New organization devoted to improving Michigan’s health care
A new Michigan organization called Michigan HealthQuarters LLC is dedicated to improving the quality of the state’s health care system, and transforming the way patient care is delivered in the state and beyond. It is a joint venture of the University of Michigan Health System and Blue Cross Blue Shield of Michigan, which was formally agreed upon on December 31, 2006. By early 2007, the organization has launched a national search for its first executive director and chosen its first project: evaluating if lower prescription drug co-payments for people with diabetes can improve diabetes care outcomes.
Executive director appointed
Marianne Udow-Phillips, director of the Michigan Department of Human Services since 2004, has been appointed founding executive director of Michigan Health Quarters, which was renamed the Center for Healthcare Quality and Transformation (CHRT). From 1992 to 2004, Marianne served in executive positions at Blue Cross Blue Shield of Michigan, including senior vice president of health care products and provider services. She holds a master’s degree from the University of Michigan’s School of Public Health.
Experts explore the problem of America’s 47 million uninsured
“In this election year, voters, candidates, and the media are increasingly focused on the issue of healthcare and the uninsured – and rightfully so,” said Marianne Udow-Phillips, CHRT’s director. “We know the public is very concerned about access to health care but when it comes to specifics, it can be hard to find common ground.” On May 2, CHRT hosted panelists to explore these issues, including Catherine McLaughlin, professor of health management and policy at the U-M School of Public Health; Kevin Seitz, executive vice president of health care value enhancement at Blue Cross Blue Shield of Michigan; and Ellen Rabinowitz, executive director of the Washtenaw Health Plan. Tracy Davis of the Ann Arbor News moderated the panel.
Health care coverage and access report released
Cover Michigan, a report on healthcare coverage released today by CHRT shows that while Michigan compares well to the country as a whole, the state is losing ground in critical areas, including the number of Michigan’s children and adults who are uninsured and the percentage of the population covered by private insurance. “Cover Michigan shows a state under stress,” said CHRT director Marianne Udow-Phillips. “More and more Michigan residents – especially our most vulnerable populations – are facing hardships in obtaining and affording health care. Our health care delivery system is destabilizing as more people are underinsured and uninsured.”
Collaborative Quality Initiative saves lives and dollars
Through collaborative quality initiatives sponsored by Blue Cross Blue Shield of Michigan and the Blue Care Network (BCBSM/BCN), Michigan physicians and hospitals are working together and proving that collaboration is indeed a powerful model for saving both lives and dollars for patients throughout Michigan. In one Michigan CQI, hospital deaths following angioplasty and other minimally invasive heart procedures declined 32 percent over five years. Another Michigan CQI saved more than $13 million in one year by reducing the rate of ventilator-associated pneumonia by 29 percent. Physicians from BCBSM/BCN and the University of Michigan Health System (UMHS) showcased the successes and strategies behind these initiatives at a June 4 health care quality symposium sponsored by CHRT. Executive director of CHRT, Marianne Udow-Phillips, presented at the symposium.
New study explores Michigan health care spending
Michigan’s health care spending has been growing at a slower pace than the national average for more than a decade says a new CHRT study. Michigan spends less per capita on personal health care than the national average, ranking 36th among the 50 states and District of Columbia in 2004 (the most recent year for which state-level data were available), and has one of the lowest rates of Medicaid payments to physicians in the country, ranking 44th on the 2008 Medicaid to Medicare physician fee index.
Issues faced by insured and uninsured populations
CHRT’s first Cover Michigan Survey focuses on health care coverage, health status, ability to pay for care, and decisions about seeking—or not seeking—needed health care services. The resulting study paints an important picture for those seeking to expand access to care in Michigan and the U.S. While health insurance coverage for all is an important goal, the survey reveals that coverage alone will not guarantee access to care. Other barriers to access—such as cost and availability of providers—must be addressed by policymakers in all sectors in order to close the gap between coverage and care. And, factors beyond medical care—such as income and education—must be considered if the focus is on achieving the ultimate goal: improved health status for all Michiganders.
Sweeping health care reform
The Patient and Protection Affordable Care Act (ACA) is signed into law on March 23rd. The most sweeping health care reform the U.S. had seen in decades, the ACA sought to dramatically increase access to health insurance for those without employer-sponsored care, to expand access to Medicaid for low-income Americans, and to encourage states to develop and explore innovative medical care delivery methods designed to lower the cost, and improve the quality, of health care.
High variation in tests and procedures across Michigan
A report released today by CHRT on the use of health care services in Michigan shows a high degree of variation in the use of certain tests and procedures—including back surgery, Cesarean section, hysterectomy, and angioplasty—among different regions throughout the state. “Geographic variation has been well-documented nationally and was a significant topic of discussion during the debate on health reform,” said Marianne Udow Phillips, CHRT’s founding executive director. “Developing a better understanding of variation in the use of health care services could support state and national efforts to improve quality and contain costs in the health care system.”
Grant to improve care for individuals with chronic conditions
In the summer of 2010, CHRT staff led the writing and analytics of the State of Michigan’s grant proposal for the Centers for Medicare and Medicaid Services (CMS) Multi-Payer Advanced Primary Care Practice Demonstration project. In the fall of 2010, CMS selected Michigan as one of eight states to host the demonstration. CHRT partnered with the State of Michigan and the University of Michigan Health System to implement the grant, with a focus on improving primary care for those with chronic disease. Michigan’s project—known as the Michigan Primary Care Transformation Demonstration Project (MiPCT)—was a five-year, multi-payer, statewide demonstration project aimed at reforming primary care payment models and expanding the capabilities of the state’s patient-centered medical homes.
MiPCT at a glance:
- Michigan’s project was the nation’s largest patient-centered medical home initiative, reaching approximately 1 million people served by 1,900 providers in 400 practices.
- MiPCT included Medicare, Medicaid and commercial carriers.
- Of the eight states in the demonstration program, MiPCT was one of only two to show consistent savings over the three years of the demonstration period, with a net Medicare savings of $336 million.
- $110 million in additional Medicare payments were made to providers in Michigan over the demonstration period.
Today, MiPCT is still an ongoing initiative. It’s now referred to as the Michigan Multi-payer Initiative (MMI) and CHRT’s executive director provides strategic consultation to the program manager.
Washtenaw Health Initiative convenes
On Monday, November 8, 2010—just eight months after the passage of the ACA—a diverse group of health and community leaders from across Washtenaw County meet to discuss how the Affordable Care Act will impact Washtenaw County residents. Marianne Udow-Phillips, executive director of CHRT, facilitated the process, with key volunteers from Washtenaw County’s health and human service organizations. The Washtenaw Health Initiative (WHI) emerged as a result of this work. CHRT continues to serve as the backbone organization to the WHI, helping volunteer leaders from more than 100 local organizations meet shared objectives as they work to improve health, health care, and health equity for Washtenaw County’s low-income, uninsured, underinsured, and underrepresented populations.
Health care coverage important, but not enough
The second annual Cover Michigan Survey shows that people who lack health coverage are more likely to seek medical treatment in costlier care settings and less likely to have regular, preventive care. The survey of 1,000 Michigan adults also reveals that simply having health coverage does not guarantee access to care. Among those with health coverage, those with Medicaid coverage reported the greatest difficulty gaining access to preferred primary care providers or specialists and were the most likely to delay seeking care when needed. The uninsured—who reported more difficulty accessing care when compared to the insured—appeared to be sicker or more acutely ill at the point they sought health care services. And among the uninsured, nearly one in three (32 percent) reported having been diagnosed with depression, compared to one in ten (11 percent) of the insured.
ACA planning tool for midsize and large businesses
CHRT releases a policy brief that explains the most significant effects of the Affordable Care Act (ACA) on midsize and large employers in Michigan and the United States. Many surveys have predicted the likely actions of employers when the ACA goes into full effect in 2014—but the accuracy of those predictions depends largely on how well employers understand the relevant provisions of the ACA. In reality, it is likely that many employers do not yet have a full picture of the ACA and its effects on their particular business situations. CHRT’s policy brief, The Affordable Care Act and its Effects on Midsize and Large Employers, is designed as an easy-to-understand analysis and planning tool for midsize (100–1,000 employees) and large (more than 1,000 employees) businesses to better inform their thinking about health care reform and its impact.
81 percent of Michigan docs willing to serve Medicaid patients
Survey results released today by CHRT, in partnership with the Child Health Evaluation and Research Unit (CHEAR) at the University of Michigan, show that Michigan primary care physicians will continue accepting new patients—including Medicaid recipients—as the state’s insured population grows under health care reform. Results of the statewide survey reveal that a majority (81 percent) of Michigan primary care physicians anticipate being able to accommodate patients who become newly insured in 2014, when health insurance coverage expands significantly under the Patient Protection and Affordable Care Act (ACA). Of those physicians, nearly all indicated that they would accept newly eligible Medicaid patients. Primary care physicians surveyed included family physicians, internal medicine practitioners, and pediatricians.
New fellowship to better connect research and policy
CHRT announces its inaugural class of Health Policy Fellows. CHRT’s new health policy fellowship program at the University of Michigan focuses on building connections between health services researchers and policymakers for more effective, evidence-based health policy decisions. The fellowship, thought to be the first of its kind in the nation, brings together five health science researchers from the University of Michigan and five Lansing policymakers to work on joint projects and learn from each other. The fellowship includes interactive seminars as well as hands-on experience.
“Researchers across the University of Michigan are engaged in significant work that can and should inform policy,” said CHRT’s founding executive director Marianne Udow-Phillips. “Similarly, policymakers can help faculty understand how the policy process works so that research can be better targeted to have a meaningful impact. In order to accomplish those goals, researchers and policymakers need open channels of communication and a shared language. This fellowship is designed to build a common knowledge-base for researchers and policymakers and help them generate ideas for working more closely together.”
In the inaugural year of the fellowship, CHRT, the Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, and the Institute for Healthcare Policy and Innovation co-sponsor a symposium as a companion event. The symposium is designed to help participants understand the barriers and solutions to increasing the impact of health services research on policy and practice. The symposium includes panels of funders, researchers, and policymakers, including then Michigan Senate Minority Leader Gretchen Whitmer. A paper on this symposium is authored by Eve A Kerr, Melissa Riba, and Marianne Udow-Phillips and published in the Journal of Health Sciences Research.
ACA Medicaid changes will simplify enrollment, reduce uninsurance
CHRT releases a policy paper that shows how the Patient Protection and Affordable Care Act (ACA) in 2014 will streamline eligibility categories and may also help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage. Currently, there are at least 40 different ways—each with varying eligibility requirements—to qualify for Medicaid in Michigan. Whether or not Michigan decides to expand coverage for Medicaid, the paper shows that enrolling in Medicaid and maintaining that coverage should become easier for Michigan residents starting in 2014, when the ACA requires states to eliminate asset tests—a review of an individual’s assets to ensure they do not exceed certain limits—and consolidate existing eligibility categories.
Initial ACA grants build workforce, health centers, and access to care
CHRT releases an issue brief showing that through the end of the 2011 federal fiscal year, Michigan organizations have received more than $82.5 million in grant funding under the Patient Protection and Affordable Care Act (ACA). The majority of the funding is targeted to workforce building, helping the state educate and train more nurses and physicians. Other funding has gone to community health centers, community-based disease prevention programs, and programs to help the state prepare for changes coming to the health insurance market.
The grants are helping Michigan prepare for the increased number of people expected to have health insurance, particularly Medicaid.
“A lot of attention on health reform has been focused on the health insurance expansion, but expanding coverage alone will not increase access to care or move us closer to a more efficient and effective health care system,” says Marianne Udow-Phillips, CHRT’s founding executive director.
“The ACA’s grant-making focus shows that the federal government was concerned about the ability of states to care for their citizens with enough doctors, nurses, and locations for care.” In addition to describing the Michigan awards, the issue brief also shows what was awarded to all 50 states and the District of Columbia, revealing that the ACA grants are placing a priority on the development of the healthcare workforce and community health center infrastructure.
Michigan could save nearly $1 billion over 10 years by expanding Medicaid
A report released today by CHRT, in partnership with University of Michigan economists Thomas Buchmueller and Helen Levy, shows that the State of Michigan could save nearly $1 billion over 10 years while extending comprehensive health insurance to more than 600,000 Michigan citizens if the state expands Medicaid eligibility under the ACA. The U.S. Supreme Court’s June 2012 decision largely upheld the constitutionality of the Patient Protection and Affordable Care Act (ACA), but a provision that would financially penalize states that opted out of the law’s Medicaid expansion was not upheld, leaving the decision to individual states whether or not to expand Medicaid eligibility to individuals at or below 138 percent of the federal poverty level ($31,809 for a family of four).
The State of Michigan has not yet indicated whether it will expand Medicaid eligibility. The CHRT/University of Michigan analysis of three different scenarios, varying mostly according to assumptions about enrollment behavior, shows that under all three scenarios, the expansion would reduce the number of uninsured while reducing overall state spending. In the most likely scenario, by 2020 the state could expect Medicaid enrollment to increase by 619,000 people—most of whom are currently uninsured.
The federal government will bear nearly all of the cost of the expansion, and the new federal funds will offset state spending on existing health programs. Because of this, the state would save an estimated $983 million over 10 years. Under all three scenarios analyzed, the state experienced a net savings over the 10‐year period.
Less than 10 percent of Michigan’s small businesses impacted by ACA’s mandate
Today CHRT released a brief showing that more than 90 percent of Michigan’s small businesses are exempt from the health insurance mandates that become effective January 1, 2014. The brief also outlines the decision areas that all small employers should consider when determining how to participate in health coverage under the Affordable Care Act. CHRT’s brief, The Affordable Care Act and Its Effects on Small Employers, shows that 96 percent of Michigan’s 154,488 private-sector small businesses have fewer than 50 employees, exempting them from penalties if they opt to not offer health coverage.
CHRT projects regional impact of ACA, Medicaid expansion across Michigan
CHRT issues projections on the likely coverage effects of the Affordable Care Act (ACA) in Michigan–both with and without an expansion of Medicaid eligibility criteria. The projections focus on the adult population, aged 19-64, that will be eligible for Medicaid if the state approves its expansion, as well as adults that will be eligible for tax credits to subsidize private coverage through the national Health Insurance Marketplace.
CHRT’s research describes the expected characteristics of those who are eligible to get coverage in Michigan as a result of the ACA, including geographic distribution, current coverage, age, gender, employment, education and race/ethnicity.
“Our research shows that access to affordable health coverage is a statewide issue,” said Marianne Udow-Phillips, CHRT’s founding executive director. “After Wayne County, four of the five top regions in the state that had the highest rates of uninsurance in 2011 were rural counties in the northern Lower Peninsula and the eastern Upper Peninsula.”
Recession, increase in uncompensated care, strain Michigan’s safety net
A report released today by CHRT outlines the severe impact of Michigan’s recession on the ability of the health care safety net to provide health care to the growing number of Michigan residents who need their services. From 2007 to 2011, uncompensated care provided by Michigan hospitals increased 42 percent, and patient volume at federally qualified health centers (FQHCs) increased by 22 percent. The number of uninsured increased by 133,000, yet there was no net increase in the number of free clinics statewide. In fact, five of seven free clinics in the Upper Peninsula closed, leaving just two clinics for the entire population.
Consumers paying more out-of-pocket for health care
CHRT today released two briefs showing that for more than a decade, employers have been dropping health insurance and consumers have been paying more out-of-pocket for health care, a trend that began many years before the development of the Affordable Care Act. The research briefs also show Michigan’s employers are increasing employee cost-sharing and moving to high deductible health plans at a faster rate than the national average. According to the data, from 1999 to 2011, the proportion of individuals covered by employer-sponsored insurance decreased by approximately 15 percent nationwide. Between 2008 and 2011 specifically, the proportion of people with private health insurance (either through their employers or individually-purchased) fell 4.7 percent in Michigan and 4.4 percent nationwide.
Sharp rise in hospitalization for sepsis
CHRT’s new report shows a dramatic increase in hospitalizations for septicemia from 2007 to 2011. The hospitalization rate for orthopedic procedures that improve mobility and alleviate chronic pain also increased. The issue brief, The Cost Burden of Disease: United States and Michigan, is an analysis of hospitalization rates and charges from 2007–2011. During this timeframe, hospital discharge rates for septicemia rose sharply among the total population in both the U.S. and Michigan, by 56.8 percent and 62.1 percent, respectively. In 2011 alone, this resulted in total charges for septicemia diagnosis of $74.2 billion in the U.S. and $1.9 billion in Michigan.
Exploring a Learning Health State
CHRT assembles stakeholders—patients, clinicians, researchers, public health professionals, and payers—in Lansing, Mich., to create an action plan to innovatively and collaboratively tackle challenges affecting the health of the people of Michigan through continuous learning and improvement. The group discusses ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later, in 2018, the initiative publishes a brief proposing the use of a learning health system approach to address persistent health care problems in Michigan.
First ACA marketplace rate analysis
In CHRT’s first marketplace rate analysis brief, CHRT summarizes the plans that have been offered on the very first ACA individual marketplace, which lasted from October 1, 2013 to March 31, 2014. CHRT explains insurers and their offered plans, the process to enroll, cost to individual consumers, and financial assistance options. “Michigan was able to mount robust enrollment in the marketplace during the first open enrollment period,” the brief says. In the first open enrollment period, there were nine participating insurers—with Blue Cross Blue Shield of Michigan being the only insurer that offered marketplace coverage statewide—and 87 percent of first time enrollees were eligible for financial assistance.
New laws covering autism treatment creating opportunities and challenges
A report examining current implementation of new autism laws in Michigan, released today by CHRT, reveals a changing environment for autism care. Under these laws, state-regulated insurance plans must cover diagnosis and medically necessary treatment for children with autism spectrum disorder (ASD) from birth through 18 years and Medicaid and MIChild must now cover a specific evidence-based behavioral therapy, known as applied behavior analysis (ABA), for children with ASD from 18 months through age 5. The brief, Autism Spectrum Disorder in Michigan, released in partnership with the Michigan Department of Community Health, examines how the new laws have enabled many children to be covered for treatment. This transformation in coverage for autism treatment also brings some challenges in accessing care for families with autistic children. For example, before a child can obtain approved, covered applied behavior analysis therapy (ABA) therapy, Michigan requires that a medical diagnosis of ASD come from a designated provider. Currently, estimated wait times for privately-insured children to be evaluated range between one month and 24 months.
Health care spending for chronic conditions in Michigan
In a new issue brief, CHRT staff member Abdullah Hammoud summarizes BCBSM’s health care spending in Michigan for five common chronic conditions:
- Coronary artery disease
- Congestive heart failure
- Chronic obstructive pulmonary disease
The brief states that “in 2010, roughly 30 percent of total national health care spending—$347 billion—was associated with the following chronic conditions: heart conditions, cancer, chronic obstructive pulmonary disease, asthma, diabetes, and hypertension.
The largest contributing factors to the increase in the prevalence of such conditions include physical inactivity, tobacco use, and poor diet. Currently, over 95 percent of Michigan adults report at least one behavior that may increase their risk for chronic conditions.”
Michigan Medicaid expansion a model for Republican-led states
A report released today by CHRT shows that the alternative approach to passing and implementing Medicaid expansion in Michigan—a state led by a Republican governor—can be a model for other states with bipartisan or Republican-led governments seeking Medicaid expansion. “The number of Republican governorships retained—and gained—during the midterm elections makes Michigan’s experience in securing Medicaid expansion through the Healthy Michigan Plan particularly important,” says Marianne Udow-Phillips, founding executive director of CHRT, one of the organizations that prepared the report.
As of November 1, 2014, nearly 450,000 people had enrolled in the Healthy Michigan Plan—Michigan’s expanded Medicaid program—and another 272,000 selected coverage through the federally-facilitated Health Insurance Marketplace. The coverage expansions in Michigan have exceeded all projections at the state and federal levels.
Michigan docs have capacity to take new patients; 64 percent taking Medicaid patients
CHRT’s 2014 survey of Michigan primary care doctors shows that the great majority – close to 9 out of 10 physicians – have capacity to accept more patients, quieting concerns about meeting increased demand as more people continue to get coverage under the Affordable Care Act.
ACA brings nearly half a billion dollars to Michigan over five years
A report released today by CHRT shows that since 2010, the state of Michigan has received close to a half billion dollars in grant funding to develop and implement programs and services as part of the Affordable Care Act (ACA). Michigan received $489.4 million from March 2010, when the ACA became law, through the most recent fiscal year ending in September 2014, ranking 14th nationally in awarded ACA grant funds. In fiscal year 2014, Michigan received $183.9 million and placed ninth.
Dramatic improvement in health insurance coverage and access since 2012
A survey brief released today by CHRT shows that in 2014, fewer Michiganders reported being uninsured and struggling to pay medical costs or delaying needed medical care, and more residents had access to primary care than in 2012, before the Affordable Care Act’s coverage expansions went into effect.
ACA impact on Michigan coverage: Alpena to Zilwaukee
CHRT, in partnership with the University of Michigan Institute for Healthcare Policy and Innovation (IHPI) and the School of Public Health, hosted a panel discussion about the ACA’s impact on health insurance coverage in Michigan. Panelists discussed how access to care is changing in Michigan in light of new coverage opportunities, how businesses and insurers are engaging in a changing marketplace, and how expanded coverage will impact the health care delivery system.
Hospital costs lower in Michigan than in Indiana, Wisconsin
A report released today by CHRT shows substantial variation in hospital costs between Indiana, Michigan, and Wisconsin, with Michigan as the lowest cost among the three states. These three states were chosen for study as Midwestern states with diverse health care policies and market conditions. The report analyzed hospital costs at the state level and hospital profit margins in the largest city in each state—Detroit, Indianapolis, and Milwaukee.
Costs, not physician choice, most important factor in coverage selection
A report released today by CHRT shows that individuals selecting health coverage in Michigan are making their buying decision based on costs more than choice of physicians and network size. The report, “Health plan selection: Factors influencing Michiganders’ choice of health insurance,” shows that consumers purchasing individual health insurance coverage were more than twice as likely to report that premium cost was very important in selecting a health plan as they were to report that the number of in-network physicians was a very important factor in their decision.
Health information exchange critical for effective, safe care
CHRT co-presents the documentary, No Matter Where, and a subsequent panel discussion with the filmmaker and other health leaders. In the 76-minute documentary, filmmaker Kevin B. Johnson, MD, MS, examines health information exchanges and their importance to effective and safe health care. Following a team of crusaders—doctors, nurses, widows, parents, and spouses—Johnson provides a glimpse into the quest to use technology to connect all of health care.
In 2013, Michigan’s underinsured outnumbered uninsured
CHRT’s new issue brief, The underinsured in Michigan, shows that in 2013, nearly 1.2 million Michigan residents with health insurance coverage had out-of-pocket medical spending that was high enough relative to income to be considered underinsured. In the report, an individual is defined as underinsured if their out-of-pocket obligations for health care expenses exceed 10 percent of their income in families that earned more than 200 percent of the federal poverty level (FPL), or exceeds 5 percent of their income in families earning less than 200 percent of FPL. These underinsured individuals exceeded the one million who were uninsured in Michigan in the same time period, the report found.
Eighth iteration of Cover Michigan Survey explores Michigan’s uninsured
Two years after the ACA’s major coverage provisions went into effect, CHRT shares an analysis of the characteristics of Michigan’s uninsured. 2014 was the first year the individual mandate took effect. Five percent of respondents reported being uninsured at the time of the survey. By comparison, in 2012, 14 percent of respondents reported being uninsured. And the rate of uninsured dropped 11 percent from 2013 to 2014.
Adults aged 18 to 25 and 26 to 34 experienced the largest decrease in uninsured rates. Further, uninsurance rates for African Americans and Hispanic individuals fell by 5.3 and 3.7 percentage points, respectively. The brief analyzes the impact of the individual mandate for Michiganders, and what the next two years will look like.
The complexity of advance care planning
A brief shared today summarizes community and physician perspectives on advance care planning (ACP). Recommendations are grouped into three categories: normalizing the conversation around advance care planning, investing in ACP training and reimbursement—such as encouraging medical schools to invest in training all physicians to have advance care planning conversations with patients—and establishing metrics and operationalizing advanced care planning—such as having clear requirements for what constitutes a reimbursable advance care planning conversation.
New CHRT board members
Today, CHRT welcomes a new board of directors that includes representation from additional health care, business, and policy organizations. CHRT’s new board of directors includes:
- John Z. Ayanian, Director, Institute for Healthcare Policy and Innovation, University of Michigan.
- Robert Casalou, President and CEO, St. Joseph Mercy Health System, Ann Arbor.
- Tony Denton, Senior Vice President and Chief Operating Officer, University of Michigan Health System.
- Kevin J. Klobucar, Executive Vice President, Health Care Value, Blue Cross Blue Shield of Michigan.
- Francine Parker, Executive Director, UAW Retiree Medical Benefits Trust.
- Lynda Rossi, Executive Vice President, Strategy, Government and Public Affairs, Blue Cross Blue Shield of Michigan.
- Thomas L. Simmer, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of Michigan.
- Terence A. Thomas, Co-Founder, Thomas Group Consulting, Inc.
- Brent C. Williams, Medical Director, University of Michigan Complex Care Management Program.
What repeal and replace could mean
A new CHRT brief titled Potential approaches to the Affordable Care Act outlines what repeal and replacement options to the Affordable Care Act could include. Following the election of President Donald Trump, the GOP is expected to share its repeal and replace plans. Ahead of this, CHRT staff describe five potential outcomes:
1) allow insurance to be sold across state lines,
2) make premiums tax deductible,
3) establish high risk pools,
4) reduce Medicaid funding and use block grants,
5) allow the importation of drugs.
Because the law is sweeping and includes many provisions that go beyond health insurance coverage issues, repealing and replacing would be complex, the brief states. The brief also explains the policy steps that would need to occur—from approval in the senate, to the budget reconciliation process, to approval from the president.
Diversifying funding sources
A major structural change occurs in December of 2016 when Michigan Medicine and Blue Cross Blue Shield of Michigan change their philanthropic priorities to focus on other important health policy initiatives. CHRT was founded, and supported during its first several years, by these two funders. In 2015, the year before the structural change, CHRT had only seven distinct funders and received a significant portion of its revenue from Michigan Medicine and Blue Cross Blue Shield of Medicine. In 2022, at the 15th anniversary of CHRT, the organization has 37 distinct funders.
CHRT participates in multi-state ACA marketplace analysis
In February, as a part an ACA Implementation Research Network established by the Center for Health Policy at Brookings and the Rockefeller Institute of Government, CHRT publishes an ACA marketplace competition analysis. The ACA Implementation Network includes representatives from five states: California, Florida, Michigan, North Carolina, and Texas.
Collecting qualitative and quantitative data from Delta, Genesee, Kalamazoo, Kent, and Wayne counties, CHRT evaluates perceptions of competition in Michigan’s exchange and insurance market. The report shares that “at the end of the 2016 open enrollment period, 345,813 residents have selected a plan through Michigan’s exchange. New consumers make up 33 percent of these plan selections, while 67 percent were reenrollees. Of the reenrollees, 42 percent chose a new plan in 2016, while 25 percent were automatically reenrolled into the same plan they held in 2015. By March 31, 2016, Michigan has 313,123 effectuated enrollments (the number of enrollees who paid premiums) through its exchange.”
However, CHRT identifies large differentials in plan offerings, premiums, and out of pocket costs between regions in Michigan. For example, in Delta County, only 16 plans were offered whereas in Wayne County, 84 plans were offered. Health care and health policy experts interviewed share varying opinions. Despite nuances, most share an overall positive experience with Michigan’s marketplace exchange.
The results of this report were presented at a Washington, DC conference with panelists from other ACA Network states.
Health care cost barriers have declined significantly since ACA implementation
In an analysis of marketplace coverage, cost, and care utilization, CHRT finds that since insurance has been expanded in Michigan under the ACA, cost-related barriers to care and delaying care have been reduced significantly. This brief presents findings on how health care access changed in Michigan with ACA implementation, using data from CHRT’s 2010, 2012, 2014, and 2015 Cover Michigan Surveys.
The researchers conclude that in its first few years, the ACA was successful in reducing financial barriers to care. Compared with two years prior to the ACA’s implementation there was an 8 percent drop in the proportion of all Michigan adults having problems paying medical bills, the analysis found.
New home for Michigan Community Health Worker Alliance
Beginning in July, the Michigan Community Health Worker Alliance (MiCHWA) and two full-time community health workers will be housed at CHRT. Community health workers serve as trusted public health workers available to support residents’ health needs. They also link individuals to the health and social services available in their communities. CHRT will help MiCHWA work with partner organizations to promote policies for continued, long-term community health worker sustainability and building a state online community health worker registry.
New care coordination for frequent ED patients
In 2015, the Washtenaw Health Initiative was selected to coordinate one of five Community Health Innovation Regions (CHIR) in Michigan’s State Innovation Model demonstration, funded by the U.S. Center for Medicare and Medicaid Innovation. The Livingston/Washtenaw CHIR would work to improve health by addressing upstream social and economic factors. With backbone support from CHRT, the local CHIR launched its demonstration in August 2017. The CHIR provides wraparound care coordination for frequent ED patients by linking these patients to community health, mental health, and human service agencies. Potential participants are identified in one of two ways: provider referrals or a predictive model. A randomized controlled trial will measure outcomes. CHRT staff help coordinate care with the 12 local agencies participating in the pilot: Avalon Housing, Corner Health Center, Home of New Vision, Jewish Family Services of Washtenaw County, Integrated Health Associates (IHA), Livingston County Catholic Charities, Livingston County Community Mental Health, Michigan Medicine Complex Care Management Program, Packard Health FQHC, St Joe’s Complex Care, Washtenaw County Community Mental Health, and the Washtenaw Health Plan.
Five-year initiatve to promote healthy aging among adults with disabilities
The University of Michigan’s Center for Disability Health and Wellness is selected as a recipient of the U.S. Administration for Community Living’s National Institute on Disability, Independent Living, and Rehabilitation Research grant. The goal of the grant: to promote the healthy aging of adults with long-term physical impairments and disabilities. UM’s Center for Disability Health and Wellness selects CHRT as a collaborator and Co-PI in the five year grant. CHRT will conduct policy analyses and health research studies while developing and disseminating policy and practice briefs on topics related to healthy aging, unpaid caregiving, and support for individuals with disabilities.
Impact of potential work requirements for Michigan’s expanded Medicaid population
In early 2018, the U.S. Centers for Medicare and Medicaid Services (CMS) announced that states could require Medicaid recipients to work a minimum number of hours to qualify for Medicaid coverage. Following this, the State of Michigan introduced a bill that would require most of Michigan’s expanded Medicaid population–Healthy Michigan Plan enrollees–to work at least 80 hours per month to continue to receive health care coverage. Under the proposed bill, if enrollees failed to meet monthly requirements for three months, coverage would be suspended until the enrollee came back into compliance. CHRT’s first work requirements fact sheet compared Michigan’s bill to similar policies in other states and predicted the impact such a policy would have on Michiganders—estimating that 5-10% of Michiganders could lose coverage if the bill were to be approved.
From health care to health
CHRT changes its name from the Center for Healthcare Research & Transformation to the Center for Health and Research Transformation. This change represents a shift in CHRT’s portfolio of work, from one focused narrowly on health care policy and access to health care to one focused more broadly on the need to address health-related social needs and to integrate health care with behavioral health care and social services. Our acronym, pronounced “chart,” remains the same—as does our longstanding commitment to improving the health of people and communities.
Improving health outcomes for expecting mothers and babies
CHRT begins work on an alcohol screening and brief intervention (SBI) pilot in women’s Detroit-area clinics. Excessive alcohol consumption for women of childbearing age has multiple health consequences for pregnancy and birth outcomes. However, health professionals are uniquely positioned to intervene using alcohol screening and brief intervention (SBI) protocols, an evidence-based approach that has proven successful. CHRT will work with the Henry Ford Health System in Detroit and other partners to conduct a multi-site evaluation of four alcohol screening and brief intervention implementation programs in health care systems and settings serving individuals of child-bearing age.
Evaluating integration models
For the next five years, CHRT will provide implementation support and serve as the evaluator of Michigan’s primary and behavioral health care integration initiative, funded by the U.S. Substance Abuse and Mental Health Services Administration. The initiative will take place in three underserved and disparate counties across the state—Barry County, Saginaw County, and Shiawassee County—all of which hold federal Health Professional Shortage Area designations for both mental health and primary care. CHRT will help to align site work plans, goals, and evaluation measures, conduct an annual integration self assessment survey, and provide quarterly quantitative and qualitative updates.
Fifth ACA marketplace rate analysis
CHRT shares its fifth annual analysis of ACA marketplace options and rates, analyzing options and costs during the six-week open enrollment period. The analysis finds that the increase in premium rates has stabilized compared to the prior year. Additionally, at least 48 of Michigan’s 83 counties saw an increased number of options in every plan type: bronze, silver and platinum. In 2018, all of Michigan’s 83 counties had at least two marketplace insurers, with many counties having additional options (the number of plans ranged from 12 to 57). However, funding for marketplace navigation assistance fell by 72 percent this year, from $2,228,692 in 2017 to $627,958 in 2018.
Expanding long-term services and supports in Michigan
CHRT shares an analysis of the State of Michigan’s long-term services and supports system along with options for expansion. In 2017, the Michigan Department of Health and Human Services asked CHRT, Health Policy Matters (HPM), and Public Sector Consultants (PSC) to explore implementing managed long-term services and supports (LTSS). The three agencies suggest that the state’s current MI Health Link program could be adapted to provide quality long term services and supports because it already integrates physical health care and behavioral health care, and, therefore, could support an additional integration of LTSS. However, the team states more research is needed to determine what is the most optimal approach to launch a long-term services and supports program.
Behavioral health workforce shortages
In 2019, CHRT’s policy team began analyzing behavioral health workforce challenges and opportunities in partnership with the University of Michigan School of Public Health’s Behavioral Health Workforce Resource Center. In February 2020, CHRT will publish The Behavioral Health Workforce in Rural America: Developing a National Recruitment Strategy, highlighting successful recruitment and retention strategies for behavioral health workers across the US. From 75 key informant interviews, the researchers identified a range of innovative approaches including: increasing the use of public private partnerships to fund tailored loan repayment, scholarships, conferences, and pipeline/pathway programs; investigation of changing certification requirements to encourage earlier entry into practice; and improvements to rural work/life balance to reduce burnout.
In future years, CHRT will complete three studies: 1) support for behavioral health providers during public health emergencies, 2) community health workers as extenders of the behavioral health workforce in certified community behavioral health clinics, and 3) the role of the behavioral health workforce in integrated models of primary and behavioral health care via telemedicine in rural and underserved areas of Michigan. In addition, Nancy Baum, CHRT’s director of policy, will be named deputy director of U-M’s Behavioral Health Workforce Research Center.
Inaugural class of Detroit public health practice fellows
With support from U-M Poverty Solutions and the DMC Foundation, the Detroit Health Department (DHD) worked with CHRT to develop a new fellowship program for front-line staff–one designed to build specific skills and knowledge that would positively impact public health service delivery in Detroit. The fellowship engages DHD personnel who work in a wide variety of departments and roles such as maternal and child health, environmental health, lead poisoning prevention, child and adult immunizations, and more. The sessions are designed to build knowledge in systems thinking, data analytics, policy engagement, and communications so that new skills and practices can be applied by DHD staff in their daily work. Two cohorts of 37 DHD staff have completed the fellowship.
CHRT supports expansion Vital Seniors Initative
In response to the rapidly growing senior citizen population in Washtenaw County, CHRT begins work with the Vital Seniors Initiative and the Washtenaw Health Initiative to prepare for the coming age wave. CHRT’s role at this time is to find places in the local senior service system where seniors and their caregivers face barriers; to map the service system’s strengths and weaknesses; to gather feedback from focus groups; to collect and analyze data; to publish reports that will help agencies implement changes; to engage in strategic planning processes to create a community action plan; and to support collaborative efforts to develop programs and secure funding for sustainability.
CHRT supports United Auto Workers health care negotiation process
In the spring of 2019, CHRT begins to provide information for the United Auto Workers (UAW) union bargaining process with Blue Cross Blue Shield of Michigan. Specifically, CHRT provides independent assessments of 23 topics of interest between May 2019 and September 2019. In a total of 26 research papers, CHRT shares the evidence base, historic coverage trends, and value proposition for a range of health care coverage options including acupuncture, air ambulance, allergy testing, chiropractic care, infertility support, genetic testing, and more.
CHRT supports Kresge Foundation integration for health and racial equity initiative
Since 2016, CHRT has been working with The Kresge Foundation to focus on the integration of health, behavioral health, and social services to enhance health and racial equity. Now, CHRT is tapped to help The Kresge Foundation launch a new initiative to recruit and support national integration leaders as they implement, align, and improve data sharing systems; blend health and human services funding streams; ensure person-centered approaches; establish shared values and goals; and create strong and effective feedback loops for continuous quality improvement among partners.
A decade of Cover Michigan
As 2019 closed, CHRT’s research and evaluation team reflected on 10 years of Cover Michigan—a health care consumer survey that originally sought to explore health, health insurance, and health care access trends across Michigan to better understand the impact of the Affordable Care Act. Over the last decade, the survey has revealed important trends about health status, health care coverage, and access to health care across populations. In the next decade, CHRT will increase its focus on the social determinants of health; use new platforms to disseminate findings; and expand statewide partnerships to inform policy decisions that positively impact the health of people in communities across Michigan.
CHRT’s new mission
In 2019, CHRT’s staff engage in a year-long strategic planning process and reflect on the health policy and practice challenges they have worked on and their ambitions for the health of people and communities in Washtenaw County, the state of Michigan, and the nation as a whole. Through a series of creative visioning exercises, CHRT crafts a new mission and new strategic objectives. CHRT’s new mission continues to hold non-partisan, objective analysis at the core of its practice, but focuses on fostering policies and practices that improve the health of people and communities. The updated mission and goals will guide CHRT’s work from 2020 to 2025.
CHRT publishes first COVID-19 rapid response research brief–more to come
Throughout the COVID-19 pandemic, CHRT conducts rapid response research for Michigan policy leaders who are working proactively to protect people and communities across the state. CHRT’s first rapid response brief, published on April 10, 2020, is conducted at the request of the Michigan Department of Health and Human Services. In the brief, CHRT staff explore funding and policy opportunities in the 2020 CARES Act, signed into law on March 27, 2020, that would be useful to local health departments.
Subsequent briefs address a broad range of topics, as requested by policymakers and practitioners, including:
- Best practices for protecting populations in nursing homes and long-term care settings
- Meeting the behavioral health needs of Michigan’s prison population
- Safe, temporary shelter for homeless populations during the pandemic
- Mitigating the impact of COVID-19 on persons in poverty
- Protecting individuals with serious mental illness from COVID-19
In addition to these and other rapid response briefs, in 2021 and 2022 CHRT publishes a series of COVID-19 research briefs for policymakers and practitioners, such as:
- Telehealth services have expanded to address COVID-19 emergency. Let’s preserve the most effective innovations.
- Build support for COVID-19 contact tracing and other public health measures by working with trusted messengers
- Reforms needed after systemic flaws in nursing homes worsen COVID-19: Read our piece in ABA journal on law and aging
- Learn how states are combatting social isolation and loneliness in adults with disabilities during the COVID-19 pandemic
- New CHRT survey analyzes who in Michigan isn’t getting vaccinated against COVID-19 and why with policy, practice recommendations
- The COVID-19 pandemic has added significant new stressors for family caregivers – here’s why that matters
- Michigan’s physicians and health care providers are burnt out: What can we do to help them navigate pandemic pressures?
- Long COVID’s impact on Michiganders and the Michigan economy
Second phase of national integration project begins
This June, CHRT launches the second phase of a national health and human services integration project, funded by the Kresge Foundation. This phase of the project focuses on supporting the project’s grantees—five county health departments from across the U.S. CHRT will help by hosting virtual learning sessions and small group discussions with health and human services integration grantees, providing technical assistance to grantees, and documenting their progress.
Michiganders willing to help with COVID-19 contact tracing
More than two-thirds of Michiganders report that they would be willing to participate in some form of COVID-19 contact tracing, a CHRT survey finds. However, the information respondents are asked to share matters, with more respondents being comfortable sharing contacts with the health department and less respondents comfortable sharing symptoms. Black respondents were more likely than white respondents to participate in contact tracing, but generally Black respondents reported lower levels of trust in health care providers. CHRT experts argue that trusted messengers are crucial throughout the pandemic to share the importance of preventive measures.
Impact of Whitmer’s COVID-19 nursing home policies
In the Spring of 2020, the Whitmer Administration developed COVID-19 nursing hubs—21 nursing homes equipped to serve COVID-19 patients transferred from other Michigan nursing homes or hospitals. CHRT shares its analysis of the policy. The analysis finds that deaths in nursing home hubs were lower (17.4%) compared to deaths in non nursing home hubs (26%). It also finds that nursing home deaths in Michigan were slightly lower than the national average. While CHRT recommends maintaining the hub strategy, it recommends a series of strategies to improve the hubs, including improving data tracking and providing additional support for nursing home staff.
Terrisca Des Jardins named executive director
Terrisca Des Jardins joins CHRT as incoming executive director. To honor Marianne, CHRT develops a zoom tribute video. “We are deeply grateful to Marianne, as she has led the implementation of CHRT’s mission, vision, and values, leading to sustained success,” says Tony Denton, CHRT board member and chief operating officer of the U-M Health System, Michigan Medicine. Des Jardins previously served as the chief operating officer for the Physician Organization of Michigan Accountable Care Organization (POM ACO), and brings expertise from her work there, and her work in Detroit, in stakeholder engagement, health system management, and health equity.
Michigan veterans need more support
A statewide survey conducted by CHRT finds that less than ten percent of Michigan’s health care providers are prepared to serve the state’s aging veterans—a growing and particularly vulnerable population. The researchers found that only about one in five (19 percent) of the health and mental health providers surveyed reported formal training in military culture or the specific health needs of veterans. About half of the providers surveyed (49 percent) reported that they would be interested in receiving this training. Roughly one-third (32 percent) indicated no such interest. CHRT offers several recommendations including screening patients for veteran status and common conditions associated with service (including PTSD, exposure to chemical agents, chronic back pain, traumatic brain injury, and military sexual trauma); training providers in military culture and conditions associated with service; and increasing awareness about VA resources and support services.
Becoming a federally Certified Community Behavioral Health Center
In this brief, CHRT staff share what becoming a Certified Community Behavioral Health Clinic (CCBHC) could mean for state agencies. In August 2020, Michigan was selected as a demonstration state for the federal program. CCBHCs are required to provide a comprehensive range of services to vulnerable individuals with both physical and behavioral health needs. The services provided by CCBHCs, which focus on wellness, recovery, trauma-informed care, and physical-behavioral health integration, include a variety of services to address complex mental illnesses and the treatment of substance use disorders. CHRT argues that the model offers the opportunity to improve behavioral health service delivery.
CHRT ED participates in national integrated care delivery learning network
CHRT executive director, Terrisca Des Jardins, has been selected to participate in a multi-disciplinary national faculty team that will provide coaching and guidance to competitively selected integrated delivery networks. The project, funded by Pfizer and in partnership with the Institute for Healthcare Improvement (IHI), will create a national learning network of integrated delivery networks. Des Jardins will help leaders communicate integration strategies and vision, advise on identification and implementation of social needs screening and referral tools and systems, coach on data analysis methods, and more.
CHRT identifies disparities in vaccine uptake
Between March 19, 2021 and April 1, 2021, CHRT fielded a representative survey of Michigan adults to better understand who isn’t getting vaccinated against COVID-19 and the reasons why. Latinx/Hispanic, adults with lower incomes, respondents without health insurance, and respondents without a medical home were all less likely to have received at least one dose of the COVID-19 vaccine compared to counterparts. Most of those who did not intend to get vaccinated were worried about side effects (86%). This was followed by concerns that the vaccine was too new (83%) and a mistrust of government to ensure the safety of the vaccine (78%). Other reasons included a belief that the effects of COVID-19 have been exaggerated or that respondents were not at risk for infection.
CHRT’s EVOLVE model outlines path to integration
CHRT’s newly published EVOLVE integration framework–which covers Environment, Values, Opportunity, Leadership, Validation, and Engagement–describes six key factors that must be considered in the development of a well-functioning, sustainable, and integrated health and human services system. CHRT conducted the research with funding from the Kresge Foundation and released the thought model in the American Public Human Services Association’s Policy and Practice magazine.
CHRT launches new health equity project
Funding from the U.S. Centers for Medicare & Medicaid Services (CMS) will support a new Health Equity Project in five Michigan counties. The project aims to advance health equity for historically disadvantaged populations by connecting people with social services such as housing and food supports. The project will also create a shared data service to facilitate more streamlined care and share population level data with policy makers so they can make more informed decisions. CHRT is providing backbone support to the local work in Washtenaw and Livingston counties, providing administrative support to the other four regions, and initiating a multi-region learning community to identify ways the participating Michigan counties can work together to accelerate progress.
10 years of collective action in the Washtenaw Health Initiative
On October 18th, more than five dozen individuals attend the Washtenaw Health Initative’s 10th-anniversary stakeholders meeting, which offered time to reflect on the focus of the WHI, what has been accomplished by WHI volunteers over the years, and the work that’s left to do. CHRT, backbone to the WHI, provides administrative and fiduciary support, staff to help WHI workgroups advance their goals, and more. To commemorate the WHI’s 10 years of impact, CHRT’s communications team organizes the stakeholders meeting and develops an historic timeline to document progress.
Medically-friendly meals and social supports
CHRT has received funding from the federal Administration for Community Living and the Ann Arbor Area Community Foundation to expand and enhance a local collaborative that provides medically-friendly meals, and referrals to home and community-based services, to vulnerable seniors and individuals with disabilities. In the pilot program, which occurred in 2020, program participants in Washtenaw County received a health and social services needs assessment, home-delivered medically-friendly meals, and referrals to home and community-based services to meet additional needs. The expanded project will reach vulnerable populations in additional counties with high levels of poverty and significant aging populations, and provide medically-tailored meals and social service connections.
Supporting unpaid caregivers
In a brief published today, CHRT outlines the most common programs to support unpaid caregivers—family members or friends who provide care for people who need assistance with day to day tasks. The brief explores:
- The reach, efficacy, and evidence of these programs
- The caregiver population in Michigan
- The capacity of organizations to meet the needs and demands of family and informal caregivers.
- The ways that family and informal support programs can be improved around the state.
The report provides state legislatures, funders, caregiver organizations, and community members with recommendations for expanding the reach and impact of caregiver programs.
Four in ten Michigan physicians are burnt out. What can we do to help?
CHRT’s Michigan Physician Survey shows Michigan primary care providers’ perspectives on burnout before and during the COVID-19 pandemic. 2,188 physicians provided their perspectives and the survey found that the prevalence of self-reported symptoms of burnout increased from 31 percent in 2018 to 40 percent in 2021. Further, 27 percent of all Michigan physicians agreed or somewhat agreed that COVID-19 and the pandemic have made them feel burned out and consider leaving medicine.
The pandemic has not only brought attention to the issue of physician mental health, but also offered insights into how to support health care workers during a crisis. In Michigan, the Michigan State Medical Society recently launched SafeHaven, a program designed to overcome barriers to seeking mental health care. The program gives physicians access to a number of convenient and confidential resources, including 24/7 telephonic support, counseling, and legal and financial consultations. Access to this and similar programs will be crucial both in the context and wake of the COVID-19 pandemic, as the
psychological distress and professional dissatisfaction caused by the pandemic are likely to have lingering consequences for the health care workforce
Evaluating Washtenaw County’s diversion program
In 2021, Washtenaw County launched a new diversion and deflection pilot program in Ypsilanti, MI. The evidence-based program, Law Enforcement Assisted Diversion (LEAD), originated in King County, Washington and has been piloted by communities across the U.S. CHRT will evaluate the program’s effectiveness and impact in Ypsilanti through surveys, interviews, and secondary data. Along the way, CHRT will communicate key findings and experiences to partners and community leaders.
10 years, 122 health policy fellows
In 2012, the Center for Health and Research Transformation (CHRT) launched its first-ever health policy fellowship. Since then, CHRT has welcomed ten fellowship classes of 10-15 fellows per year for a four-month program designed to teach them about health research, policy, and practice. By 2022, 122 fellows have graduated from the program, including:
Policymakers like Elizabeth Hertel, director of the Michigan Department of Health and Human Services (2012), Shaquila Myers, chief of staff for Lieutenant Governor Garlin Gilchrist and senior advisor to Governor Gretchen Whitmer (2017), and Renée Smiddy, director of policy at the Michigan Health and Hospital Association (2016).
Researchers like Dr. Michelle Moniz, obstetrician-gynecologist at the University of Michigan Medical School (2018); Dr. Mark Peterson, physical medicine and rehabilitation specialist at the University of Michigan Medical School (2019), and Dr. Renu Tipirneni, internal medicine at the University of Michigan Medical School (2018).
Nonprofit leaders like Kristie King, association executive at the Southeast Michigan Senior Regional Collaborative (2022), Elise Bur, director of the Northern Michigan Center for Rural Health (2022), and Kimberly Motter, director of quality and training at Reliance Community Care Partners (2022).
“There are policymakers in the room with a wealth of knowledge who really know the ins and outs of the policy system,” says Nancy Baum, director of health policy at CHRT. “And if you’re a policymaker in Lansing and you’ve got a piece of legislation you’re analyzing, it’s really great to be able to say ‘I know an expert in this field.’”
First Rebecca Copeland Memorial Internship
In the summer of 2022, CHRT welcomed its first Rebecca Copeland Memorial Intern. Rebecca Copeland was a dual-degree student in public health and public policy at the University of Michigan, and an intern at CHRT. She graduated with an MPP and an MPH in the spring of 2021. Because of her deep interest in working to improve population health by addressing social needs, she sought out mentorship from CHRT ED Terrisca Des Jardins who, at the time, was chief operating officer of the Physician Organization of Michigan Accountable Care Organization (POM ACO). Rebecca Copeland passed away in July 2021, and CHRT honors her memory by offering the Rebecca Copeland Internship to students at the University of Michigan. Holly Quivera Teague, MPH, a health behavior and health education graduate from the University of Michigan (UM) School of Public Health (spring ’22), served as the first Copeland intern.
Opioid Settlement prioritization survey
From November 2021 through January 2022, CHRT analyzes a survey for the Michigan Department of Health and Human Services. The survey asked Michiganders how they would like to see opioid settlement dollars allocated. Respondents were mostly staff of medical and social service organizations or government entities, however, 16 percent of respondents identified as being in recovery.
The survey identified three top priorities:
- opioid use recovery,
- opioid use prevention, and
- expanded access to medications used to treat opioid use disorder.
In each priority, the survey analysis broke out subpriorities. In opioid use prevention, for examples, programming priorities included: evidence based prevention programs in K-12 schools, training for first responders on programming to connect at-risk individuals with services and supports, and medical provider education and outreach around prescribing best practices.
Additionally, the survey showed that top priority populations were individuals with co-occurring mental health diagnoses or other substance use disorders, pregnant and postpartum women, and rural communities.
Supporting Michiganders and the Michigan economy from Long Covid
CHRT’s latest Cover Michigan Survey explores how Long COVID is impacting Michiganders and the Michigan economy. Out of 138 survey respondents that reported testing positive for COVID-19, 48 reported long COVID symptoms–a proportion that falls in line with national estimates. The survey found that women were four times more likely to report Long COVID while people with diabetes were two times more likely.
Respondents experiencing Long COVID most frequently cited breathing issues, distorted taste and smell, and lingering anxiety, depression, or other mental health issues as symptoms. People with Long COVID also reported being in a worse financial situation than those without Long COVID; 63 percent of people with COVID-19 diagnoses who experienced Long COVID had a hard time making money last as long as needed.
CHRT provides three recommendations for state legislators and funders. Simplified, these include:
- Prioritize research investments designed to understand and mitigate the health and economic impact of Long COVID in the state of Michigan.
- Develop funding programs, policies, and approaches to bolster existing clinical care resources to address the health and well-being of long haulers in Michigan.
- Organize cross-sector partnerships to strategically coordinate and address the impact of Long COVID on multiple domains across the state.
Michigan docs screen for social needs, but there’s room for improvement
More Michigan physicians screen for social needs today than in 2018, a CHRT brief finds. Over 50 percent of physicians screen for ability to afford treatment, domestic violence, and social isolation. However, physicians are less likely to report that they screen patients for health literacy (43 percent), employment status (39 percent), and traumatic life experiences (36 percent). Further, not all physicians that screened for social needs knew where to refer patients who screened positively. And conversely, some physicians knew where to refer patients but did not have a formal screening process in place. Such findings suggest that more streamlined processes for screening and referrals could be useful for patients with one or more social needs. The authors also explain that reimbursements for organizations that provide social need services could improve community capacity to address these needs.
CHRT shares MiCC impact report
In August, CHRT staff shared an impact report for MI Community Care (MiCC), a program designed to help individuals with multiple chronic conditions get connected to care and meet their health goals. The Washtenaw-Livingston program, facilitated by CHRT, is part of a larger statewide initiative with four other regions. CHRT provides support to all of the participating regions. Key findings from the MiCC impact report include: participants reported reduced social service and medical needs and improved mental health. The report also highlights partners and programs designed to improve the health care delivery system, evaluation model, and vision for the future.
Making telehealth more accessible for people with disabilities
“Approximately one in four Americans have a disability, and Americans with disabilities can benefit from telehealth use as much as, if not more than, the general population,” a CHRT study reports. Telehealth can increase access to care, help health systems reduce long term costs, and promote consumer independence.
People with disabilities are more likely to seek care from a physician and be admitted to a hospital than people without disabilities. People with disabilities are also more likely to experience challenges with telehealth barriers, such as internet access, and ability to afford technology needed to access telehealth.
Other challenges also exist for people with disabilities; for example, video communication platforms may be challenging for people who are deaf, hard of hearing, deafblind, blind, or intellectually or developmentally disabled.
Therefore, people with disabilities are a critical population to consider when determining telehealth policy. In this brief, CHRT provides policy recommendations to improve telehealth for people with disabilities.
CHRT to help Michigan respond to opioid epidemic
The State of Michigan received a $800 million share of the national opioid settlement. The dollars are being distributed across the state for local outreach and prevention measures. The Center for Health and Research Transformation will provide recipients of settlement funds across Michigan with information about evidence-based programs to address gaps in care experienced by Michigan residents. CHRT will analyze local data to help municipalities decide how to put the dollars to use. The goal: to reduce opioid-related harm and deaths.
Integrating primary care and public health
In October 2022, CHRT receives a grant from the Commonwealth Fund to continue previous public health and primary care integration work. The new project’s goal: to develop state toolkits about worthwhile approaches to integration and coordination between public health agencies and primary care organizations. This work is important to increase trust in public health measures, develop stronger systems to address public health emergencies and deliver public health services, mitigate health and racial inequities, and improve the public’s health.
CHRT supports new equity center for marginalized populations with disabilities
CHRT receives additional funding to expand its work with the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The University of Michigan Center for Disability and Wellness is selected to create a national Equity Center to identify and address disparities experienced by individuals from marginalized backgrounds with physical, cognitive, sensory, and developmental disabilities.
The Equity Center will partner with CHRT to enhance the capacity of trainees, community organizations, and researchers across the United States as they work to inform evidence-based policy changes related to equity and disability health. CHRT will conduct policy training workshops and symposia via webinars several times throughout the course of the grant, focusing on improving knowledge and skills about the policymaking and advocacy process. All trainings will be accessible through ASL interpreters, open captioning, braille materials, wheelchair ramps, and more.
Recent briefs funded by CHRT’s original work with the Rehabilitiation Research and Training Center include:
- A policy brief outlining ways to support unpaid caregivers. CHRT staff review six different state and federal policy options to support family caregivers in the U.S. including Medicaid waivers, workplace anti-discrimination laws, investments in long-term care and other programs, expansion of the Family and Medical Leave Act (FMLA) National Family Caregiver Support Programs, and Social Security work credits.
- Policy recommendations to improve telehealth for people with disabilities. Telehealth can increase access to care, help health systems reduce long term costs, and promote consumer independence. However, people with disabilities face access challenges; for example, video communication platforms may be challenging for people who are deaf, hard of hearing, deafblind, blind, or intellectually or developmentally disabled. CHRT provides recommendations for policymakers and funders.
- A brief on new COVID-19 stressors for unpaid family caregivers. Caregivers may have a heightened risk of infection, as research shows that more than one-third have medical conditions that make them more susceptible to contracting COVID-19. And during the pandemic, many caregivers have had to manage risks to their care recipient’s health, as well. The brief provides recommendations for policymakers and funders.
- A paper in the Annals of Family Medicine on annual wellness visit use among people with disabilities. The paper looks at annual wellness visit (AWV) use among persons with physical disabilities from 2008 to 2016–before, during, and after the rollout of the ACA. Researchers consider insurance type (Medicare Advantage or commercial) as well as race, sex, and disability type to determine how persons with disabilities use AWV. Overall,
- An infograph outlining how states are combating social isolation and loneliness for adults with disabilities during the COVID-19 pandemic. Forty percent of adults with a debilitating disability or chronic condition report feeling lonely or socially isolated, say CHRT staff. However, programs that encourage interaction within neighborhoods, fund resources for seniors such as transportation and medication delivery, and media campaigns may offer protection against the negative consequences of social isolation.