In The Media Archive

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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Four new projects focus on financing for supportive housing, peer support for SUD, community paramedicine reimbursement, and CCBHC evaluation

The Center for Health and Research Transformation (CHRT) has taken on several new projects. The four most recent projects include research on innovative financing models for supportive housing, a pilot for a peer support program for those struggling with Substance Use Disorder (SUD), sustainability research for Community Paramedicine, and an analysis of Michigan’s CCBHC demonstrations.

For the first project, CHRT is conducting research, funded by the Michigan Department of Health and Human Services, on innovative financing models for supportive housing. This project builds on a successful permanent supportive housing pilot that addressed the intersection of homelessness and chronic illness. CHRT will review and report on federal, state, foundation, and private sector financing mechanisms for supportive housing initiatives.

A second project is a Peer Support Program for the United Auto Workers (UAW) union. CHRT has partnered with UAW to develop, implement, and evaluate a Peer Support Program for union members who are struggling with Substance Use Disorder (SUD) or who have a loved one with SUD. The volunteer-based program will first be launched at two UAW manufacturing facilities and then evaluated for effectiveness and scalability. CHRT will also make recommendations on how to change employer workplace drug-use policies to encourage more employees to seek help.

For our third project, CHRT has partnered with Huron Valley Ambulance (HVA) to analyze and eventually help create reimbursement strategies for their Community Paramedicine (CP) program. The CP program intends to improve care delivery and reduce costs by providing comprehensive care for low-acuity 911 calls in the patient’s home. From 2016-2018, HVA’s CP program saved an estimated $2.3 million by treating 53 percent of patients in place, instead of the 1.6 percent of patients treated in place by non-CP paramedics. However, HVA has not been able to obtain reimbursements to cover the full cost of CP care. CHRT will develop a more contextual understanding of HVA’s CP program and explore reimbursement rates and policies.

And most recently, CHRT has heard that it will be working with the Michigan Department of Health and Human Services, with funding from the Michigan Health Endowment Fund, to conduct a thorough evaluation of Michigan’s Certified Community Behavioral Health Clinics (CCBHCs) to understand their impact and guide future expansion efforts. CCBHCs offer a new model of care with the potential to increase access to behavioral health services statewide.

To learn more about CHRT’s research, evaluation, and policy projects, visit our projects page.

Please join us in welcoming our newest team members, who bring expertise in gerontology, sociology, and user experience

We’re excited to welcome our newest team members –Marissa Rurka, Erin Horne, and Vinusha Devarakonda. We’re happy to have them and looking forward to working with them.

Marissa Rurka

Marissa Rurka is a senior research and evaluation analyst at CHRT and a Ph.D. candidate in gerontology and sociology. Before joining CHRT, Marissa assisted with an evaluation of Minnesota’s value-based reimbursement policies for nursing facilities. In particular, her role was to evaluate a measure of long-stay resident quality of life.

Prior to that, Marissa served as a research assistant and graduate project coordinator for the Within-Family Differences Study, a panel survey exploring the implications of family relationships and caregiving for health and well-being. Marissa has also interned at the Patient-Centered Outcomes Research Institute (PCORI), where she analyzed PCORI’s portfolios of comparative effectiveness research studies related to advanced illness and caregiving.

At CHRT, Marissa will assist with the Cover Michigan and Michigan Physician Surveys, which collect data and perspectives from Michigan residents and primary care physicians. She will also support projects related to healthy aging, family caregiving, and social determinants of health. She has published in the Journal of Gerontology: Social Sciences and The Gerontologist.

Erin Horne

Erin Horne is CHRT’s Community Engagement Program Manager. She provides strategic support on racial health care equity and justice for the Washtenaw Health Initiative (WHI). She also works closely with Vital Seniors and the Healthy Aging Collaborative to create enduring outcomes for vulnerable elders and their caregivers in Washtenaw County, supported by data and research.

Prior to joining CHRT, Erin primarily worked in clinical psychiatric spaces. She has worked for non-profits, hospitals, and Michigan Medicine’s Department of Psychiatry Sleep and Circadian Research unit. After realizing that policy and systemic flaws hindered effective treatment for clients and patients, she began to pursue macro social work and public health. Her passion lies within diversity, equity, and inclusion informed policy to advance quality healthcare delivery for oppressed identities.

Erin holds a master’s degree in social work from the University of Michigan with a concentration in management in human services. She obtained her bachelor’s from the University of Michigan – Dearborn in behavioral and biological Sciences.

Vinusha Devarakonda

Vinusha is a master’s student at the University of Michigan School of Information with a focus on human-computer interaction and user experience (UX) research and design. During her time at the School of Information, she has worked on various UX projects with the Department of Veteran’s Affairs, Gale Cengage, and the Michigan Institute for Clinical Health Research (MiCHR).

At CHRT, Vinusha will support CHRT’s communications team as it conducts an analysis and usability testing of the Washtenaw County Community Mental Health website. She is passionate about incorporating accessibility into design and using design principles to promote inclusivity and equity. She is especially interested in the intersection of health and UX design.

Vinusha holds a bachelor of science degree in health science from Manipal University, a bachelor of biological science from the University of Michigan – Dearborn and has experience as a network engineering consultant at AT&T.

New Board Members: Toshiki Masaki of the Asian and Pacific American Affairs Commission and Dr. Amy McKenzie of BCBSM

CHRT is delighted to welcome to its board of directors Toshiki Masaki, former chair of the State of Michigan Asian and Pacific American Affairs Commission, and Dr. Amy McKenzie, associate chief medical officer for provider engagement at Blue Cross Blue Shield of Michigan.

Amy McKenzie, MD, MBA is a board-certified family medicine physician with 13 years of experience in private practice and over seven years of experience in health care administration and clinical leadership. She joined Blue Cross Blue Shield of Michigan in 2013 as a physician consultant supporting quality management and accreditation. She is now the associate chief medical officer leading provider engagement.

In her current role, Dr. McKenzie and her team provide clinical leadership for value-based provider programs and risk contracting. She helps to enable and support the provider network through education, communication, and practice transformation partnerships. She also leads a team responsible for BCBSM’s enterprise-wide behavioral health strategy. Read more.

Toshiki Masaki retired at the end of 2018 from the Ford Motor Company where he held a variety of leadership positions in vehicle engineering, finance, global data insights and analytics, government and community relations, and purchasing. His last position was as a manager in global data insights and analytics. Before that, he was senior manager of government relations, where his responsibilities included public policy and economic impact analyses, and management of Ford’s global career development and training program in government relations.

Masaki served on Michigan’s Asian and Pacific American Affairs Commission from 2013 to 2020. The commission is charged with advising the Governor and the State Legislatures on issues concerning Asia and Pacific Americans in the state and serving Asian and Pacific American communities to inform them of state resources available to all Michigan residents. Read more.

We are excited to have Mr. Masaki and Dr. McKenzie as part of our board and we look forward to working with them and welcoming them into the CHRT family.

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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Michigan’s mental health system is a complex web, not an easy system to navigate writes Crain’s Detroit citing CHRT

In “State of confusion: Michigan’s mental health system has many layers for those in need to navigate,” Chad Livengood of Crain’s Detroit describes Michigan’s complex and daunting mental health system. Livengood notes that the system is facing financial hardships due to its complexity, as well as the huge financial hit caused by the COVID-19 pandemic itself.

COVID-19 has delayed state plans to improve the mental health system and provide more resources for those with severe mental health issues (SMI). Individuals with SMI often find themselves lost in the medical system, or the ER, instead of getting adequate mental health treatment from the proper organizations.

Livengood writes that when mental health facilities do receive funding from the Michigan Department of Health and Human Services, those funds tend to come with a long list of requirements that cost money to implement.

Certified Community Behavioral Health Clinics (CCBHC) are designed to address this issue by integrating primary care with mental health treatment. Experts hope that integrated health networks like these will dramatically improve the state’s mental health system.

Livengood cites the Center for Health Research and Transformation’s recent brief on CCBHCs, which notes that there are 18 CCBHCs across the state, and none in the northern Lower Peninsula and Upper Peninsula.

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