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CHRT begins new projects on legislative education, autism diagnosis, and mobility accessibility

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A photo showing the room where Michigan's legislators meet in Lansing.

CHRT begins new projects on legislative education, autism diagnosis, and mobility accessibility

June 23, 2024

The Center for Health & Research Transformation (CHRT) is pleased to announce three new projects:

Health education for Michigan legislators and legislative staff

Due to the substantial turnover and subsequent loss of subject matter expertise in health issues in both the state House and Senate each election cycle, there is a need to support of both legislators and their staff. CHRT will provide one-pagers on policy-relevant health topics and their impact on the people of Michigan and will participate in legislative education fora to share and discuss with state leaders.

Early diagnosis of autism in Michigan

Earlier diagnosis of autism spectrum disorder (ASD) will allow patients to access services and resources sooner. CHRT will work with the Autism Alliance of Michigan on a plan to reduce disparities in diagnosis timing and enable earlier diagnosis in Michigan. 

Mobility accessibility in Washtenaw County

CHRT will work with Feonix Mobility Rising to create a Transportation Assistance Hub and Transportation Task Force in Washtenaw County, MI. This project aims to remove barriers to transportation access for community members.

A Q&A with CHRT Health Policy Fellowship alumnus Romesh Nalliah

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Photo of Romesh Nalliah wearing a blue jacket, pink oxford, and pink and blue tie.

A Q&A with CHRT Health Policy Fellowship alumnus Romesh Nalliah

May 28, 2024

In 2018, Romesh Nalliah participated in CHRT’s Health Policy Fellowship. Now the associate dean for patient services and clinical professor of dentistry at the University of Michigan School of Dentistry, Romesh spoke with us about what he’s working on now–a number of equity initiatives–and how the fellowship training impacted his career.

Photo of Romesh Nalliah wearing a blue jacket, pink oxford, and pink and blue tie.

What are you working on now?

Leading up to 2020, my research was focused on the link between hospital outcomes and dental outcomes. But after the murder of George Floyd, I started to reflect on how all of the studies I saw showed that Black Americans have worse outcomes. I started thinking that I should study how race affects oral health. 

A couple of years ago I did a study looking at nationwide CDC data, and found that there has been a consistent gap between Black Americans and all other Americans in regards to oral health for the last 15 years. In fact, outcomes for Black Americans in 2014 are comparable to outcomes for white Americans in 1999. 

Another recent study we did found that, in the last 20 years, there has been no significant change in the proportion of Black students admitted to dental school. A few months after we published that study, a study came out showing similar results for medical schools.

Thanks to my time at CHRT in 2018, I also began to advocate for an improvement in adult dental Medicaid. After many meetings in Lansing by my group and many others, on January 1st of 2023 we saw a huge change in the reimbursement rate. 

Michigan had one of our nation’s worst adult dental reimbursement rates, and now it’s one of the best. There’s still advocacy work to do however, since our state has not attached any outcome measures to the increased rates, which means sustainability through budgetary cycles could be fragile unless we can change that.

What would you say makes this work important?

There are so many ways that oral health affects overall health, with dozens and dozens of studies supporting the association. Famously, there are associations between diabetes and oral health as well as between cardiovascular disease and oral health. However, not everyone knows that oral health is also associated with preterm birth and low birth weight. Additionally, we’ve done a study looking at stem cell transplants, and found a six day longer length of stay for patients who had concurrent periodontal disease. In fact, we found there was $85,000 in additional hospital charges, and a higher reinfection rate. We’ve done other studies with similar findings too. The mouth is part of the human body. So when there’s uncontrolled infection in the mouth, it affects outcomes in other surgical procedures.

How was your fellowship experience?

I participated in the fellowship in 2018, but for me the seeds were planted a decade earlier. Like many young researchers, I was excited to get published or do presentations. We were doing all these publications and presentations, and everyone was patting us on the back, and then one day I was presenting and two women stood up and said they wanted to thank our group because they used several of our papers to change legislation in their state. And I thought to myself, “Oh my goodness, they’ve done so much more than we’ve done with this data.”

Ten years later when I moved to Mighican and encountered CHRT, I thought it seemed like a great opportunity to learn. Because of CHRT, I now see the publication as the start of the process, and not the end. It’s just as important to get your findings in front of people that make a difference, like legislators and health policy advisors. That’s been a complete reframing for me.

I’ve interacted with legislators significantly more often since my time at CHRT, and because I’m in Michigan, I often ask CHRT for help. CHRT has also connected me with people who have changed the course of my research, including guiding me to more research on opioid over-prescribing in dental care.

The connection to the policy fellows was especially significant. Every time I go to Lansing, I try to meet up with as many of the policy fellows as possible – I continue to learn so much from them. They are sacrificing so much for their work, and they have such a passion and dedication. It’s very similar to researchers actually.

What are your plans for the future?

The fellowship has made me look at research in a different way. Now, I feel an urgency to publish a paper so we can move on to the real work, which is how does this affect the way that we practice dentistry?

Now, as the associate dean for patient services, my goal is to take some of what I’ve learned about quality and patient safety in hospital settings and apply them to everyday dentistry.

My dream is to reduce the operational separation between medical and dental. As an example, when my wife and I had our first baby I was shocked that, in all the prenatal appointments, there was not one conversation about oral health. Yet there’s 15 years of research about how oral health affects birth weight and preterm birth. One thing I’d love to see is a referral to a dentist as soon as someone begins their journey in starting a family. 

And it’s similar for cardiovascular disease, or diabetes. All these medical specialties should be requiring a trip to the dentist. It’s complex right now, because dentists are not co-located with hospitals and there are different insurance pathways, but that should not stop us from doing the right thing. I would like physicians to think about ensuring that conditions in the mouth are stable when they’re trying to address a systemic complaint.

For more information and to apply:

Announcing the 2024 Health Policy Fellowship cohort  

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Instructor speaking to a class of fellowship students

Announcing the 2024 Health Policy Fellowship cohort  

January 26, 2024

We are pleased to announce our 2024 Health Policy Fellowship cohort. 

More than 125 health researchers, policymakers, and nonprofit leaders have completed the fellowship since its launch in 2012. Many fellowship alumni occupy influential roles as policymakers and leaders across Michigan. 

The 2024 fellowship cohort will include:

  • Chelsea Alcock, Legislative Assistant, 52nd District, Michigan House of Representatives
  • Dr. Frank Conyers, Clinical Assistant Professor, Department of Neurology, Michigan Medicine 
  • Samantha Cornell, Director of Community Based Services, Access Health
  • Elizabeth Crenshaw, Director of District and Constituent Services, 7th District, Michigan Senate 
  • Jennifer Day, Community Building Manager, Michigan Breastfeeding Network
  • Thye Fischman, Manager of Government Relations,  Department of Government Relations, Michigan Medicine
  • Morgan Foreman, Director of Constituent Services, 33rd District, Michigan House of Representatives
  • Shannon Jackson, Program Manager, Residents in Action
  • Stephen Jackson, Policy Advisor, Michigan Senate Democrats
  • Dr. Patrick Johnson, Resident, Department of General Surgery, Michigan Medicine 
  • Dr. Beth Kuzma, Clinical Associate Professor, Department of Nursing, Michigan Medicine 
  • Kristina Leonardi, Director of Aging and Community Services Division, Michigan Department of Health and Human Services
  • Kelsey Ostergren, Director of Health Policy Initiatives, Michigan Health and Hospital Association
  • Beverly Ryskamp, Chief Operating Officer, Network 180

The program is an immersive four-month experience that brings together a diverse group of professionals to foster collaboration among policymakers, researchers, and nonprofit professionals. 

“The CHRT Fellowship enhanced my ability to think about policy—from the formulation of the research questions to the translation of the research findings to inform policy in real- time,” says Dr. Renuka Tipirneni, Assistant Professor of Internal Medicine, University of Michigan Medical School and Institute for Healthcare Policy & Innovation. “I valued going through the experience with an incredible cohort of both policymakers and researchers. This inter-sectoral peer mentorship enhanced my training and helped me build connections that I hope will last for my entire career.”

The 2024 cohort of Health Policy Fellows will engage in interactive workshops and learning sessions in Ann Arbor, Detroit, Lansing, and Washington, DC. These sessions are designed to provide fellows with opportunities to gain insights into local, state, and federal health policy landscapes. Orientation briefings will cover essential topics such as the legislative process, Michigan state government structure, strategies to effectively communicate with legislators, and the challenges in building sustainability for nonprofit organizations.

For further information about the CHRT Health Policy Fellowship and to apply for the 2025  cohort, please contact Holly Quivera Teague, Fellowship Program Manager, at [email protected].

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CHRT is grateful for the generous support of our 2024 fellowship sponsors: Blue Cross Blue Shield of Michigan, the Michigan Health Endowment Fund, Michigan Medicine, and the Michigan State Medical Society.

Providing decision makers with evidence

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Nancy Baum, systemic and policy analysis team lead

Providing decision makers with evidence

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

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

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

Describe some of the challenges the health policy team addresses. 

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

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

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

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

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

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

Do you have any projects in the behavioral health space?

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

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

Do you work with other teams?

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

Describe some of the processes the team uses.

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

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

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

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

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

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

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

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Joshua Traylor

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

December 8, 2023
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 

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Kimberly Snodgrass

The important role of human-centered design in health care 

November 14, 2023

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.

Helping organizations create successful, sustainable programs

August 31, 2023
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

Introducing CHRT’s new health and social equity team

May 10, 2023

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: 

Accepting applicants for the second annual Rebecca Copeland Memorial Internship

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Rebecca Copeland

Accepting applicants for the second annual Rebecca Copeland Memorial Internship

February 22, 2023
Rebecca Copeland

CHRT is now accepting applicants for the second annual Rebecca Copeland Memorial Internship.

CHRT seeks a high-achieving individual who is thoughtful and analytical, with interests and experiences in health policy analysis. This is a full-time paid summer internship, with flexible start and end dates. Graduate students who have completed at least one year of coursework in public policy or public health are encouraged to apply.

The intern will have the opportunity to work on relevant, timely health policy issues. The intern will be responsible for elements of health policy and research projects that align with CHRT’s mission of improving the health of people and communities.

Apply now or learn more.

About the CHRT Rebecca Copeland Memorial Internship

Rebecca Copeland was a dual masters degree student in public health and public policy at the University of Michigan, and graduated in the spring of 2021. She had a deep interest improving population health by addressing social needs. Rebecca sought out mentorship from Terrisca Des Jardins, CHRT’s former executive director serving from late 2020 – February 2023. 

Rebecca was deeply committed to improving health, health care and social justice. She brought enthusiasm and excellence to analysis of important health policy issues and inspired those alongside whom she worked.

At CHRT, Rebecca interned with Nancy Baum, CHRT’s health policy director. At CHRT, she worked to improve the public mental health system, among other projects. “Her energy was amazing,” says Baum. “Rebecca showed us just how valuable interns can be in an organization like ours. When an intern is both smart and dedicated to making systems better to improve health, as Rebecca was, they are a real asset,” says Baum.

Rebecca Copeland passed away in July 2021. CHRT and the RAC Fund for Social Justice honor her memory by offering the Rebecca Copeland Internship to graduate students at the Gerald R. Ford School of Public Policy.

15 years in review with Executive Director Terrisca Des Jardins

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15 years in review with Executive Director Terrisca Des Jardins

November 16, 2022

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