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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

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)

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Analysis Finds Strong Association Between Chronic Disease Burden and Financial Outcomes

Analysis Finds Strong Association Between Chronic Disease Burden and Financial Outcomes

The Commonwealth Fund recently reported that the U.S. continues to spend more on healthcare than other nations, and has the highest rate of people with multiple chronic conditions. Within this healthcare environment, many individuals are at risk of financial crises in part due to medical debt. MVC recently helped prepare a unique data set that linked its robust claims-based data with Experian’s commercial credit report data, resulting in an insightful analysis of the association between a patient’s chronic disease burden and their financial outcomes. The work was led by Nora Becker, M.D., Ph.D., and other colleagues from the U-M Institute for Healthcare Policy and Innovation, who published their analysis in JAMA Internal Medicine.

The financial burdens of illness can be due to the direct cost of medical care or the indirect effects of lost income due to illness. Many healthcare providers have first-hand anecdotes about patients who struggle to cover expenses necessary to manage their chronic condition, then avoid future healthcare services that lead to a worsening of their health or the development of additional chronic conditions. This negative feedback loop and the burden of medical debt are critical to understand so that healthcare leaders can adopt policies that improve financial outcomes for patients with chronic conditions.

Dr. Becker and her colleagues sought to understand the association between chronic disease diagnoses and adverse financial outcomes among commercially insured adults. Prior work in this area was limited, as researchers lacked data containing both clinical diagnoses and financial outcomes for the same individuals across a variety of chronic conditions. This time, however, MVC helped link patient data from its Blue Cross Blue Shield of Michigan (BCBSM) Preferred Provider Organization (PPO) claims to Experian credit data for the same patients’ financial histories. This data set was prepared for Dr. Becker and her colleagues, who performed the subsequent analysis and composed the resulting publication.

The 13 chronic conditions included in the analysis were selected for their prevalence, clinical importance, and association with financial challenges. These included cancer, congestive heart failure, chronic kidney disease, Alzheimer’s disease and other dementias, depression and anxiety, diabetes, hypertension, ischemic heart disease, liver disease, chronic obstructive pulmonary disease and asthma, serious mental illness, stroke, and substance use disorders.

The results of the analysis demonstrated a strong association between a patient’s chronic disease burden and adverse financial outcomes. For instance, among individuals with no chronic conditions versus those with 7 to 13 chronic conditions, the estimated probabilities of having medical debt in collections (7.7% vs 32%), nonmedical debt in collections (7.2% vs 24%), a low credit score (17% vs 47%) or recent bankruptcy (0.4% vs 1.7%) were all considerably higher for patients managing more chronic conditions (see Figure 1), with notable increases in rates of adverse financial outcomes between patients with no chronic conditions and those with 2 to 3 conditions or 4 to 6 conditions. Furthermore, among individuals with non-zero amounts of debt, the amount of debt increased as the number of diagnosed chronic conditions increased (see Figure 2). For instance, the adjusted dollar amount of medical debt increased by 60% from $784 for individuals with no chronic conditions to $1252 for individuals with 7 to 13 chronic conditions.

Figure 1. Predicted Probability of Credit Outcomes by Number of Chronic Conditions

Figure 2. Average Debt Among Individuals with Nonzero Debt by the Number of Chronic Conditions

In addition to finding an almost dose-dependent association between adverse financial outcomes and the presence of multiple chronic diseases, the analysis examined which conditions had the highest dollar amount of debt for the 10% of patients with medical debt in collections (see Figure 3). Congestive heart failure, stroke, substance use disorders, and serious mental illness racked up the most debt. Additionally, the probability of having medical debt in collections was substantially higher for patients managing serious mental illness or substance use disorders (see Figure 4).

Figure 3. Estimated Increase in Dollar Amount of Medical Debt in Collections by Type of Chronic Condition Among Individuals with Nonzero Medical Debt in Collections

Figure 4. Estimated Increase in the Probability of Having Medical Debt in Collections by Type of Chronic Condition

“We were expecting an association between adverse financial outcomes and chronic disease burden, but we were really struck by the magnitude and strength of the association that we found,” said Dr. Becker. “To see such a large increase in rates of adverse financial outcomes by chronic conditions really emphasizes that there is a crisis of financial instability among individuals with high chronic disease burden.”

Such significant variation across chronic conditions could be the result of several factors, such as some conditions requiring more costly treatments and high out-of-pocket expenses, and others making it more likely that patients miss work or cannot stay employed. The implications of such findings are impressive given the already high rate of patients with multiple chronic conditions—4 in 10 adults in the U.S. have more than one chronic condition—and the fact that poorer financial health is linked to more forgone medical care, worse physical and mental health, and greater mortality. Chronic conditions are already the leading causes of death and disability as well as the leading drivers of America’s $4.1 trillion in annual healthcare costs.

Dr. Becker and her colleagues were clear that their analysis did not determine causality—it is still unknown whether poor financial health leads to the development of chronic conditions or vice versa. Therefore, they advocated for the value of further analyses to determine underlying causes, which would inform how to approach improvements. The authors offered that if poor financial health causes additional chronic disease, then new social safety-net policies intended to reduce poverty rates may be beneficial. If chronic diseases are leading to poorer financial outcomes, then changes to the design of commercial insurance benefits could provide additional protections from medical expenses for costly chronic conditions.

“Additional work to determine the causal mechanisms of this association is crucial,” said Dr. Becker. “If we don’t figure out why this association exists, and who is most vulnerable, we can’t hope to design social policies to help protect patients from adverse financial outcomes.”

One of MVC’s core strategic priorities is intentional partnerships with fellow Collaborative Quality Initiatives (CQIs) and quality improvement collaborators. In the future, MVC hopes to do more with commercial credit report data given its unique uses and implications. It is the Coordinating Center’s hope that this work will help identify at-risk populations, understand how economic instability affects health outcomes, and generate insights that help working-age adults recover and return to work after major health events. The MVC team will continue exploring uses for this data in 2023 and engage its partner CQIs and collaborators to identify additional reporting opportunities for members.

As was recently highlighted in MVC’s 2022 Annual Report, MVC contributed to several other projects in the last 12 months similar to the analysis completed by Dr. Becker and her colleagues. MVC data and expertise also contributed to projects that resulted in new condition and report development, return on investment estimations for various healthcare initiatives, and additional insights on care delivery and patient outcomes. MVC will continue to identify partnerships and projects that leverage its rich data to achieve more sustainable, high-value healthcare in Michigan.

Publication Authors

Nora V. Becker, MD, PhD; John W. Scott, MD, MPH; Michelle H. Moniz, MD, MSc; Erin F. Carlton, MD, MSc; John Z. Ayanian, MD, MPP

Full Citation

Becker NV, Scott JW, Moniz MH, Carlton EF, Ayanian JZ. Association of Chronic Disease With Patient Financial Outcomes Among Commercially Insured Adults. JAMA Intern Med. 2022; 182(10): 1044–1051. doi:10.1001/jamainternmed.2022.3687.


Continuous Glucose Monitoring Has Potential in Inpatient Setting

One of the most prevalent comorbidities in the United States is diabetes; as many as 1 in 10 Americans are diagnosed with this condition, and 90-95% having potentially preventable Type 2 diabetes. It is well documented that unstable blood glucose levels can contribute to increases in morbidity, mortality, and healthcare costs.

In the inpatient setting, the current standard of care for monitoring and testing blood glucose levels in diabetic patients is point-of-care (POC) testing, which combines a specific testing schedule and approved devices to measure blood glucose levels. A recent study involving 110 adults with Type 2 diabetes looked at implementing real-time continuous glucose monitoring (RT-CGM) in order to better manage inpatient glycemic levels. The patients were on a non-intensive care unit (ICU) floor, and received either the standard of care or the RT-CGM with Dexcom G6 monitoring—where a tiny sensor wire is inserted just beneath a person’s skin using an automatic applicator. Data was transmitted from the bedside wirelessly, and monitored by hospital telemetry. The bedside nurses were notified of any abnormal glucose levels or trends and the patients were treated accordingly. The results indicated that patients in the RT-CGM group demonstrated lower mean glucose levels and less time in hyperglycemia.

Another study that evaluated the efficacy of RT-CGM discussed the effect that uncontrolled glycemic levels can have on clinical outcomes and healthcare costs. Currently, hospitals use POC glucose testing in order to monitor and treat hypoglycemia, and it is recommended that POC testing occur four to six times per day. However, this leaves many hours throughout the day where hypoglycemia can go undetected. RT-CGM using a glucose telemetry system (GTS) offers an alternative method to monitor these glucose values. A total of 82 patients participated in this study. Patients in the RT-CGM group experienced 60.4% fewer hypoglycemic events compared to the POC group. Figure 1 below illustrates the number of hypoglycemic events per patient for both the CGM/GTS and the POC.

Figure 1.

RT-CGM has yet to be implemented in inpatient settings for several reasons. The primary reason is the lack of U.S. Food and Drug Administration (FDA) approval. Additionally, institutional challenges may act as a significant barrier. For instance, staff need to be prepared for increased workload and educated on appropriate protocols and procedures. Technological support is required to ensure hardware compatibility and maintain a robust internet network with minimal interference in transmission of results and alerts. Additional factors within the hospital setting include certain medications, procedures, nutrition, acute illness, and any other condition that may affect glucose control. All of these challenges have the potential to impact CGM and its associated workload because of the effect they may have on the patients’ blood glucose levels. Although challenges remain to the implementation of RT-CGM in the inpatient setting, the benefits may outweigh the risks; thus, it is worth considering, especially given the successes in the outpatient arena.

The Michigan Value Collaborative hosts diabetes workgroups where topics such as continuous glucose monitoring are discussed by Collaborative members. If you are interested in attending the next MVC diabetes workgroup, please connect with the MVC Coordinating Center at: michiganvaluecollaborative@gmail.com.


Monitoring Chronic Disease Utilizing Social Media and Sensors

According to the Centers for Disease Control and Prevention, “treating individuals with chronic diseases accounts for 86% of health care costs.” While the number of those living with chronic conditions and the associated costs may be increasing, the Michigan Value Collaborative (MVC) is committed to providing you with current data around providing the right care, at the right time, at the right cost. Technological advances in healthcare are changing how and where chronic disease care is being delivered, how these patients interact with providers, and how organizations exchange information.

Both diabetes and abnormal blood pressure (BP) are extremely common in chronic disease patients and cause various complications, including an increased risk of cardiovascular events. When thinking about the way in which these chronic diseases should be managed moving forward after the COVID-19 pandemic, technological advances offer promising solutions.  Most devices in the healthcare industry have been digitalized. This advancement allows for routine monitoring using various devices that some patients may already own, such as a smart phone or a smart watch. These devices contain sensors that can be used to obtain information that can then be transmitted straight into the electronic health record (EHR). Other devices that can be used to collect patient information include a glucometer sensor, pulse oximeters, temperature sensors, scales, and many more. However, this method is not without its limitations.

The amount of data that is generated from these devices is vast and not all systems are capable of storing and processing it efficiently for precise and real time monitoring. In order to negate this issue, a framework was recently published that can be seen in Figure 1 below. This framework utilizes the cloud environment along with a large analytics engine layer to help store and process the data. The recently published study identifies the importance of utilizing wearable sensors and social networking platforms in collecting patient data, but identifies the challenges that come with this such as issues with data storage and running correct analyses.

Figure 1. Layers in the proposed healthcare monitoring framework

Chronic disease management patients may use social media platforms in order to seek support or learn new ways in which they may be able to reverse certain symptoms. Other ways in which monitoring is done through social networks include patient and provider conversations through application programming interfaces (APIs). Through these APIs, providers can pick up on tone or social connection status. Through this proposed framework of social media and sensor monitoring, providers can closely monitor chronic disease management patients.

MVC hosts chronic disease management workgroups where collaborative members discuss their current initiatives and connect on ways in which they can work together to better the health of Michigan. If you have any questions about upcoming chronic disease management workgroups, please feel free to contact the coordinating center at michiganvaluecollaborative@gmail.com