In The Media Archive

Regional Health Collaboratives work to improve behavioral healthcare

AI diagram of interconnected health images

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

Female health care worker filling out chart of adjacent older female

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.”

CHRT explores the individual and environmental factors linked to healthy aging for people with long-term disabilities

An older person in a wheelchair touching tall grass

Since 2018, CHRT has worked closely with one of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDLRR) rehabilitation research and training centers (RRTC). The project, Investigating Disability factors and promoting Environmental Access for Healthy Living (IDEAL), aims to promote healthy aging for people with long-term physical disabilities.

What we’ve done

For the IDEAL RRTC, housed within the University of Michigan’s Center for Disability Health and Wellness, CHRT has produced multiple articles and policy briefs that elevate challenges and solutions for individuals aging with long-term disabilities.

In a brief titled Housing crisis is magnified for people with physical disabilities. Here’s how we can help, CHRT describes how individuals with physical disabilities are impacted by the U.S. housing crisis and shares ways to make housing more accessible and affordable.

In another brief titled Telehealth for people with disabilities, CHRT recommends national and state policies to make telehealth more accessible, functional, and supportive for people with disabilities, such as incorporating closed captioning during appointments.

In a third brief, CHRT investigates policy and programmatic solutions for supporting family caregivers, and in a fourth, CHRT explores the additional stress COVID-19 has caused for unpaid caregivers, and why that matters.

And in a 2021 issue of the Annals of Family Medicine, CHRT staff Robyn Rontal, Jaque King, and IDEAL RRTC colleagues describe annual wellness visit (AWV) use among persons with physical disabilities from 2008 to 2016–before, during, and after the rollout of the ACA.

The Annals article, Annual wellness visits for persons with physical disabilities before and after ACA implementation, reports that while the rate of annual wellness visit use was decreasing before the inception of the ACA, that trend reversed when the ACA rolled out and the use of AWVs among persons with disabilities has continued to increase.

The analysis, however, also found stark differences in AWV use based on gender, race, and other factors.

In 2016, for example, commercially insured women with congenital disabilities had the highest rates of AWV use at almost 50 percent. However, Black and Hispanic men with congenital disabilities (commercially insured or Medicare Advantage members) had AWV utilization rates around half that. In addition, people with disabilities were 15 percent less likely overall to use annual wellness visits.

Recent accomplishments

More recently, CHRT fielded a national survey of disability and aging services organizations and shared findings in a webinar titled, Serving those aging with a long-term physical disability during the COVID-19 pandemic: Challenges, successes, and innovations.

Among the 138 organizations surveyed, close to half (48 percent) changed or cut services during the pandemic, and 85 percent reported that the success of their programs was challenged by financial constraints.

“Organizations play an important role to ensure people with disabilities can age successfully,” says Marissa Rurka. “It’s important to uplift their strategies and share what they did during COVID-19 and how they adapted to unprecedented times.”

During the webinar, Riba and Rurka facilitated a panel of representatives from four organizations. The Arc Detroit in Michigan, the Ability Center in Ohio, The League in Indiana, and the Thompson Senior Center in Vermont each discussed challenges that their organizations faced as a result of the pandemic.

Panelists discussed how they adapted to those challenges. They also shared opportunities to better serve those aging with physical disabilities.

In April 2023, findings from this survey were published in the peer-reviewed journal, Disabilities, in a special issue of the journal titled: Aging with disabilities.

The article, Organizations’ Perspectives on Successful Aging with Long-Term Physical Disability, describes the researchers’ methodology and results. Authors define successful aging for this population and which strategies and programs work well.

What we plan to do

CHRT policy staff are now conducting an analysis of dually-eligible (Medicare and Medicaid) members with a physical disability and tracking their utilization of annual wellness visits from 2007-2016.

“We will compare members from a sample of Medicaid expansion states to a sample of states that did not expand Medicaid in order to test the impact of Medicaid expansion,” says Jaque King, associate director of health policy at CHRT.

The team will look at other measures too, such as hospital admissions and emergency department visits pre and post-Medicaid expansion, to test the impact of Medicaid expansion.

Beyond this project, CHRT has also begun working with UM’s Center for Disability Health and Wellness, led by Michelle Meade, an associate professor in the University of Michigan Department of Physical Medicine and Rehabilitation, to launch an RRTC Equity Center.

The new equity center will foster collaboration between organizations and investigators. Participating investigators hail from organizations dedicated to enhancing the health and functioning of individuals with disabilities–particularly those from marginalized and underserved communities.

Collaborating organizations and researchers will analyze existing data, and will develop and evaluate new interventions to change the behaviors of health care providers and systems. CHRT will help center participants learn how to share their findings through policy engagement and advocacy.

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The project is funded through a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90RTHF0001). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS).

CHRT’s Interim Executive Director Robyn Rontal is one of the co-PIs.

Michigan’s CCBHCs open mental health access to all

Green felt brain next to green mental health awareness ribbon

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.

Center for Disability Health and Wellness shares one-pager based on CHRT research

A doctor and a patient in a wheelchair look at a chart together.

In 2021, CHRT researchers co-authored an article, published in the Annals of Family Medicine, studying annual wellness visit (AWV) use among people with disabilities before and after the Affordable Care Act.

The article, written by Jaque King and Robyn Rontal from CHRT, broke down AWV use by gender, race, and other factors and shared the finding that people with disabilities were 15 percent less likely to attend AWVs than the general population.

This month, the Michigan Medicine Center for Disability Health and Wellness shared a one-pager with key findings from the article. The one-pager, “Did people with disabilities increase their use of annual wellness visits after the implementation of the ACA?” details the health disparities that still remain in the use of wellness visits.

READ THE ONE-PAGER

Nancy Baum quoted on mental health provider shortage

Young girl speaking to attentive therapist

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

Woman at work, distressed due to face mask restricting breathing

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

New CHRT projects explore the root causes of opioid overdose in one Michigan county and infectious disease control innovations across the U.S.

The Center for Health and Research Transformation (CHRT) has begun two new projects in recent months.

Innovations in infectious disease control

CHRT will synthesize lessons from Pfizer’s Direct Relief Innovation Awards in Community Health. Direct Relief, a humanitarian aid organization focused on improving the health and lives of people affected by poverty or emergencies, gave these awards to Federally-Qualified Health Centers and other clinics to help address infectious disease in underserved communities during the COVID-19 pandemic.

Two members of the CHRT team will attend a two-day learning summit to hear from Direct Relief awardees about their projects, the challenges they sought to address, and what they learned and achieved along the way. Topics will include strategies to prevent and treat infectious diseases, such as mobile vaccine clinics and offering flu vaccine uptake and PrEP at primary care visits.

CHRT will conduct a thematic analysis of the information gathered at the summit and synthesize results. CHRT will then share learnings and themes from the summit, such as common challenges, successes, and strategies shared by the awardees.

CHRT’s analysis will be distributed to Direct Relief’s partner network of over 1,500 Federally Qualified Health Centers, community health centers, free and charitable safety net clinics, as well as the National Association of Community Health Centers and the National Association of Free and Charitable Clinics.

Backbone support for the Washtenaw County opioid summit

For the last 13 years, CHRT has provided backbone support to the Washtenaw Health Initiative (WHI) Opioid Project. This has included helping project members organize an annual opioid summit designed to address the root causes of opioid overdose in the county. The 2022 opioid summit brought together 141 participants from over 60 organizations across Michigan to remember those lost and celebrate hope and recovery. In 2020, an online opioid summit drew 175 participants from over 65 organizations to discuss the impact of the COVID-19 pandemic on Washtenaw’s treatment and recovery system.

In 2023, the WHI Opioid Project and the Washtenaw Recovery Advocacy Project (WRAP), a program of Home of New Vision, will organize the summit together. CHRT will facilitate a committee to define the audience, objectives, and content of the summit, to contact presenters, and to develop and execute a promotional plan. CHRT will also prepare the technological resources and provide technical operations for the hybrid summit in September. After the summit, CHRT will conduct a post-summit participant survey and analyze results. CHRT will also arrange continuing education credit opportunities for participants.

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.”

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