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Regional Health Collaboratives work to improve behavioral healthcare

The Promotion of Health Equity Project engages six Regional Health Collaboratives — care coordination programs designed to improve a region’s wellbeing – to address health-related social needs and establish a framework for statewide expansion. 

A recent MI Mental Health Series article by Estelle Slootmaker, “Regional Health Collaboratives improving access to behavioral health services,” discusses the goals of these six collaboratives and specifically highlights MI Community Care (MiCC), the collaborative serving Livingston and Washtenaw Counties. 

CHRT provides the administrative backbone for MiCC, and is also evaluating the progress of all six collaboratives. The article interviews two CHRT staff members: Ayşe Büyüktür, MiCC program manager, and Jonathan Tsao, senior project manager on CHRT’s research and evaluation team. 

While the Regional Health Collaboratives help patients with a wide range of health and social needs — including housing, medication management, transportation to and from medical appointments, and food security — one of the collaboratives’ key objectives is to improve access to behavioral health care. To do so, each collaborative works with local partners to make behavioral health referrals.

Behavioral health is still stigmatized, Büyüktür says: “Not everyone is comfortable asking for help or knows how to access services … If someone is struggling with behavioral health needs, expecting them to navigate complex systems of care … places extra burden on them.”

“Most of the residents who come to their region’s programs have complex medical, behavioral health, and social needs,” says Tsao. “[Regional Health Collaborative] programs are designed to address all of those needs through care coordination.”

MiCC partners with Washtenaw County Community Mental Health (WCCMH) and Livingston County Community Mental Health.

To coordinate behavioral health care for a MiCC participant, the lead care coordinator arranges care and resources for patients, and community health workers (CHWs) and peer support specialists help patients access these resources. 

CHWs and peer support specialists “meet participants where they are,” says Buyuktur. “They see their living situations. They have the expertise to recognize needs and problems … They are incredibly knowledgeable about community resources. And because they build strong, trusted working relationships with community members based on those individuals’ personal goals, they help to de-stigmatize behavioral health at the individual level.”

MI Mental Health interviews Ayse Buyuktur about the importance of community health workers

CHRT’s Ayse Büyüktür, program manager for the MI Community Care (MiCC) program, recently spoke with MI Mental Health about the extensive work community health workers do to support the behavioral health needs of residents.

Across the state, community mental health agencies enlist community health workers to extend their reach, writes reporter Rylee Barnsdale in “Community health workers bring mental health home.”

Washtenaw County Community Mental Health, for example, partners with MI Community Care to provide CHW services.

MI Community Care works in both Washtenaw and Livingston counties, providing cross-sector care to support the needs of residents with complex lives and conditions. The story outlines how MiCC CHWs–centered at the Washtenaw Health Plan and the Livingston County Community Mental Health agency, support MiCC participants under challenging situations, helping them get the care and support they need.

One role of a CHW is performing home visits to patients to “meet them where they are,” Büyüktür explains. Home visits go beyond “simply helping to make appointments and phone calls,” she continues. During home visits, CHWs also can analyze what state an individual and their home are in and find community resources to improve their conditions, and to lessen feelings of social isolation.

When asked, “Are there changes for CHWs and how health care systems recognize them?” Büyüktür says Michigan “is working out how to pay CHWs who service people on Medicaid,” which is something she and others across the state are really excited about. To appropriately compensate CHWs for their work, though, requires understanding their value.

“[CHWs] do so much for us. It’s hard in some ways to describe it because they are changing lives. That’s not a cliche in this situation. It’s reality.”

Michigan’s CCBHCs open mental health access to all

CHRT’s work evaluating Michigan’s Certified Community Behavioral Health Clinics (CCBHCs) was highlighted in a Second Wave Media article, “Michigan’s CCBHCs open mental health access to all.” The article features interviews with CHRT team members Erica Matti, senior health policy analyst, and Jonathan Tsao, research and evaluation project manager. 

CCBHCs provide whole-person care and aim to consider all aspects of a person’s health, including physical, emotional, and behavioral health, as well as social challenges such as financial and housing insecurity. To address these needs, CCBHCs provide a range of mental health and substance use disorder services to individuals, regardless of their income or insurance coverage. 

There are 34 CCBHCs in Michigan, including Washtenaw County Community Mental Health. Of those CCBHC sites, 13 are demonstration sites, which are full-service clinics where anyone can walk in and receive services. The federal government provides 75 percent of the funding for demonstration sites; the other 25% is provided by the state.

The National Council for Mental Wellbeing (NCMW) 2022 CCBHC Impact Report showed that CCBHC status enables clinics to: 

  • serve an average of 900 more people per year than they were able to serve before implementation and
  • increase hiring, with an average of 27 new staff per clinic hired as a result of being a CCBHC. 

The report estimates that in 2022, 2.1 million people were served across all 450 active CCBHCs and grantees nationwide, a 600,000-person (29 percent) increase from 2021.

As the designation of demonstration sites in Michigan is relatively recent, there’s not yet been any Michigan-specific evaluations conducted on the CCBHC model. Michigan recently received federal funding for this purpose and partnered with organizations, including CHRT, to carry out the evaluations. 

“There’s a number of findings that we’re really hoping to see in Michigan including improvements in staffing, training for staff, care, and care coordination,” says Erica Matti. “Care coordination is a huge one for the CCBHC model. the states that have had this for a long time have seen really good improvements in care coordination.”

Tsao outlined that the evaluations have three purposes. First, to understand why Community Mental Health (CMH) centers are implementing the CCBHC model, as well as their successes and challenges in doing so. Next, to deliver an outcomes evaluation of the impact on access to behavioral health services and sustainability. Finally, the evaluations will document lessons learned to help future CCBHC clinics.

Nancy Baum quoted on mental health provider shortage

As mental health needs surge, the demand for care in Washtenaw County far exceeds the number of providers available. In an article by Rylee Barnsdale, titled “How can Washtenaw County solve its mental health care provider shortage?” Concentrate quotes Nancy Baum, health policy director for the Center for Health and Research Transformation (CHRT).

The article discusses the growing need for behavioral health providers, both nationally and in Washtenaw County, noting that clinical mental health provider salaries average roughly $52,000 annually in Michigan, compared to $241,000 for psychiatrists. Thus, hiring behavioral healthcare providers is a challenge.

“Recruiting is one thing. Retaining is another,” says Baum. “And level of pay is a big part of that …”

It is not unusual these days for Washtenaw County Community Mental Health (WCCMH) to have dozens of open positions. Staff turnover is generally attributable to the fact that salaries are low, especially given the amount of emotional care required to support the community.

Trish Cortes, executive director of WCCMH, says that WCCMH has historically been “pretty competitive in terms of recruiting.” Cortes says WCCMH often attracts mission-driven staff, dedicated to helping the community.

Doug Campbell, CEO of the Ypsilanti-based nonprofit provider Hope Clinic, echoed these sentiments: “We’ve doubled down on mission and culture,” Campbell said. “We attract a particular person that is keen on the mission and culture that we live out.”

Read the article here

CHRT study cited in Second Wave article on long COVID impact on Michiganders

As of May 2022, a CHRT study found that more than 700,000 Michiganders are living with long COVID, the lasting symptoms of COVID infection. Second Wave Media’s article “Researchers seek solutions for Michigan’s 700,000 COVID long haulers,” written by Estelle Slootmaker, cites CHRT’s research on long COVID and its impact on individuals, the state, and health care systems. The author interviews Jonathan Tsao, research and evaluation project manager at CHRT.

Among “COVID long-haulers,” common symptoms include brain fog, shortness of breath, heart palpitations, depression or anxiety, and digestive difficulties. As outlined in the CHRT study, these symptoms affect the professional lives of long haulers, resulting in major economic burdens for families.  

“There was a significant difference between long haulers in their financial situation compared to [those who do not have long COVID],” says Tsao. “There are two main reasons for this. One is their decreased ability to work at a full capacity. They are more likely to work reduced hours, quit their jobs altogether, or get laid off — and they would be more likely to miss out on a promotion. And they have to deal with increased medical costs.”

As disability insurance does not cover long COVID, many employees face unfair workplace expectations without protection. Paired with the lack of research and awareness surrounding the condition, policy action may be needed to accommodate individuals dealing with long-term symptoms of COVID.

“We suggest policymakers increase awareness and make it easier for workplaces to make accommodations for long haulers,” Tsao says. “Long COVID is one of those outcomes that’s going to require more study and research to understand. Our health systems, research centers, and the National Institutes of Health are establishing programs specifically to look at the ongoing impacts of COVID and long COVID. The reality is that we don’t know a lot about the cause and effect.”

CHRT’S STUDY MAIN FINDINGS ARE:

  • More than one in every three of the Michiganders surveyed who reported a COVID-19 diagnosis identified themselves as COVID long haulers
  • Women and people with diabetes were more likely to report long COVID
  • The three most common symptoms of long COVID reported were breathing issues, lost or distorted sense of smell or taste, and lingering anxiety, depression, or other mental health issues

READ SECOND WAVE’S ARTICLE

READ CHRT’S BRIEF

CHRT’s Matt Hill in opioid overdose prevention article

Between 2020 and 2021, the U.S. experienced a 28 percent increase in opioid overdose deaths. In Washtenaw County, opioid overdose deaths increased by 26% in the same timeframe. 

A Concentrate article by Estelle Slootmaker titled “How can Washtenaw County turn around a startling rise in opioid overdose deaths?” highlights organizations in the county — like Washtenaw Recovery Advocacy Project, Home of New Vision, and the Washtenaw Health Initiative’s Opioid Project — working to decrease substance use and overdoses. The article interviews Matthew Hill, CHRT program manager who helps facilitate the Washtenaw Health Initative’s Opioid Project, about overdose prevention in the community.

While the traditional approach to substance use treatment follows a “come get help when you’re ready to stop using” ideology, Hill explains, a harm reduction model is more effective. 

With the harm reduction model, treatment is achieved by developing relationships with people currently using, meeting them where they’re at, and working with them until they are ready to overcome their addiction. Part of this approach includes efforts to increase free naloxone distribution in Washtenaw County. Naloxone, more commonly known by its brand name Narcan, is a medicine that can reverse an opioid overdose.

“We’ve had a dramatic expansion of access to naloxone,” Hill says. “That switch to the harm reduction model has been huge in Washtenaw County. Unified [an Ypsilanti-based harm reduction organization] is doing great work with their syringe service exchange program, naloxone distribution, and getting people connected to health resources when they have other health events related to substance use.”

Hill says that while legislative progress is being made, there are many challenges to overcome in preventing opioid overdoses. One discrepancy Hill notes is racial disparities: 19 percent of Washtenaw County’s opioid overdoses were among Black residents, despite them constituting only 12 percent of the county’s population. Additionally, Hill emphasizes the importance of education surrounding substance use.

“The ‘just say no’ philosophy is really harmful. That didn’t work. I myself came from the [Drug Abuse Resistance Education] DARE era. Being a person in recovery, I can tell you, that didn’t work for me,” he says. “We know that young people are going to experiment. If they’re going to experiment with drugs, they should know to do that with a group of people. They should know to have naloxone on hand just in case, even if they’re not ingesting opioids. Having some practical knowledge and practical education can really reduce the effects of accidental overdose.”

Naloxone is currently available in free vending machines at the Washtenaw County Health Department, Ann Arbor District Library, and Washtenaw County Sheriff’s Office Reentry Center. 

READ SECOND WAVE’S ARTICLE

Medicare’s $35 per month insulin cap excludes many Michigan diabetics

CHRT Senior Policy Analyst Emma Golub was quoted in a Bridge Michigan article commenting on Medicare’s $35 per month insulin cap that went into effect on Jan. 1 and the broader issue of medication affordability. 

The cap on insulin prices is a win for the estimated 122,000 diabetics in Michigan on Medicare, as without it this medication can cost up to $2,000 per month. However, the shift in Medicare coverage excludes more than 900,000 diabetics who don’t qualify for Medicare, and therefore won’t benefit from the insulin cap.

Additionally, some diabetics who are covered by Medicare still find themselves straddled with high costs for other medications. 

Kent County resident Pam Bloink, who was interviewed for the Bridge Michigan article, is on Medicare and said she takes nine other medications in addition to insulin, for ailments including high blood pressure, cholesterol, depression, and heart issues. She spent more than $7,000 on medications last year, as Medicare left her without coverage for many of her prescriptions. 

“Prescription drug affordability continues to be a major hole in our healthcare system,” says Golub. “Lifesaving drugs are only lifesaving if people can afford them.” 

The American Association of Retired People (AARP) estimates that 32 percent of Michigan adults skip taking medications due to cost. Insulin prices have soared in the U.S. over the past decade—in 2020, they were more than eight times as high as prices in 32 other high-income nations, according to a RAND Corporation study.

Other drug prices have exponentially risen in recent years as well, such as EpiPen. A self-injecting device for a drug that neutralizes severe allergic reactions, its cost rose from just over $100 in 2009 to $608.61 in 2016. 

In October, Michigan Governor Gretchen Whitmer issued an executive order to build an insulin manufacturing facility in Michigan for in-state residents, and designated $150 million for its construction in her fiscal 2024 budget. State health insurers endorsed the plan, applauding Whitmer’s efforts to lower insulin prices in Michigan. 

But a 2020 study published in JAMA Internal Medicine found that insulin accounted for just 18 percent of out-of-pocket diabetes expenses for people with Type 1 diabetes on private insurance. Of the $2,500 per year average out-of-pocket cost for this population, insulin pumps, syringes, and glucose monitors accounted for the majority.

Pediatrician Kao-Ping Chua, a researcher at Michigan Medicine’s C.S. Mott Children’s Hospital and the study’s lead author, told Bridge, “The danger is that if you are solely focused on insulin, it doesn’t help people with diabetes with their other expenses.”

Project Manager Marissa Rurka discusses physician food interventions

Man looks into a nearly empty refrigerator

Man with food insecurity looks into a nearly empty refrigerator.Marissa Rurka, a project manager on CHRT’s research and evaluation team, joined Phil Knight, executive director of the Food Bank Council of Michigan, and Gerry Brisson, president and CEO of  the Gleaners Community Food Bank, for a conversation about how Michigan physicians screen patients for food insecurity, and what happens next. The Food First Michigan podcast (episode 91) is available online.

During CHRT’s most recent statewide survey of Michigan Physicians, Rurka and other members of CHRT’s research and evaluation team learned that about half of Michigan physicians do not routinely screen patients for food insecurity, and about 40 percent don’t know where to refer patients to meet their food needs. Their findings are published in Physicians screen patients for social needs: what happens next? Survey, analysis, and policy recommendations.

“I think traditionally, there’s this tendency to think about how we can intervene at the physician level,” Rurka told Food First listeners. “What trainings can we bring to physicians? How do we convince physicians to screen more patients?

But there’s this whole other component of that gap, which is, do community-based organizations like food banks have the resources not only to support the patients that are being referred to them, but also to provide closed loop referrals to the health exchange platforms.”

“If we want people to use food—which is fairly inexpensive and very accessible—to help manage their chronic conditions, we’ve got to connect the screening and the referral and the fulfillment of that referral wherever that person goes to get food,” said Brisson, who says that California, Massachusetts, North Carolina, and Oregon have all developed closed loop systems to report back to physicians and health care professionals on the status of referrals.

In Michigan, Brisson and Knight explained, they are expanding an existing 1-800 helpline for physicians to call when they encounter patients with food insecurity.

“So when you talk about 40 percent of the physicians don’t know where to refer someone for food, they’re going to have that 1-800 number. They’re going to come to us. We’re going to find out where they live and what programs they qualify for. And then if they live in one of the five counties that Gleaners serves, we’ll contact Gleaners, they’ll put the box together, and in our perfect scenario, DoorDash will come and pick that box up and deliver it to the patient’s home.”

Rurka, who points out that physicians want to help patients in this way, but have a lot of time pressures, said the 1-800 line sounds like a good solution. The easier you can make it for physicians and health care teams, she said, the better it will be.

Health navigators say Medicaid members benefit from plain language, reduced administrative burden

A family fills out a Medicaid form.

On June 30, State of Reform published an article relating the results of a newly released CHRT study about the effectiveness of Michigan Department of Health and Human Services (MDHHS) outreach methods to Medicaid members. The study explored MDHHS communications around the implementation of Medicaid work requirements for the Healthy Michigan Plan (HMP) in early 2020. 

While Medicaid communications are traditionally text heavy and technical, MDHHS used simplified language, streamlined the format, and employed attention-grabbing colors and icons in letters to beneficiaries. MDHHS also used administrative data to automatically exempt individuals who were not required to report work hours. 

Patrick Kelly, who completed the study while working as a senior analyst at CHRT, explained that “the department took a number of steps to make their communications more easily digestible or human-centered to draw more attention to their communications to Medicaid beneficiaries.” 

In a series of focus groups and a survey, health care insurance navigators reported their belief that these new communication interventions worked better than previous methods.

Lessons learned from this study could be effectively applied to other public benefit programs and policies to improve implementation and ensure that everyone can receive the benefits they are entitled to.

Cited publication: Kelly RP, Marcu G, Hardin A, Iovan S, Tipirneni R. Health Navigator Perspectives on Implementation of Healthy Michigan Plan Work Requirements. JAMA Health Forum. 2022;3(6):e221502. doi:10.1001/jamahealthforum.2022.1502

 

MLive cites CHRT’s study on the impact of long COVID on Michiganders

Microscope picture of a COVID virus.In this article, MLive summarizes research findings about long COVID, and cites CHRT’s study on the disease impact on Michiganders and Michigan’s economy.

“We want to raise an alarm, raise a flag to say ‘hey, this is potentially going to be and could be a really big deal for policymakers, for the state, for the economy, for the health care system and we need to be prepared,” said Melissa Riba, CHRT research and evaluation director.

The CHRT survey found that common ongoing symptoms include breathing issues, loss or distorted sense of smell or taste, and mental health issues, as well as nervous system symptoms, neurologic problems, diabetes, heart problems, kidney damage, and fatigue.

“I like to think this is sort of the tip of the iceberg with long COVID, because everything about this virus and this pandemic and this disease is so new and every day we’re still learning more stuff,” said Riba.

CHRT’S STUDY MAIN FINDINGS ARE:

  • One in three Michiganders with COVID-19 are “long haulers” or someone experiencing long COVID.
  • 15% of men and 55% of women identified as long haulers.
  • Michiganders with diabetes were two times more likely to report long COVID.

 

READ MLIVE ARTICLE

READ CHRT’S BRIEF