helps partners define overarching, cross-regional goals for health equity and for social equity. 

We do this by asking: What are the common outcomes that need to come from this? Can we identify shared goals, target populations, or interventions? How do you ensure that all of the different regions and different programs are working toward some of the same end goals and working together effectively?

These questions help us craft a shared vision. 

After determining a shared vision, we create a shared framework and implementation plan. The framework outlines the approach we’re going to take, including strategies for the interventions, for continued outreach, and how we’re going to connect with the state and funders more broadly. Then we determine how to assess the success of our work, not only for the regions individually, but as a whole. 

All of our projects focus on supporting the most vulnerable and underserved folks in our community in a way that’s holistic, coordinated, and uplifts the lived experience of people in the community. 

Health and Social Equity team members include: 

15 years in review with Executive Director Terrisca Des Jardins

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Fifteen years ago, no one could have anticipated where the Center for Health and Research Transformation (CHRT) would be today. We’ve gone through many iterations, making our 15th anniversary truly significant. 

We were only guaranteed three years of funding when we opened the doors of our center. We started as a grant-making nonprofit to support health services research. For many years, much of our work sought to improve health care and access to care. Then in 2018, we changed our name from the Center for Healthcare Research and Transformation to the Center for Health and Research Transformation. This shift highlighted our recognition of the critical role that health-related social needs and influencers have on the health of communities, as well as the substantive number of projects in our portfolio designed to address those needs. 

Today, all of our work asks: How do we create healthier populations, healthier individuals, and healthier communities? Three primary strategies guide our work and help us answer these questions.  

The first: To be, and be known as, a key source for evidence-based, non-partisan information on health policy issues and trends. 

  • Our policy briefs have remained neutral, trusted sources of information. We’ve analyzed a wide range of topics—like ways to recruit and retain behavioral health workers in rural America and effective state and federal policy options designed to support family caregivers—to determine how we can reshape policy to better serve vulnerable populations. We place a lot of attention on disseminating our briefs to policymakers, stakeholders, and other leaders, and have influenced several local, state, and federal policies.
  • Our policy fellowship—which is now celebrating its tenth year—has greatly influenced the health policy space. Historically, we’ve welcomed a diverse set of researchers and policymakers. In recent years, we added nonprofit leaders to the fellowship. In the ten years the program has run, we’ve had 122 fellows. And we launched a new fellowship for Detroit Health Department (DHD) staff, the DHD Public Health Practice and Policy Engagement Fellowship. This fellowship program has trained 37 frontline DHD staff to date, helping them build knowledge in systems thinking, data analytics, public policy, and communications. We are currently training our third cohort of DHD fellows. 
  • Our communications work has grown to be its own area, expanding from supporting CHRT’s core communications to helping partners and funders raise awareness about their programmatic efforts. For example, CHRT’s communications team is working with the national Social, Behavioral, and Economic COVID-19 Coordinating Center (SBECCC) to develop a research report showcasing NIH-funded COVID-19 research projects centered on disparities. The SBECCC hopes the report will help highlight evidence-based COVID-19 mitigation strategies and provide important data to inform future pandemic mitigation strategies across the country. 

The second: To help community-based health collaborations improve population health and magnify their impact. 

  • Our backbone support has helped community-based collaborations like MI Community Care, Vital Seniors and the subsequent Healthy Aging at Home Network, and the Washtenaw Health Initiative get started and off the ground. We’ve also facilitated the evolution of their work. Over time, that has positively impacted both individuals and populations. 
  • Our technical assistance has facilitated health care delivery transformation, new initiatives, and evolving strategies. For example, we’ve recently worked with the Michigan Department of Health and Human Services to identify more equitable long-term services and supports. In this work, we focus on data analytics and strategic planning to help our state scale solutions to a range of populations. 

And the third: To build the evidence base for local and state programs that can be replicated and scaled to improve health and social welfare. 

CHRT has evolved a lot over the past 15 years. It’s even evolved significantly over the past two years since I assumed my role as executive director in 2020. Reflecting on my time at CHRT, I think of three meaningful shifts we’ve made. 

CHRT has covered topics including health care access, health care delivery, health care integration, healthy aging, behavioral health, unpaid caregiving, health equity, the social determinants of health, and pandemic response, to name only a few of the areas we’ve addressed in our first 15 years.

We are a team of problem solvers and thought partners working alongside our funders and clients. While our approaches are evidence-based, we can also push the envelope and contribute to the evidence as we identify creative solutions to the pressing health challenges of the day.

I’m grateful to have the CHRT team by my side as we move into our next chapter. Our team is incredibly passionate. Everyone brings a unique perspective and experiences to the table, and I’m continuously humbled to be a part of it.  

In partnership,

Terrisca Des Jardins 

Insurance companies are no longer waiving cost-sharing for COVID hospitalizations. Seems fair to me.

by
Melissa Riba
By Melissa Riba, director of research and evaluation, Center for Health and Research Transformation (CHRT)

In the early stages of the COVID-19 pandemic, insurers stopped charging their members for COVID-related hospitalizations. 

Partly, that was just common sense. Charging copays and deductibles in the middle of a global pandemic–when people were sick and worried and losing their jobs–would have discouraged people from seeking care. 

But insurers were also in a really good financial position to waive those fees. 

People were continuing to pay their premiums while delaying routine care, skipping wellness visits, postponing preventive screenings, and generally toughing it out until the coast was clear. All of that saved insurers money. 

Now, consumers seem surprised that insurance companies are planning to reinstate copays and deductibles during a significant COVID-19 surge. I’m not entirely sure why that’s surprising. 

As research and evaluation director at the Michigan-based Center for Health and Research Transformation (CHRT), I have seen the data and heard the stories. And it shows that over 90 percent of the folks who are really sick–the ones who are crowding hospital ICUs and EDs–are unvaccinated. And that’s a situation that’s easily remedied. 

Vaccines are safe, free, and plentiful. Plus they’re highly effective at protecting us from COVID-19. 

Sure, there have been breakthrough infections among the vaccinated. But the evidence demonstrates that people who are vaccinated have less severe symptoms, and are less likely to end up in the hospital costing insurers a ton of money. 

A recent Kaiser Family Foundation study shows that in Michigan, only 1.6 percent of new COVID infections are occurring among the fully vaccinated. And even among those relatively rare cases, incidence of serious illness or hospitalization is practically zero (.01 percent to be precise). 

In the U.S., health insurance isn’t a human right; it’s a market commodity. 

Whether we believe that’s right or wrong, our health care system is built on a very basic capitalist principle–provide a good or service and try to make money doing it. 

Unvaccinated COVID-19 hospitalizations cost the U.S. health system $2.3 billion in June and July 2021. And if costs exceed what insurers anticipated, or result in excessive uncompensated care for hospitals, who do you think will make up for it? We all will:  Through higher premiums and cost sharing requirements; through increased hospital charges. Vaccines can save money–for insurers, for individuals, and for society. It’s as simple as that. 

Waiving copays and deductibles at the start of the pandemic was a way for insurers to encourage members to take care of themselves and others by seeking necessary care. Reinstituting copays and deductibles is a way for insurers to encourage members to take care of themselves and others by getting vaccinated. 

We’ve already done a lot to incentivize people to get vaccinated. 

There are free donuts, cash payouts, scholarship lotteries, free transportation. 

We’re now starting to see vaccination requirements at work and play. I just uploaded a photo of my own vaccination card, and my daughter (who is also vaccinated) tells me that you can’t see Harry Styles at Little Caesars Arena in September unless you can show you’re vaccinated (for those of you with a Harry fan in your household, you know this is a really big deal).

Penalties are the logical next step. We’ve tried the ‘carrot’; now it’s time for the ‘stick’ to encourage (some might say ‘force’) individuals to get vaccinated. Health insurers might not deny coverage, but they can definitely make it more expensive to make the choice to remain unvaccinated. That’s health insurance 101.

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This blog post originally appeared in The Detroit News on September 3, 2021 (Op-ed: Insurers are driving up the price of staying unvaccinated)

Backbone organizations: What they do, and why they matter

by
Nancy Baum in a black jacket, smiling
Backbone organizations and why they matter

At CHRT, we devote much of our time to policy analysis, research and evaluation, and project management.  More recently, as our emphasis on collective impact has grown, CHRT is expanding our role as a backbone organization. So what does it mean to be a backbone organization, and why does it matter?

One way to conceptualize a backbone organization is that its goal is not to work one-on-one with individuals or organizations, but to create a broader understanding of what a community needs and provide capacity to address those needs in the community. Backbone work is accomplished working among multiple organizations in a community, rather than between two entities, as might occur in project management or traditional consulting work.

Until very recently, foundations and other organizations historically hadn’t funded the infrastructure necessary for this type of coalition work. Now, as government agencies and NGOs increasingly recognize the interconnectedness of multiple factors affecting the health of people and communities, support for the work of backbone organizations is growing. Backbone work provides both infrastructure and context for mission-based organizations, and can help focus efforts taking place across entire communities and among those community organizations.

CHRT’s work with the State Innovation Model (SIM) is one example of the role a backbone organization can play in facilitating collaborative efforts to reach shared goals across regions and organizations. CHRT’s job with the SIM is, in part, to help develop key strategies and provide capacity to align resources so that regional partners – social service and health organizations in two counties – can achieve their specific missions as service providers while working together to focus on the needs of their shared clients. In the case of the SIM, care management services are provided to individuals who have high health and social needs to help them achieve their health goals and to reduce reliance on emergency departments.

As we collect and aggregate partner data locally we can start to see what the need is at a community level and measure collective impact of our joint work. We can also disaggregate the data in nuanced ways to pinpoint specific challenges key populations face and identify best practices that help our partners better address those specific needs. Similarly, in the process of facilitating the collaborative approach, we learn how to help the organizations we work with more effectively carry out their complementary work. The vantage point and capacity of a backbone organization helps local organizations that individually deal with housing, or food insecurity, or complex health care to talk to each other, collaborate, and work more efficiently together for the good of the individual.

The perspective and expertise of a backbone organization also extends beyond the ability to connect and synergize mission-driven organizations with differing core competencies. As collective work becomes more effective through better insight into process and practice, backbone organizations like CHRT also help ensure that funders understand what the partners are addressing in their community, what’s working, and where further efforts should be focused. Backbone organizations can provide expertise in budgets, offer administrative capacity and resources, create summary documents or presentations, and implement convenings to make it easier for foundations and legislative allies to support regional collaborations and tout the results of ongoing public, private or non-profit investments.This level of backbone work provides the partners with crucial resources to make the case for longer-term sustainability. 

To learn more about CHRT’s backbone work, policy analysis, research and evaluation click here.

The gift of simplicity means a lot. It means even more in the midst of coronavirus.

by
Erin Spanier

When it comes to business, simplicity is the rule. 

Amazon lets you buy with a single click. The App Store lets you do it with a print. And you can sign up for discounts at your favorite stores with an email address–no name, no phone number, no hassle.

But when it comes to government–particularly when it comes to government aid for people and families in poverty–simplicity is too often the exception. 

I recently learned that Michigan is trying to buck that trend. And as a professional communicator watching from the sidelines as coronavirus threatens the livelihood of hourly workers and business owners across the state, that makes me proud to be a Michigander.

Last summer, the Michigan Department of Health and Human Services launched a “Simple Gifts’ contest for its staff. The department-wide competition encouraged staff members to submit ideas that would make it less challenging for Michiganders to apply for government aid. 

Some 331 entries were submitted to streamline and improve the application process for healthcare coverage, emergency housing, food assistance, cash assistance, and other basic aids for those who are struggling financially.

Jennifer Bellini, an eligibility specialist from Ingham County, suggested updating verification checklists with plain language to make it easier for clients to understand requirements.

Stacy Kiger, an eligibility specialist from Genesee County, suggested making a computer and printer available at each county office so clients could print off the documents and forms they needed to complete their applications. 

Angela LaLonde, a registration support staff member from Iosco County, suggested implementing live chat on the MiBridges website for quicker responses to client questions. 

Emily Luther, a family independence manager from Macomb County, suggested adding an option to pay by phone to the toll-free line for MiChild, a health insurance program for Michigan’s working families. 

The suggestions to increase simplicity went on and on. And they were good ones. Really good.

In January, more than 30 Michigan Department of Health and Human Services employees were honored for their winning ideas at a celebratory lunch at the George W. Romney Building near the State Capitol. 

“We aim to simplify everything we do and the winning Simple Gift ideas advance that goal,” said MDHHS Director Robert Gordon at the luncheon. “We will implement as many as we can as quickly as we can.” 

Already, the state has simplified asset tests for several assistance programs, and I hope to see more of these ideas implemented in the weeks ahead.

Luke Shaefer, director of Poverty Solutions at the University of Michigan, warns that with virus-related social distancing policies “many low-earning hourly workers don’t have the option to work remotely, and this unexpected change in income will exacerbate challenges for families working hard to make ends meet.”

Small food and financial supports could go a long way toward helping those families weather this time. But to apply, families will need to navigate paperwork, procedures, and protocols that have been tooled, retooled, and complexified by generations of administrations. 

Streamlining these applications, and making sure they can be completed quickly and easily online or over the phone, would be a win for everyone–government and workers alike.

Ten years in, Riba shares the legacy and future of CHRT’s Cover Michigan Survey

by
Melissa Riba
Melissa Riba, Research and Evaluation Director, Center for Health and Research Transformation (CHRT)

Recently, our research and evaluation team sat down for a 2020 work-planning meeting, and we asked ourselves, “what did we want to accomplish in 2020?” As our conversation focused on the year ahead, it also led me to think about the last ten years of Cover Michigan – the issues and subjects we explored, and the impact that the survey has had.

The initial concept for Cover Michigan was to conduct a consumer survey that regularly explored health, health insurance, and health care access trends across Michigan.

We developed the concept in 2009 to better understand the likely impact of the Affordable Care Act on the state of Michigan and the people who live here. Over the last decade the survey has revealed important trends about health status, health care coverage, and access to health care across populations.

Survey findings

Some of the topics we asked people about included insurance churning and access, satisfaction with health coverage, and wellness and prevention programs – and we learned a lot.

  • In 2013, we found that Michigan’s mental health care system faced significant capacity challenges.
  • In 2015 we learned that cost, not physician choice, was the most important factor for consumers selecting a health plan. And we also learned that race and economic status were strong predictors of whether people had a flu vaccination, and that Michigan had opportunities to improve vaccination rates.
  • In 2016 we found that a substantial share of Michiganders reported having participated in wellness programs – though they perceived limited benefit from those programs – and that those who participated in mental health and stress relief programs reported the greatest perceived benefits.

And of course, it’s always gratifying when a Cover Michigan Survey brief is part of a story in the media, whether it’s regional coverage of our mental health care access survey brief in Crains Detroit or national print stories mentioning our Insurance churning survey findings in The Week or The New Republic.

This partial list of the useful information that has developed from the Cover Michigan survey really just scratches the surface of what we’ve learned and shared at CHRT over the last decade.

Going forward

So the Cover Michigan Survey will continue, and expand.

In the next decade, we will maintain our emphasis on learning about the health of people and communities, and we will continue tracking trends in coverage and access to care.

But we will also increase our focus on the social determinants of health; use new platforms to disseminate what we learn through the survey; and work to expand statewide partnerships that help us provide local and regional health data to inform policy decisions that positively impact the health of people in communities all across Michigan.