In The Media Archives

Reflecting on the Washtenaw Health Initiative’s 10 year anniversary

A new article in On the Ground Ypsilanti reflects on ten years of Washtenaw Health Initiative (WHI) accomplishments.

The Washtenaw Health Initiative is a voluntary collaboration to improve the health of low-income, uninsured, under-insured, and underrepresented people in Washtenaw County.

Co-sponsored by Michigan Medicine and the St. Joseph Mercy Health System and supported by the Center for Health and Research Transformation (CHRT), the Washtenaw Health Initiative helps 200+ members and stakeholders work together to:

Improve coordination across providers and integrate health and human services locally;
Support community-wide efforts to improve care and services for mental health, substance use, and other health issues impacting vulnerable populations;
Strengthen community-wide efforts to improve health equity by working closely with the Washtenaw County Health Department;
Increase insurance coverage among uninsured individuals and help those with Medicaid and Marketplace health plans maintain their coverage, use it more effectively, and find access to care;
Help local and regional health agencies reduce service redundancies and use resources more efficiently and effectively;
Connect community resources to health care organizations and to each other; and
Explore opportunities to partner with Livingston County health and human service organizations.

“When information is shared like that in a community, that community can only become better for it,” said Sharon Moore, WHI co-chair.

The article, written by Jaishree Drepaul-Bruder, discusses the WHI’s work to address the opioid epidemic, insure 100% of the population, and support healthy aging.

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Nancy Baum on Medicaid funding for Certified Behavioral Health Clinics (CCBHC)

State of Reform quoted Nancy Baum, health policy director for the Center for Health and Research Transformation (CHRT), in an article by Patrick Jones on funding for Certified Community Behavioral Health Clinics (CCBHCs).

Published on October 19, 2021, the article reports on a press conference announcing that thirteen Michigan CCBHCs will be fully funded by Medicaid in the same way that community health centers are funded for physical care. The Michigan Department of Health and Human Services (MDHHS) will also allocate $26.5 million state and federal dollars to support all CCBHCs. The initiative will allow for a sustainable flow of funding to these CCBHCs, which will allow CCBHCs to plan for future expansions, reduce jail time for those in crisis, and create job security for providers. CCBHCs are integrated health centers that provide mental health, substance use treatment, and physical health to all, regardless of the ability to pay.

Baum shared many advantages of this more sustainable revenue source. CCBHCs will no longer have to chase grants, they may have an easier time hiring health professionals because of improved job security, and they will be able to plan for the future.

“When you have sustained funding, you can say ‘we are investing in you’ [to employees] and we [can] have predictable services for our community. Sustained funding allows for planning, and it allows for organizations to think about how [they] can do what [they] do even better, instead of spending all their energy just looking for sustainable funding.”

Baum believes the funding will allow CCBHCs to plan to expand services and create lasting, efficient teams.

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Melissa Riba quoted in Bridge Michigan on reinstituted copays and deductibles for COVID-19 patient cost-sharing

Hospital billing statement for covid Bridge Michigan’s Robin Erb and Makayla Coffee quote Melissa Riba, director of research and evaluation at the Center for Health and Research Transformation (CHRT), in “Costs rising for Michigan COVID care with return of deductibles, copays.”

The story discusses an upcoming shift in patient cost burden for COVID-related illnesses—costs that have largely been waived by Michigan’s largest insurers for more than a year, ensuring that patient costs remained low.

By September 30, 2021, at least six insurers will resume charging copays and deductibles for COVID-related care.

Riba explains that while we’ve tried to encourage more Michigan residents to get vaccinated through a variety of incentives, this shift represents “the leading edge of the stick” in a carrot-and-stick approach.

She notes that shifting the COVID-19 cost burden to patients signals “moving away from the incentives to more of the penalties associated with making a choice to be non-vaccinated,” a shift that reflects a national trend among health plans as vaccines have become widely available to the public.

Dr. Michael Genord, CEO of Health Alliance Plan, agreed with her. “There’s been a lot of effort for people to take personal responsibility for the prevention of COVID that we didn’t have before.”

Insurers have noted that waivers for cost-sharing were intended to be temporary before vaccines were available.

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The effects of case management on ED use: CHRT research published in the Journal of General Internal Medicine

Smiling older couple across a table from a smiling woman

Case manager speaks with two patients. In a new piece published in the Journal of General Internal Medicine, Predictive model-driven hotspotting to decrease emergency department visits: A randomized controlled trial, Center for Health and Research Transformation (CHRT) staff report the results of the largest randomized trial examining the effects of case management on emergency department (ED) use.

The study was conducted by faculty and staff from Northeastern University, the University of Michigan, and Washtenaw County organizations, including lead author Brady Post, and coauthors Jeremy Lapedis, Karandeep Singh, Paul Valenstein, Ayşe Bȕyȕktȕr, Karin Teske, and Andrew Ryan.

Recent literature suggests that case management can improve care quality and reduce ED and acute health care use. As part of the State of Michigan’s State Innovation Model, CHRT and the Washtenaw Health Initiative (WHI) organized a study to evaluate the effectiveness of predictive-model driven case management and care coordination in the Livingston-Washtenaw Community Health Innovation Region.

Using a predictive model designed by Assistant Professor Karandeep Singh of Michigan Medicine, the Department of Learning Health Sciences, and the School of Information, patients were identified for the intervention. “Patients whose risk exceeded a threshold were randomly assigned to a group offered case management or to the control group,” write the authors. They then assessed ED visits in both groups during the six months post-intervention.

Average results showed no significant decrease in ED visits in the group that received case management.

“This study demonstrates the challenges of successfully engaging individuals with complex needs,” says coauthor and Washtenaw Health Plan director Jeremy Lapedis. “One potential place of future research and experimentation could include efforts to understand how best to engage individuals who use the ED frequently.”

The null results may be because the six-month post-intervention period was too short (other trials of case management used periods of 12 to 24 months). Case management organizations may also require more time to establish strong relationships with patients and create measurable results. The CHRT study was not able to follow participants longer due to discontinuation of funding, though the WHI did continue its care coordination pilot program beyond the time of the study.

“Our findings highlight the importance of understanding how to effectively engage complex patients in community interventions, and further underscore the need to use high-quality evaluation designs to build evidence of program effectiveness,” write the authors.

The authors emphasize that case management may still have a positive effect on patients overall. “For complex patients, case management may improve certain aspects of care delivery or the patient experience by more holistically addressing social and environmental needs.”

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Karin Teske and Marissa Rurka discuss new survey findings about COVID vaccine hesitancy and avoidance

covid vaccine interview Michigan Radio’s Kate Wells quotes Karin Teske and Marissa Rurka senior analysts at the Center for Health and Research Transformation (CHRT), in “Here are the biggest reasons Michiganders say they don’t want the COVID vaccine.”

The article describes CHRT’s recent analysis of vaccine hesitancy and avoidance, using data from a supplemental Cover Michigan survey that examined trends in vaccination rates and the reasons why Michiganders may be choosing to delay or avoid vaccination.

Teske notes that uninsured people were three times less likely to have received at least one dose of vaccine compared to those who were insured, explaining that those who “don’t have insurance [and] don’t have a medical home, may not be interacting with the health system as often and receiving those trusted messages about the safety and efficacy of the COVID vaccine.”

Teske also touches on the finding that 83 percent of those who didn’t intend to get vaccinated reported that they believe the vaccine “is too new and I want to wait to see how it works for other people,” noting this information “is pretty encouraging: the fact that we would hope that, over time, that concern might be alleviated as people see that the vaccine is safe and effective.”

The survey also found that hesitancy and avoidance reasons differed by race, and, as Rurka explains, “understanding what some of the most common concerns are [for different communities] is a helpful guide moving forward, to try and tailor messages to two different groups.”

For example, says Rurka, “we saw that respondents who were Black and Latino/Hispanic, were more concerned about the vaccine [itself],” compared to white respondents who were more likely to think they weren’t at risk for COVID-19 transmission.

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CHRT Fellow Dr. Romesh Nalliah warns against dental opioid prescriptions in American Journal of Preventive Medicine study covered by U.S. News

Dr. Nalliah warns against dental opioid prescriptions

CHRT Health Policy fellow Dr. Romesh Nalliah recently published an article entitled “Dental Opioid Prescriptions and Overdose Risk in Patients and Their Families” in the American Journal of Preventative Medicine.

Dental opioid prescriptions are one of the most widely used medications for chronic pain. When a patient receives a dental procedure, such as a tooth extraction or root canal, they are often given an opioid prescription to treat their pain. These medications can be very beneficial for treating chronic pain, but there are also many potential side effects that patients should be aware of before taking them.

The study analyzed data from 8.5 million Americans who received dental work between 2011 and 2018. They found that the overall rate of opioid overdoses was 2.5 times higher among patients who filled an opioid prescription after their procedure compared to those who did not. The rate of overdose among family members of the dental patient was also higher if the patient filled an opioid prescription: 1.7 per 10,000 procedures versus 1 per 10,000 procedures.

U.S. News covered the study in a story by Robert Preidt titled Opioids After Dental Work May Be Dangerous. The story quoted Dr. Nalliah saying, “When a dentist, like me, prescribes an opioid to a patient I am putting their entire family at risk of overdose. Dentists should consider, if the family concerned was yours, would you take that risk?”

Dr. Romesh Nalliah is a former CHRT Health Policy Fellow, associate dean for patient services, and clinical professor of dentistry at the U-M School of Dentistry.

Freep reports Michigan did not undercount nursing home COVID-19 deaths, citing CHRT study

On June 3, 2021, the Detroit Free Press cited the Center for Health and Research Transformation’s (CHRT) report on nursing home policies in Michigan during COVID-19 for an article about whether or not the state undercounted assisted living facility COVID-19 deaths. Senior in Nursing Home during Covid-19

Written by Dave Boucher, the Freep article describes the claims that Michigan is undercounting pandemic-related assisted living facility deaths and that the policies of Gov. Grethen Whitmer contributed to those deaths. Boucher reports that Michigan did not undercount pandemic-related nursing home deaths, though deaths at smaller long-term care facilities may have been missed.

Department of Health and Human Services Director Elizabeth Hertel said,

The number (of pandemic-related nursing home deaths) that is being reported is accurate because the number that we have reported on our website is the self-reported number from the nursing homes.

Michigan Attorney General Dana Nessel announced that she would not investigate Gov. Whitmer or her administration on the subject of nursing home policies, and cited CHRT’s report which found no evidence that Gov. Whitmer’s nursing home policies contributed to COVID-19 transmission, and concluded that the decision “was executed in a crisis situation and was an appropriate response to the surge of COVID-19 cases in Michigan.”

CHRT’s study did, however, include a number of recommendations for the state to implement to improve wellness and safety for nursing home residents during the remainder of the pandemic. A number of these have already been implemented.

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MLive quotes Jaque King and Robyn Rontal on how the pandemic is galvanizing shifts in how we care for the elderly

MLive’s Julie Mack quotes Jaque King, lead healthcare analyst at the Center for Health and Research Transformation (CHRT), and Robyn Rontal, CHRT’s policy analytics director, in “COVID-19 pandemic hit seniors hard. Could it lead to a rethinking of how we care for the elderly?” The article describes how the COVID-19 pandemic brought to light many chronic problems in the way our health care system cares for the elderly.

King discusses research CHRT conducted on how nursing homes responded to the pandemic. “There’s really a clear need to care for and support staff,” she said. “During our study, we heard a lot of issues around being undervalued and underpaid, and about the need for training and education going forward.” In addition, “staffing levels are really important to keeping nursing home residents safe,” said King. “Those are the kinds of challenges the pandemic really highlighted and brought to light.”

Rontal notes that the pandemic is galvanizing a shift to home-based care. For years, Rontal says, there has been a movement “to find ways to shift care to the home with supportive services. There are a lot of good examples [of innovative] programs and polices that are starting to test that approach,” she says. “But I think the pandemic shone a spotlight on the need for better services in the home.”

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Detroit News quotes Terrisca Des Jardins on whether hospital price transparency provides meaningful information

In a Detroit News article by Karen Bouffard, Price shopping in Michigan proves difficult despite new rule for hospital costs, Terrisca Des Jardins, the executive director of the Center for Health and Research Transformation (CHRT), discusses the complexity of hospital price transparency.

Since January 1, hospitals have been required to publish their discounted cash prices and the prices they have negotiated with insurance companies for 300 medical services. Supporters of hospital price transparency hope the publicly available price information will help consumers make decisions as well as reduce prices by creating competition between hospitals.

However, pricing information at hospitals is complex and difficult to compare. Some hospitals include doctor fees in their prices, for instance, and some don’t. Hospitals may offer different versions of procedures with different aspects included. Adding complex medical language makes the pricing information even more difficult for consumers to understand. Consumers find it difficult to evaluate pricing and make knowledgeable decisions about their healthcare options due to all of these factors.

“Our biggest concern is whether price transparency is going to provide meaningful and actionable information to consumers about what the actual cost of their care is,” Des Jardins said. “And unless there is a clear and consistent process for translating and comparing price data, it may be confusing to consumers.”

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No evidence of transmission between COVID-19 patients in nursing homes

Covid test strip reads positive On March 12, 2021, PolitiFact reported on the criticism surrounding Michigan Gov. Gretchen Whitmer’s nursing home COVID-19 policies. Clara Hendrickson and Kristen Jordan Shamus reported that under Gov. Whitmer’s administration’s policies, elderly patients with COVID-19 were released back to their long-term care facilities or to nursing home hubs designated for COVID-19 patients. The Michigan Republican Party has said that this policy caused the deaths of other seniors in nursing homes.

In the article, Hendrickson and Shamus cite a Center for Health and Research Transformation (CHRT) report that showed no evidence of transmission between COVID-19 patients admitted from hospitals to nursing home hubs. CHRT did, however, find that the overall COVID-19 death rate was lower (17% vs. 26%) at nursing homes that were classified as regional centers than at nursing homes that weren’t. Non-hub facilities admitted more than twice as many COVID-19 patients in recovery during the course of the study period.

CHRT’s findings do not mean that there wasn’t the transmission, emphasized Udow-Phillips. But Udow-Phillips suggested that COVID-19 may have been transmitted from staff to residents, instead of between residents. “Most of the national data has supported this observation that it’s the transmission from the community into nursing homes,” she said.

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