The important role of human-centered design in healthcare 

Male filling out tax form

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. 

15 years in review with Executive Director Terrisca Des Jardins

"1" and "5"candles burning


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.

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.

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

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

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.