26 Mar 2025
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Overcoming Barriers to Healthcare Access: A Success Story at Marshfield Medical Center-Dickinson

Overcoming Barriers to Healthcare Access: A Success Story at Marshfield Medical Center-Dickinson

March 26, 2025 | 0 Comments | , ,

In recent years, the pursuit of high-quality healthcare has pushed an increasing number of organizations to consider how tailored approaches can reduce gaps in outcomes, increase the value of care, and enhance patient experiences with the healthcare system. Reflecting this growing recognition, the Michigan Value Collaborative (MVC) surveyed its members in 2024 to better understand how members were approaching variation in health outcomes across populations. This survey resulted in MVC’s 2024 statewide health equity report [PDF]. With questions focused on data collection, strategic planning, and programming, MVC gleaned a wealth of impactful and innovative solutions already under way in hospitals across the state. To champion and share those stories across the collaborative, MVC will publish quarterly member spotlight blogs that reflect examples of ongoing programs that improve patients’ outcomes and access to care.

For the majority of the surveyed hospitals, the most common focus areas for programming were enhancing access to providers (i.e., telehealth, mobile units, and nontraditional clinic hours), improving access to reliable transportation, offering financial support, and providing translated materials. Although it is common for hospitals to have strategies in place in these areas, the specific approaches are often as varied as the communities they serve.

At Marshfield Medical Center-Dickinson, for example, one way they approach challenges to healthcare access in the community is through dental care programming for low-income patients. Recent studies have established a clear link between oral health and overall health, underscoring the importance of proper dental hygiene as a preventive measure against serious health complications. According to the Mayo Clinic, poor oral health can lead to significant conditions such as endocarditis, cardiovascular disease, pregnancy complications, and pneumonia. Consequently, effective dental hygiene education and preventive care can provide substantial health benefits that extend well beyond oral health alone.

Recognizing the multifaceted benefits of accessible oral healthcare, Marshfield has partnered with Smiles on Wheels to offer monthly dental services—including cleanings, sealants, and fluoride treatments—at their primary care clinic, regardless of the patient's ability to pay. This initiative has been especially beneficial for young children and parents who face financial challenges related to transportation. It also helps families avoid future costs associated with more complex treatments that may result from a lack of preventive care. The program has received positive feedback from the patient population, with many community members expressing their gratitude for the support it provides.

Figure 1. Smiles on Wheels provides dental care services to Marshfield Medical Center-Dickinson patients during wellness care visits.

Photo courtesy of Marshfield Medical Center-Dickinson

Dr. Alexis Cirilli Whaley, MMC-D Pediatrician said, “We are fortunate to have Smiles on Wheels offering dental care to our local children, particularly for those families needing additional support due to economic stressors. The initiative allows for increased access to dental treatment, conveniently scheduled during wellness care visits."

By partnering with Smiles on Wheels, Marshfield Medical Center-Dickinson is leveraging existing resources to create a meaningful impact. This collaboration optimizes the use of available assets and showcases an effective strategy that harnesses the strengths of community partners. Stories like that of Marshfield Medical Center-Dickinson highlight the power of community partnerships in bridging known gaps in care and making a significant difference.

Throughout the coming year, MVC looks forward to showcasing other examples of patient-focused programming that improves the value of care across Michigan’s populations. If your hospital or organization has an initiative they would like to share, please contact the Coordinating Center at Michigan-Value-Collaborative@med.umich.edu – we would love to hear from you.

02 Oct 2024
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September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

September MVC Workgroups Highlight Initiatives for COPD Readmissions, Health Equity

October 2, 2024 | 0 Comments | , , , ,

Since its founding, a core component of MVC’s strategy has been organizing opportunities to collaborate with and learn from peers, leading to the ongoing facilitation of MVC workgroups. MVC has hosted workgroup presentations twice per month in recent years, and this year’s workgroups are focused on six topic areas: post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and health in action. Going forward, MVC will publish a monthly blog to highlight key takeaways and shared resources from the prior month’s presentations. In doing so, all MVC members and partners may utilize and benefit from the content regardless of their live participation.

September Post-Discharge Follow-Up Workgroup

MVC hosted a post-discharge follow-up workgroup on Sept. 10 featuring a presentation by Brian Leideker, RRT, COPD Navigator for Trinity Health Oakland Hospital. Leideker’s presentation summarized Trinity Heath Oakland Hospital’s progress since initiating an A3 COPD readmission committee in June 2021, including the key interventions their team has implemented to date.

One initial intervention was the hiring of a COPD navigator. Leideker described how his unique role as a respiratory therapist involved in case management has allowed him to be “a middleman between respiratory physicians and other entities trying to deliver and support services” for COPD patients.

Following several root cause analyses, the COPD committee identified that nearly 90% of patients readmitted for COPD at Trinity Health Oakland Hospital had an interruption in intended continuation of pharmacotherapy and/or non-pharmacotherapy treatments. This finding encouraged Leideker’s team to work to improve the education of patients, providers, and the greater healthcare community on ambulatory treatment for COPD as well as reviewing the testing and documentation needed to ensure coverage of durable medical equipment (DME) post-discharge.

With the help of an MVC custom analytic report, Leideker was able to trend DME utilization rates for patients hospitalized with COPD since the initiation of these interventions, as seen in Figure 1.

Figure 1. Annual Select* DME Utilization Rates During the Index and 30-Day Post-Discharge Period Among Patients Hospitalized for COPD at Trinity Health Oakland (2020-2023)**

Generally, the utilization rate of post-discharge non-bi-level home ventilators (E0466) was found to increase over time, while bi-level home ventilator (E0470) utilization has decreased. Leideker noted that this was somewhat expected since patients routinely report difficulty with the utilization of bi-level home ventilators (BiPAP) and often move on to non-bi-level home ventilators (CPAP). Additionally, based on Trinity Health Oakland’s internal analyses as of May 2024, their COPD three-day readmission rates have been reduced to <18% for all payers.

Sept. 10 Post-Discharge Follow-Up Workgroup

September Rural Health Workgroup

MVC hosted a rural health workgroup on Sept. 26 featuring a presentation by Brent Mikkola, MBA, PMP, Manager of Community Health at MyMichigan Health. Mikkola’s presentation summarized MyMichigan Health’s approach to developing a strategic plan for health equity and an overview of some specific community programs currently in place. MyMichigan Health’s phased approach to integrating health equity is currently focused on evaluating social determinant of health (SDoH) opportunities in an “assess, analyze, and address” model.

Some unique community partnerships that resulted from this process include:

  • Gratiot County Public Transit voucher program
  • Rx 4 Health – partnership with Michigan State Extension and specific grocery suppliers including SpartanNash, SaveALot, and Meijer
  • Food Pharmacies & Weekend Kits - partnership with the Greater Lansing Food Bank and the Food Bank of Eastern Michigan
  • Bridge to Belonging - virtual series on loneliness and social connection
  • Continuing Care Clinic Pilot with Community Health Workers (CHWs)
  • Intervention for Nicotine Dependence: Education, Prevention, Tobacco and Health (INDEPTH) Suspension Diversion Program

In addition to developing a strategic framework for reporting and developing objectives around health equity, Mikkola described how MyMichigan Health delved into the data collection, analysis, and quality improvement work surrounding health equity. For example, after initially integrating CHWs into community practices and inpatient services, MyMichigan Health further integrated CHWs following the WHO’s CHW Lifecycle Approach, as seen in Figure 2.

Figure 2.

CHWs have become instrumental to MyMichigan’s assessment of SDoH as required by CMS and JCAHO mandates by filling gaps in system workflows and in the expansion of the Continuing Care Clinic Pilot. To date, nearly 500 well visit appointments have been completed by CHWs at MyMichigan. Of those patients, 34% were identified as having SDoH needs and 50% of those needs have now reportedly been met through connections to community support services.

To learn more about the efforts showcased by Trinity Health Oakland and MyMichigan Health, or to view past workgroup presentations, visit MVC’s YouTube channel here.

October’s workgroups will include a health in action presentation on Oct. 8 about the University of Michigan’s Hospital Care at Home program, as well as a sepsis presentation on Oct. 17 by Garden City Hospital. You can view the complete 2024 calendar of events and register for workgroups here. To learn more about MVC workgroups or other presentation opportunities, contact the MVC Coordinating Center by emailing us here.

24 Apr 2024
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Health Equity in Action: Using Data to Drive Systematic Change

Health Equity in Action: Using Data to Drive Systematic Change

April 24, 2024 | 0 Comments

In the United States, disproportionate rates of chronic disease and illness are commonly documented among communities of color. National Minority Health Month (NMHM) takes place throughout April as a way to raise awareness about health disparities among minority groups and how racism and barriers to healthcare access have historically marginalized such groups. According to the CDC, health equity is “the state in which every individual has a fair and just opportunity to attain their highest level of health.” To achieve such a state, extensive efforts are necessary to address systematic injustices and support equitable access to healthcare.

At MVC, emphasizing this vast issue and supporting change begins with one critical step: identifying and quantifying current disparities within patient communities in Michigan. MVC is utilizing claims-based data analytics to identify differences in care for specific patient demographic groups. For instance, in a recent analysis of MVC claims, MVC found differences by race in the rates of patients attending cardiac rehabilitation after a coronary artery bypass graft (CABG), with lower average utilization rates among some minority groups compared to patients who are white and higher average utilization rates among other minority groups (Figure 1). There are also significant disparities in cardiac rehabilitation utilization rates after CABG by gender and payer categories. Highlighting the landscape of current healthcare utilization may help quality improvement teams understand where disparities exist within their patient populations and prompt discussions about the social and environmental circumstances that may contribute to such findings.

Figure 1.

MVC also recently collected surveys from its members on their health equity priorities, challenges, and initiatives to date. The survey results will be summarized at MVC’s upcoming spring collaborative-wide meeting, and some of the survey responses will be further expanded upon and shared with members as blogs and case studies to provide real-world examples of the work happening in hospitals across the state. Since health equity is a strategic priority for many healthcare teams, MVC’s recent survey was developed to help members understand what others are doing and facilitate shared learning on this topic.

However, there is also much to learn from national examples and strategies. In December 2022, for example, Blue Cross Blue Shield of Massachusetts announced the creation of payment contracts that provide financial rewards to practices addressing racial and ethnic inequities in healthcare delivery. Dr. Mark Friedberg, Senior Vice President, Performance Measurement and Improvement at Blue Cross explained, “This encourages health care systems to increase their investments in developing, expanding and sustaining programs that produce measurable improvements in equity.” This financial investment is a huge breakthrough for Blue Cross which will allow healthcare providers and organizations to learn what barriers to care exist and methods of resolution.

Financial incentives focused on equity are also a large component of State Medicaid strategies. In California, Medicaid plans could earn incentive funds by demonstrating improvement in the two race/ethnicity groups with the lowest baseline vaccination rates. In Michigan, there are financial incentives for using withheld funds for improvement on a subset of quality measures within the African American and Hispanic population groups. As more states and systems begin to invest in financial incentives with equity goals, MVC is working to re-evaluate the methodologies and metrics of the MVC Component of the BCBSM Pay-for-Performance (P4P) Program for opportunities to similarly incentivize and reward achievement and/or improvement in equitable care delivery.

As health equity activity continues to grow and evolve, MVC is committed to expanding its data sources and reporting to support members' understanding of the needs of their patients. Studies emphasize that disparate health outcomes are closely related to social determinants/influencers of health (SDOH/SIOH), with social factors often predicting the incidence of illness and disease. It is for this reason that MVC has continued to incorporate Distressed Communities Index (DCI) data into patient demographic tables in MVC push reports, in addition to stratifying select outcome measures by relevant demographic categories. MVC continues to explore opportunities to integrate additional supplemental SDOH data sets into its analyses – a recent example was shared at MVC’s October collaborative-wide meeting presentation (see slides), which focused on the relationship between county-level social need indicators and post-discharge care utilization.

Organizational strategies and investments are rapidly growing and evolving within healthcare, and will likely be necessary for years to achieve meaningful improvements. MVC is eager to support member activity in this space to achieve high-value care for all and will continue to highlight the excellent work and success stories happening across its membership. If you have a success story to share or would like to request a custom analysis focused on a specific patient population, please contact the MVC Coordinating Center.

11 Jan 2024
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MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

MVC Reflects on Legacy of Dr. Martin Luther King Jr. and Equity Opportunities in Healthcare

January 11, 2024 | 0 Comments | ,

On Monday, organizations large and small will honor the work and legacy of Dr. Martin Luther King Jr. His work has continued to inspire the country on issues such as equality, discrimination, and systemic racism. As the MVC Coordinating Center approaches this national holiday, we reflect on the continued relevance of one of Dr. King’s famous quotations about healthcare injustices: "Of all the forms of inequality, injustice in health is the most shocking and inhuman.” Dr. King made this comment and others about healthcare discrimination in 1955, and yet almost 70 years later our healthcare system continues to grapple with issues of inequity, discrimination, and racism.

As a result, health equity is currently a priority across most major healthcare and government agencies. The MVC Coordinating Center has similarly identified health equity as a strategic priority in recent years and in its newest strategy refresh. This means that a variety of health equity conversations, reporting, and learning opportunities will be offered to MVC members throughout the year. In discussions with members to date, it has been evident that many are still in an information-gathering phase and desire advice around best practices. Therefore, MVC will seek to identify differing approaches to health equity across the collaborative through a health equity survey, which will be shared with members at the end of January. Members will have until mid-April to complete this survey, after which MVC will report aggregate results and facilitate connections between members.

MVC also plans to continue integrating health equity into its workgroup offerings, with each workgroup series (e.g., cardiac rehab, preoperative testing, post-discharge follow-up, rural health, sepsis, health in action) offering at least one session focused on equity. In addition, MVC is planning to offer a reimagined health equity report informed by the results of the survey that integrates supplemental data sets tied to social determinants of health.

MVC’s equity activities this year come on the heels of MVC’s fall collaborative-wide meeting, which focused on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare. The agenda incorporated the voices of key leaders and community-based organizations working to improve equity in care delivery, including keynote speaker Renée Branch Canady, PhD, MPA, who serves as CEO of the Michigan Public Health Institute (MPHI) and is a recognized national thought leader in the areas of health inequities and disparities, cultural competence, and social justice. Key takeaways and links to slides from Dr. Canady and other guests are available in MVC’s meeting summary. The session also included roundtable speakers from community-based organizations, which helped to facilitate collaboration and networking to support direct patient support services. MVC will strive to offer similar networking and collaboration opportunities at future collaborative-wide meetings.

The MVC Coordinating Center wishes its members and partners well as they celebrate MLK Day in their way. We are grateful for your continued engagement and partnership on important issues as we collectively strive to provide high-quality care for all.

16 Nov 2023
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MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

MVC Celebrates National Rural Health Day with MyMichigan Workgroup Presentation

November 16, 2023 | 0 Comments | , , ,

Today is National Rural Health Day. Since 2010, the National Organization of State Offices of Rural Health set aside the third Thursday of every November to highlight the unique healthcare challenges facing residents within rural communities and celebrate providers who deliver innovative, affordable, and coordinated rural healthcare. MVC’s current membership includes 44 hospitals based in rural communities, 22 of which are designated as Critical Access Hospitals (CAHs). In tribute to National Rural Health Day and the needs of its growing rural membership, MVC hosted a special rural health workgroup yesterday.

The workgroup featured a guest presentation by Stephanie Pins, MSA, CPHQ. Pins is the Director of Quality, Risk, and Compliance for MyMichigan Medical Center Sault, formerly War Memorial Hospital, and is co-leading the Health Equity Council for MyMichigan Health. She led the creation of a transportation program for War Memorial Hospital by working with local transportation companies and applying for grants to cover the cost of the program.

This guest presentation focused on how MyMichigan is supporting rural communities through their Non-Emergency Medical Transportation (NEMT) Project, and the steps their team took to develop this program. Beginning in 2024, CMS will require that hospitals screen admitted patients for five social determinants of health (SDOH) domains. One of those five required domains is transportation needs since access to transportation and distance to care have a significant impact on healthcare outcomes.

MyMichigan Medical Center Sault primarily services the very rural communities of Chippewa, Luce, and Mackinac counties, located in the eastern Upper Peninsula of Michigan. A resident of Drummond Island—part of Chippewa County—may have to drive as many as 70 miles each way to get to an appointment at MyMichigan Medical Center Sault. Limited vehicle access in this part of the state was highlighted recently at MVC’s fall collaborative-wide meeting; the eastern Upper Peninsula had some of the highest rates in the state for housing units with no vehicle (Figure 1).

Figure 1.

While presenting, Pins emphasized that once MyMichigan identifies a need through screening, the next step is to find a way to connect those patients with the assistance they need to access medical care. One transportation solution utilized by MyMichigan Medical Center Sault is the Road-to-Recovery program, offered in partnership with McLaren Northern Michigan in Petoskey. The MyMichigan Medical Center Sault location offers some oncology cancer treatment services, but not radiation, so patients may need to travel to Petoskey—a distance of over 90 miles—to receive radiation therapy as part of their cancer treatment. The fully funded Road-to-Recovery program is available five days a week free of charge to anyone in the eastern Upper Peninsula. A hospital-owned van is driven by a volunteer driver from the MyMichigan Medical Center Sault location to scheduled pick-up locations along the I-75 corridor to Petoskey. Service times are coordinated with McLaren Northern Michigan’s oncology group so all the patients using this service have aligned appointment times. Pins shared that one noteworthy ancillary benefit of this program has been the peer support and relationship building that resulted from patients traveling together for extended periods while going through a similar treatment experience.

A second transportation solution utilized by MyMichigan Medical Center Sault is the Rides-to-Wellness Program, a partnership effort with local transportation companies and Connect UP. Patients can use this service to travel to other appointments or patient care services and serves as a critical stopgap in ensuring patients have somewhere to turn for time-sensitive transportation needs. Pins shared that the patient testimonials from those utilizing the service are helpful evidence of its value to the eastern Upper Peninsula (Figure 2).

Figure 2.

MyMichigan Medical Center Sault identified several lessons learned from delivering its Rides-to-Recovery Program over the last 10 years and applied many of those lessons to the development of its more recent Rides-to-Wellness Program. Pins also shared several tips for starting similar hospital-based transportation support programs at other locations throughout the state (Figure 3).

Figure 3.

Those who missed the workgroup and would like to learn more about these two programs, how they are managed, and how they were developed can review the full recording here. MVC is excited to offer a new rural health workgroup series quarterly in 2024. Contact MVC if you are interested in receiving invitations to those workgroups.

29 Aug 2023
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MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

MVC Data Used to Investigate Impact of Unmet Social Needs on Postpartum Contraceptive Use

August 29, 2023 | 0 Comments | , , ,

After childbirth, all individuals should have access to patient-centered counseling about birth spacing, and, if desired, contraceptive methods to help fulfill their personal reproductive goals. Promoting patient-centered contraceptive care and equitable access to contraceptive methods for those who desire them may improve population health outcomes.

Researchers and medical professionals are increasingly recognizing the impact of social determinants of health (SDOH) on individuals’ access to care and overall health outcomes. Unmet social needs may affect contraceptive initiation after childbirth by influencing individuals’ preferences for future childbearing, as well as individuals’ access to high-quality contraceptive care. To better understand this relationship, a group of clinician investigators used MVC data in a paper published in the American Journal of Obstetrics and Gynecology to evaluate the association between living in a neighborhood with high social vulnerability and the use of long-acting reversible contraception (LARC) and sterilization methods during the postpartum period.

Lead author Michelle H. Moniz, MD, MSc, Program Director of the Obstetric Initiative (OBI), and her colleagues utilized MVC administrative claims data to identify childbirth episodes from Jan. 2016 to Dec. 2019 with outcomes including LARC and sterilization use by 60 days into the postpartum period. Social vulnerability was determined using the Centers for Disease Control and Prevention’s Social Vulnerability Index (SVI). The SVI measures a community’s economic and social resilience by integrating 15 U.S. Census variables to generate composite scores across 4 themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation.

In 140,345 delivery episodes at 79 hospitals, 8% of patients initiated LARC devices, and 8.3% initiated sterilization by 60 days postpartum. Dr. Moniz and colleagues observed independent associations between social vulnerability and postpartum contraceptive use. It appeared that different SVI themes such as socioeconomic status, minority status and language, household composition and disability, and housing type and transportation aligned with varying use of LARCs or sterilization (Figure 1). Individuals living in neighborhoods with the highest socioeconomic vulnerability and minority status/language vulnerability were more likely to utilize LARC methods. Individuals living in neighborhoods with the highest household composition vulnerability were less likely to initiate LARC methods.

Figure 1. Adjusted LARC and Sterilization Use by 60 Days Postpartum (Using SVI Theme)

Conversely, sterilization was more likely among populations living in neighborhoods with highest housing/transportation vulnerability and less likely among those living in neighborhoods with highest socioeconomic vulnerability and minority status/language vulnerability.

Dr. Moniz and colleagues suggest that “structural factors—such as distance to clinic, fees for parking and transportation, clinic hours, childcare access, ability to miss work to seek healthcare, and out-of-pocket costs for healthcare—may affect postpartum contraceptive use.” They also note that more research is needed to fully understand the means by which SDOHs influence an individual’s healthcare preferences and choices. Additional investigations could shed light on the mechanisms by which unmet social needs influence reproductive wishes and access to patient-centered contraceptive counseling and methods after childbirth.

In all sectors of healthcare and medical research, but especially in maternal health where inequities in health outcomes have worsened in recent years, further studies must be done to better understand the impact of SDOHs. While medical advancements and the pursuit of best practices are critical to ensuring improvement in healthcare delivery, these innovations cannot impact outcomes for all patient populations until we understand the structural factors affecting patient access and goals.

MVC is committed to using data to improve the health of Michigan through sustainable, high-value healthcare. Therefore, one of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. MVC shares its data with clinical, administrative, and CQI experts for investigative analyses to help identify best practices and innovative interventions that help all members improve the quality and cost of care.

Publication Authors

Michelle H. Moniz, MD, MSc; Alex F. Peahl, MD, MSc; Dawn Zinsser, BA; Giselle E. Kolenic, MA; Molly J. Stout, MD, MS; Daniel M. Morgan, MD

Full Citation

Moniz, M. H., Peahl, A. F., Zinsser, D., Kolenic, G. E., Stout, M. J., & Morgan, D. M. (2022). Social vulnerability and use of postpartum long-acting reversible contraception and sterilization. American Journal of Obstetrics and Gynecology, 227(1). https://doi.org/10.1016/j.ajog.2022.03.031

30 Mar 2023
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MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

MVC Service Day Highlights the Impact of Food Bank Partnerships on Healthcare Outcomes

March 30, 2023 | 0 Comments | , , , ,

MVC staff stepped out of their daily routines recently when they volunteered as a team at a local nonprofit organization. Eager to make this service opportunity as meaningful to their work as possible, MVC staff selected an organization with ties to health and well-being. Last month they were hosted by Food Gatherers, the food bank and food rescue program serving Michigan residents in Washtenaw County. MVC teammates worked together to sort rescued produce in the Food Gatherers warehouse, saving and packing 1,312 pounds of produce for the community.

Though MVC teammates were excited and impressed by that number, it pales in comparison to the amount of food processed by food banks like Food Gatherers, which last year distributed 7.3 million pounds of food — the equivalent of 6 million meals — through its network of partner programs. In order to collect and distribute all those meals, Food Gatherers maintains a working warehouse where an average of nine tons of food are processed each day, and a busy community kitchen prepares and serves hot meals seven days a week. Volunteers play a significant role in these operations.

Produce boxes and other foods that are processed by volunteers eventually find their way into the hands of over 170 community partners, such as food pantries or emergency groceries. In addition to distributing food, Food Gatherers also works to connect beneficiaries to SNAP and other federal food programs and provide innovative food distribution initiatives at area schools and clinics. A new area of focus is the cultivation of partnerships with healthcare providers to further identify and address food insecurity in the community.

Food Gatherers established its Health Care and Food Bank Partnership Initiative to create a connection between local healthcare institutions and Food Gatherers’ network of partner pantries. It was designed to increase access to food for community members in partnership with healthcare providers. Key activities of the initiative include establishing food insecurity screening and referral programs within primary care locations, training medical professionals such as residents and allied health professionals on the role of food security as a key social determinant of health, and drawing attention to the issue of hunger and healthy food access with healthcare providers.

This is a growing area of interest for food banks across the country since food insecurity is closely linked to poor health outcomes and increased risk of chronic disease. According to one study, in fact, the rate of Type 2 diabetes is 25% higher in adults who are food insecure. In addition, as many as one-third of patients with a chronic illness are unable to afford food, medications, or both. A recent publication using MVC data also found strong associations between chronic disease burden and financial outcomes.

Several components of the Food Gatherers Health Care and Food Bank Partnership Initiative were initially supported through a Michigan Medicine grant. Food Gatherers has worked with Michigan Medicine, Trinity Health St. Joseph Mercy Ann Arbor, and IHA as well as with community-based clinics such as the Hope Clinic, Packard Health, and the Corner Health Center. Though the grant ended in 2021, the larger concept of partnership between healthcare providers and community food banks is still an area of interest and opportunity.

"Food Gatherers has been working with our local health care partners to support and encourage the use of food insecurity screening in primary care settings,” said Markell Miller, MPH, Director of Community Food Programs at Food Gatherers. “When providers can identify food insecurity in a patient, they can help connect the individual to resources - specifically SNAP, or if it's an urgent need, a local food pantry. Hunger is a health issue, and when providers talk about food security, they reinforce the connection between nutrition and health, and also destigmatize the experience for individuals facing food insecurity. Our Hunger and Health Training program provides baseline information for physicians on food security as a social determinant of health, and how to support individuals facing food insecurity. We've focused on training medical residents going into careers in primary care, but there is an opportunity to train other providers to increase knowledge and comfort with food insecurity screening and referrals. We look forward to future opportunities to expand our partnership with health care providers, and also continue to seek sustainable funding solutions to support the network of healthy pantries that are available in our community."

Similar programs are also underway at other food banks across Michigan, such as Gleaners Community Food Bank of Southeastern Michigan. In 2015, Gleaners was one of three participating food banks in a two-year randomized controlled research study on the impact of food bank interventions on outcomes for patients with Type 2 diabetes. They have partnerships with the CHASS Center, Covenant Community Care, Henry Ford Health System, the Michigan Health Endowment Fund, the National Kidney Foundation of Michigan, and Trinity Health St. Joseph Mercy Livingston, and have thus far connected more than 500 patients with healthy food.

MVC recently invited Jessica Ramsay, MPH, Director of Wellness and Nutrition Education at Gleaners, to present at MVC’s upcoming chronic disease management workgroup on Thurs., April 20, from 2 - 3 p.m. The presentation will focus on partnerships between healthcare providers and community organizations, highlighting pilot programs and initiatives at Gleaners that improved both patient outcomes and healthcare utilization through reduced food insecurity. Registration for this workgroup presentation is open now.

To learn more about the food banks mentioned, please visit the websites of Food Gatherers and Gleaners Community Food Bank of Southeastern Michigan. Reach out to MVC if your hospital or PO has a similar partnership in place with a community-based organization – MVC would love to highlight this work.

To learn more about the ways in which food insecurity impacts health, check out the video below from Feeding America.

Illuminating Intersections: Hunger and Health (Feeding America)

09 Feb 2023
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MVC to Honor Medical Pioneers for February’s Black History Month

MVC to Honor Medical Pioneers for February’s Black History Month

February 9, 2023 | 0 Comments | ,

Black History Month is an opportunity to celebrate the triumphs and reflect on the struggles of African American or Black persons throughout the history of the United States. In honor of this celebration, the MVC team is highlighting some of the Black pioneers who opened doors to medical fields and advanced the field of health through research.

It seems logical to begin by highlighting the work of James McCune Smith (Figure 1), notably America’s first Black physician. He received a medical degree from the University of Glasgow in 1837, when African Americans were denied admission to medical schools in the U.S. He also later became the first Black man to operate a pharmacy as well as the first Black author to be published in a medical journal. He applied his scientific mind and expertise to debunking poor science, outdated assumptions, and racist theories related to African Americans. As an abolitionist and close friend of Frederick Douglass, he wrote the introduction to Douglass' book, My Bondage and My Freedom.

Figure 1.

He was followed by many inspiring African American and Black healthcare providers who made history in their respective fields. There were leaders such as Daniel Hale Williams (1856-1931), who founded the Provident Hospital and Training School for Nurses in Chicago, America’s first Black-owned and interracial hospital. He is also known for having performed the world’s first successful heart operation, which saved the life of a man who had been stabbed in the chest.

Then there was Robert F. Boyd (1858-1912) who in 1895 co-founded the National Medical Association, the nation’s oldest and largest organization representing Black physicians and health care professionals. He served as its first president.

Alexa Canady (Figure 2), born in 1950, is also a Black physician of great strength and impact. She fought her way into one of the most competitive and exclusive fields of medicine when she became the first Black female neurosurgeon in the U.S. in 1981. She is an alumnus of the University of Michigan Medical School who specialized in pediatric surgery. She became chief of neurosurgery at the Children’s Hospital of Michigan from 1987 until her retirement in June 2001.

Figure 2.

As representation and institutional support grew, so too did the voice of African Americans in published medical research. Prominent physician and researcher Charles Richard Drew (1904-1950) studied blood transfusions and helped develop large-scale blood banks deployed during World War II. Patricia Bath (1942-2019), an ophthalmologist dedicated to blindness prevention in marginalized communities, was the first Black female physician to be awarded a medical patent for her invention of a laser cataract treatment.

A wealth of researchers working today dedicate their expertise to studying disparities, race, and ethnicity in healthcare. The Agency for Healthcare Research and Quality (AHRQ) honored Black History Month recently by highlighting the work of its grantees. Dr. Fabian Johnston, for instance, studies early utilization of palliative care for African Americans using culturally informed patient navigation, and Dr. Mya Lee Roberson evaluates geographic variation in breast cancer surgical outcomes among Black women in the South. AHRQ’s spotlight for Black History Month also includes an expansive list of recent research findings and publications related to race and health equity.

These professionals and countless others had a profound impact on medicine, research, and society. However, Black History Month is also a time to acknowledge the struggles and ongoing challenges experienced by the African American and Black communities. While much of the 20th and 21st centuries allowed for a series of “firsts,” they also bore witness to abhorrent racism that resulted in gruesome experiments, forced sterilizations, harmful research studies, and undertreatment for pain. As a result, there is rampant mistrust of the healthcare system within the Black community, even among some medical professionals. This was evident throughout the COVID-19 pandemic; hospitalized patients who did not trust healthcare providers were less likely to believe they were at increased risk of severe illness and were less likely to become vaccinated.

The MVC Coordinating Center is committed to emphasizing equitable care in Michigan by providing members with equity metrics and collaboration opportunities. The MVC team set several concrete goals to share research findings and resources throughout 2023 in service of members’ equity-related initiatives. Some of these resources may be used to build communication and trust with patients and solicit their input on healthcare practices.

In addition, those who follow MVC on Twitter or LinkedIn will see additional stories about African American medical pioneers throughout the remainder of February. If you have a colleague or individual you would like to nominate to be featured this month, please contact the MVC Coordinating Center at Michigan-Value-Collaborative@med.umich.edu.

02 Feb 2023
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MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

MVC and MHA Keystone Center Partner to Develop New Statewide Childbirth Outcomes Report

February 2, 2023 | 0 Comments | , , , ,

The birth of a child is a life-changing experience and a significant clinical event, with those experiencing pregnancy and childbirth hoping for a positive experience and healthy outcome. Yet the maternal mortality rate in the United States was 23.8 per 100,000 live births in 2020, and four in five pregnancy-related deaths were preventable according to the CDC. One in four of these deaths occur on the day of delivery or within one week, with considerable evidence that negative outcomes are more likely for patients of color. These findings are evidence of the need for quality improvement initiatives that ensure all people who are pregnant or postpartum receive the care they need. In light of this, the Michigan Value Collaborative (MVC) recently collaborated with the Michigan Health and Hospital Association (MHA) Keystone Center on the development of a statewide report on birth outcomes.

MVC claims data comprise approximately 84% of Michigan's insured population; these data are processed into 30- and 90-day price-standardized and risk-adjusted episodes of care that allow MVC to identify practice variation and measure the value of care. MVC creates episodes for over 40 medical and surgical conditions, including vaginal and cesarean childbirth delivery. MVC used a subset of claims from its data on Michigan childbirth episodes to create this new statewide report. The goal was to highlight statewide disparities in care and support the MHA Keystone Center and the Michigan Alliance for Innovation on Maternal Health (MI AIM) in their efforts to increase equitable care and decrease preventable severe maternal morbidity and mortality in Michigan.

MVC’s new statewide childbirth episodes report provides information on total episode payments, mode of delivery, patient characteristics, and rates of certain birth-related complications using 90-day episodes of care for vaginal and cesarean delivery. Measures in this report are based exclusively on Blue Cross Blue Shield of Michigan (BCBSM) PPO Commercial episodes for childbirth index admissions that occurred at MVC-participating hospitals between 1/1/19 and 12/31/21. Hospitals in this report were unidentified and each was required to have a minimum of 20 childbirth episodes across the reporting period to be included. Similarly to other MVC reports, several metrics were displayed by the index hospital’s geographic region of Michigan as categorized by MVC (see MVC regions here), with others stratified by race or mode of delivery.

The analysis found an average price-standardized, risk-adjusted 90-day total episode payment of $7,765 for vaginal delivery and $10,264 for cesarean delivery (Figure 1), with average index lengths of stay of 3.1 and 4.0 days, respectively. Additionally, the overall rate of cesarean delivery was 32.3% in July-Dec. of 2021, a slight increase compared to cesarean rates in 2019 and 2020 (Figure 2).

Figure 1. Average Price-Standardized and Risk-Adjusted 90-Day Total Episode Payments by Mode of Delivery, Overall and by Hospital

Figure 2. Rates of Cesarean Delivery, 2019 Through 2021, Overall and by Region of Michigan

Overall, 7.5% of patients had a diagnosis of hemorrhage, 4.2% had a diagnosis of hypertension, and 1.8% had a diagnosis of severe maternal morbidity (SMM) during their index birth hospitalization. A notable finding was the difference in rates of these complications by race (Figure 3). Patients who were identified as Asian or Pacific Islander had higher rates of hemorrhage than other race categories, and patients who were identified as Black had higher rates of hypertension and SMM than the overall population. This is consistent with other research findings related to disparate health outcomes for non-white patients.

Figure 3. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity (SMM), Overall and by Race

Health disparities such as these are an area of focus within the MVC Coordinating Center’s broader strategic framework. MVC’s health equity sub-committee meets regularly to strategize how to emphasize equity among its membership and support related quality improvement initiatives. The Coordinating Center’s aim is to use MVC data to help members identify areas of opportunity and support quality improvement through collaboration with peers. To this end, MVC is currently developing a hospital-level adaptation of the new statewide birth outcomes report to share site-specific data with its members later this year.

“Claims data such as those included in MVC’s episodes of care present a great opportunity to use state-wide data to highlight important findings and disparities related to birth outcomes in Michigan,” said Kristen Hassett, the lead MVC analyst for the analysis. “This report represents an important step in MVC’s work to identify areas of health inequality and then support initiatives to reduce those disparities.”

For the MHA Keystone Center, the statewide report provides valuable data to further inform its work.

“We are proud to partner with organizations like the Michigan Value Collaborative to collect and examine critical data related to childbirth within Michigan health systems,” said Sarah Scranton, vice president of safety and quality at MHA and executive director of MHA Keystone Center. “By evaluating hemorrhage, hypertension and severe maternal morbidity rates across several regions of the state, we are able to address the challenges facing Michigan mothers and birthing centers.”

The MVC statewide childbirth episodes report will aid MHA’s field engagement team while they engage with hospitals not yet partnering with MI AIM. Since its adoption in Michigan in 2016, MI AIM has contributed to significant improvement in hemorrhage-related SMM, hypertension-related SMM, and overall SMM through the implementation of hemorrhage, hypertension, and sepsis patient safety bundles with Michigan birthing hospitals.

To view the complete report, visit the MVC website. The Coordinating Center welcomes any additional questions about the report findings or any custom report analyses inspired by its creation. Contact the MVC team at Michigan-Value-Collaborative@med.umich.edu.

10 Nov 2022
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Distressed Community Index Data Supplements MVC Equity Work

Distressed Community Index Data Supplements MVC Equity Work

November 10, 2022 | 0 Comments | , , , ,

Emphasizing health equity in Michigan is a key strategic initiative for the Michigan Value Collaborative. MVC kicked off this strategic initiative at its October 2021 semi-annual meeting with the theme of “The Social Risk and Health Equity Dilemma.” Since then, MVC has expanded its access to data sets related to health equity, developed hospital health equity reports, and regularly convened stakeholders from around the state via a health equity workgroup series that launched in January 2022. MVC is eager to find new and exciting ways to utilize data and collaborate with members on health equity topics in Michigan.

One of the more recent enhancements to MVC’s capacity was the addition of more granular data on social determinants of health. MVC secured access to Distressed Community Index (DCI) data, a tool for measuring the comparative economic well-being of US communities. DCI data was first integrated into MVC reporting in August with the distribution of a new push report on emergency department and post-acute care use. It was also incorporated in MVC’s newest physician organization report on chronic obstructive pulmonary disease, which was distributed to PO members last month.

The DCI data are developed by the Economic Innovation Group and derived from the US Census Bureau’s Business Patterns and American Community Survey Five-Year Estimates (2016-2020). The DCI is a composite measure of ZIP-code level socioeconomic distress comprised of seven key indicators, including education, housing, unemployment, poverty, income, employment changes, and business (see Figure 1).

Figure 1.

The resulting DCI composite measure assigns individual five-digit ZIP codes a number from 0 to 100 with 0 representing the least distressed communities and 100 representing the most distressed communities. The DCI is then grouped into five ordered categories for ease of comparison: distressed, at risk, mid-tier, comfortable, and prosperous. The data include details on 874 ZIP codes in Michigan that have at least 500 residents, of which 192 (22%) are prosperous communities and 120 (14%) are distressed communities. The map below (see Figure 2) highlights the distribution of community-level distress categories across the state of Michigan, with the blue areas representing more prosperous communities and the red areas representing more distressed communities.

The data also reveal staggering racial/ethnic disparities in Michigan. As seen in Figure 3 below, Black/African American Michiganders are far more likely to live in distressed communities relative to non-Hispanic whites. This information is further evidence of the need for broad efforts to reduce disparities according to race/ethnicity and local community distress.

Figure 3.

Incorporating the DCI into MVC data analytics will offer new opportunities to better understand health equity challenges in Michigan. The MVC Coordinating Center looks forward to using these data in collaboration with its members and is eager to discuss how best to leverage such data sets to identify inequity in Michigan healthcare. Please contact MVC to learn more or request custom analytics.