16 Apr 2025
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State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

State-of-the-State Health Equity Report: A Snapshot of Hospital-Level Priorities, Barriers, and Opportunities in Michigan

April 16, 2025 | 0 Comments | , , , ,

Hospitals across Michigan are increasingly focused on using their available data to assess care delivery gaps, inefficiencies, and areas for improvement. The Michigan Value Collaborative (MVC) developed its 2024 Statewide Health Equity Report to provide a detailed summary of how hospitals across Michigan are approaching this process with a health equity lens. By analyzing MVC claims data along with survey responses from 52 hospitals and 11 health systems, the full report captures how hospitals are leveraging data to evaluate patient care, identify disparities in outcomes, and develop interventions that improve the overall value of care delivery.

Data Collection and Utilization

One of the key highlights of the report was the varied approach and capacity for collecting, measuring, and utilizing data on health equity. Many hospitals utilize readmission rates, clinical quality indicators, and demographic information to identify variations in care. However, the extent to which this data informs hospital-level decisions varies. While some hospitals remain in the early stages of collecting and organizing health equity data, others are beginning to analyze and apply these insights to shape their initiatives. Nearly a third of respondents indicated they were using data to guide funding and program priorities, while a smaller percentage integrated equity metrics into quality improvement strategies.

To further support hospitals in taking action, MVC used its robust medical insurance claims-based data to highlight established disparities for specific service lines. A notable finding was the difference in rates of birth complications by race (Figure 1). Women who identify as Asian and/or Pacific Islander had higher rates of postpartum hemorrhage than other race categories, and patients identified as Black had higher rates of hypertension and severe maternal morbidity (SMM) than the overall population.

Figure 1. Rates of Hypertension, Hemorrhage, and Severe Maternal Morbidity During Index Hospitalization, Overall and by Patient Race/Ethnicity, 2021-2024

Another notable finding was sex differences in cardiac rehabilitation enrollment (Figure 2). Women are significantly less likely to enroll in cardiac rehab within 90 days of discharge for eligible cardiac procedures, take longer to enroll in their first session, and attend fewer sessions on average than male patients. These patterns point to differences in how patients access and engage with follow-up care, and these gaps are present even among hospitals with strong cardiac rehabilitation enrollment rates.

Figure 2. Rates of Cardiac Rehabilitation Utilization within 90 Days of Discharge from a Qualifying Event by Sex, 2015-2023

These MVC claims-based investigations into healthcare outcomes across populations can assist hospitals in setting or enhancing their health equity goals.

Efforts to Improve Healthcare Access

Beyond data collection and analyses, the report summarized a range of efforts to improve healthcare access. Most hospitals have expanded telemedicine services, increased clinic hours, deployed mobile health units, support non-emergency medical transportation programs, and offer rideshare assistance to reach a variety of patient populations who struggle to access care in their community. Language accessibility has also been a focus, with nearly 90% of hospitals offering translated materials and on-site interpretation services. Financial barriers remain a concern, with 79% of hospitals reporting efforts to support patients dealing with medical debt or lacking insurance coverage.

There were also several hospitals implementing community-based programming and solutions in response to gaps for specific disease impacted communities or underserved groups. The most common types of solutions currently supported by hospitals across the state included:

  • Food Security Initiatives: Many hospitals are addressing food insecurity by screening patients for social needs, partnering with community food programs, and even launching hospital-based farms and Healthy Food Rx programs to encourage nutrition-based health interventions.
  • Community Health Workers (CHWs): Increasingly, hospitals are integrating CHWs into their care models to bridge the gap between clinical care and community-based support, particularly in rural and underserved areas.
  • Incorporating Patient Voices: Hospitals are utilizing Community Health Needs Assessments (CHNAs), patient experience surveys, and community advisory boards to ensure that patient perspectives inform quality improvement initiatives.

Looking Ahead

Although most hospitals have taken steps to improve care delivery across all patient populations, they face significant organizational barriers, such as insufficient funding for dedicated staff and programming, lack of staff training or expertise in community-focused challenges, and difficulty communicating the business case or return on investment of such efforts. These barriers and new ones will likely grow in the coming months and years as the field’s federal funding streams shift.

Amid that uncertainty, MVC hopes to play the role of facilitator by supporting hospitals with actionable equity data, facilitating peer learning opportunities through dedicated meetings and sharing of success stories, and financial incentives through the MVC Component of the BCBSM P4P Program. In addition, the MVC Coordinating Center regularly consults with the Michigan Social Health Interventions to Eliminate Disparities (MSHIELD) team on best practices for data collection and equity-centered quality improvement. MVC will demonstrate this commitment via its quarterly MVC member spotlight blog—which will highlight successful initiatives across MVC’s membership—and via dedicated learning sessions at MVC’s Oct. 10 collaborative-wide meeting in Livonia.

If you are interested in pursuing a health equity initiative, MVC has a robust registry of claims data that can be utilized, as well as site specialists who can help facilitate connections with peers doing similar work. Please reach out to us by email if you have a success story to share or want to learn more about related MVC data.

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.

04 Feb 2025
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January Workgroups Highlight System-Level Sepsis Efforts and Community Paramedicine

January Workgroups Highlight System-Level Sepsis Efforts and Community Paramedicine

February 4, 2025 | 0 Comments | , ,

In January, MVC hosted two virtual workgroup presentations – the first a sepsis workgroup focused on the development of a system-level sepsis improvement plan, and a health in action workgroup focused on the implementation of a community paramedicine program. MVC hosts two virtual workgroups per month with topics rotating between post-discharge follow-up, sepsis, cardiac rehabilitation, rural health, preoperative testing, and heath in action (ad hoc focused topics). Each month, the MVC Coordinating Center publishes key highlights from the past month’s presentations to support resources and best practice sharing across the state.

January Sepsis Workgroup: Munson Medical Center

On Jan. 14, MVC hosted its first sepsis workgroup of 2025 with a presentation on Munson Healthcare’s system-level sepsis improvement plan. Munson representatives who contributed to the presentation included Alex Callaway, MBA, CPHQ, CPPS, Director of Quality & Patient Safety; Diane Barton, MHA/MSN, CPHQ, CPPS, Director of Organizational & Clinical Quality; Jennifer Bentley, RN, BSN, Nursing Quality Coordinator; and Stephanie Bowen, RN, BSN, Nursing Quality Coordinator.

Barton commented that sepsis care became one of Munson Healthcare’s system-level driving strategies several years ago. This focus was partially driven by the system not performing well in comparison to state and national benchmarks but also because sepsis was found to be the number one cause of death for patients across Munson Healthcare.

With a goal to improve both internally as well as in comparison to state and national peers, Barton noted that early on Munson Healthcare identified the CMS SEP-1 bundle as a metric to guide their progress with quality improvement efforts. The CMS SEP-1 bundle is a protocol for treating patients with severe sepsis or septic shock focusing on early intervention and timely recognition of sepsis. It has been directly correlated to reduced mortality and improved patient outcomes.

Barton explained that since Munson is a relatively young system, they utilized an A3 problem solving system to examine the current state of sepsis management across all eight Munson Healthcare sites. With a system-level focus in mind, they created both site and system-level sepsis teams that engaged a variety of team members including representation from direct care providers and support services. The presenters then explained that to ensure provider buy-in, they first needed to develop a standard for monitoring sepsis compliance outcomes and the accompanying feedback pathways to provide up-to-date information to clinicians and quality staff.

At the start, Barton notes they were meeting compliance rates of only 60% but have recently seen less variation in their CMS SEP-1 bundle compliance and are encouraged by this trend. Callaway explained that over time they have modified their approach in response to provider feedback; for example, they eliminated the automated Cerner Sepsis Advisor alert in preference of a Sepsis Power Plan order set. Overall, the presenters noted that the improvement plan implemented by Munson Healthcare has had an overall positive impact on the system.

Following the presentation by Munson Healthcare, MVC Site Engagement Coordinator Emily Bair, MS, MPH, RDN, provided a brief review of the Program Year 2026-2027 sepsis value metric changes for the MVC Component of the BCBSM P4P Program. To better align with HMS sepsis measures, the MVC sepsis value metric transitioned from a readmission measure in PYs 2024-2025 to a follow-up measure in PYs 2026-2027. Bair noted that, following these changes, MVC observed a nearly fourfold increase in the number of participating P4P hospitals that selected the “14-day follow-up after sepsis” value metric.

Blinded MVC data for 14-day outpatient follow-up rates among patients hospitalized for sepsis was then shared with the workgroup attendees (Figure 1). The data showed an MVC All follow-up rate of 57.9% based on claims data for 30- and 90-day inpatient or surgical episodes of care for adults with index admission between 1/1/2022 and 12/31/2023. The hospital-level distribution of 14-day follow-up rates among patients hospitalized for sepsis ranged from 20% to 68% across MVC’s membership.

Figure 1. 14-Day Outpatient Follow-Up Rates Among Patients Hospitalized for Sepsis

Bair closed out the sepsis workgroup by facilitating discussion about 2025 organizational goals related to sepsis and the specific strategies care teams plan to implement in service of those goals. The interventions shared throughout Munson’s presentation and MVC’s blinded data inspired robust discussion about goals and strategies across the collaborative. Common discussion themes for sepsis efforts in 2025 included:

  • Building upon 2024 successes
  • Inclusion of clinical champions to sepsis teams
  • Addition of inpatient sepsis cases into fallout tracking
  • Implementation of data tracking and feedback communication strategies
  • Standardization of documentation and order sets across hospital systems

Jan. 14, 2025: MVC Sepsis Workgroup

January Health in Action Workgroup: Tri-Hospital EMS

The second workgroup of 2025 focused on a bird’s eye view of community paramedicine programming. This workgroup featured a presentation by Amanda Biskner, RN, Paramedic, CP-C, the Community Paramedicine Coordinator for Tri-Hospital EMS in St. Clair County, Michigan. The presentation reviewed the benefits and parameters of community paramedicine as well as the steps taken to implement a program in St. Clair County.

The practice of community paramedicine (CP) includes providing “out of hospital” care for non-emergent patients in their own home while also tending to their social determinants of health to improve overall quality of life. The CP’s ability to interface with the 9-1-1 system, extensive education in various topics including acute and chronic care, and license to utilize EMS and CPP protocols prior to PCP contact are just a few items that separate these practitioners from mobile integrated healthcare (MIH) and home health care programs. Bickner summarized the various services that community paramedics may cover within a patient visit (Figure 2).

Figure 2. Community Paramedicine Services

Biskner described the process by which the Tri-Hospital EMS community paramedicine program was initiated, starting with identifying a portion of the objectives for the 2023-2027 St. Clair County Community Health Improvement Plan (CHIP) that could be supported by the program. Next, a pilot program was launched, and between June and October 2024 a total of 12 patients were enrolled and 45 visits completed through the program.

While the established goals for the trial were met –such as increased communication, healthcare access, patient satisfaction, and experience in care transitions – Biskner explained that there remain challenges to program expansion. Even though nearly 100 EMS agencies in 33 states across the U.S. have launched some version of a community paramedicine program, Biskner noted that funding and reimbursement issues are likely to continue since community paramedicine is not yet standardized in its training, licensure, or practice protocols. Increased community education, exposure, and relationships with local healthcare authorities are the primary methods Biskner recommended for expanding community paramedicine opportunities to other communities.

Jan. 30, 2025: MVC Health in Action Workgroup

In February, MVC will host two more virtual workgroups. The first workgroup on Tues., Feb. 11 will focus on cardiac rehabilitation, and the next on Thurs., Feb. 27 will feature a health in action workgroup focused on patient journey mapping. To register for these or other future workgroups, please view the 2025 calendar on MVC’s events page [LINK]. If you are interested in leveraging MVC’s robust claims data and data specialists to inform a local or system-level quality improvement effort, reach out to the MVC Coordinating Center [EMAIL].

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.

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.

14 Sep 2023
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MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

MVC Announces Registration, Speakers for its Oct. 20 Fall Collaborative-Wide Meeting

September 14, 2023 | 0 Comments | , , ,

The MVC Coordinating Center is excited to announce open registration for its upcoming Fall Collaborative-Wide Meeting on Friday, Oct. 20, 2023, from 10 a.m. – 3 p.m., in Lansing, MI. This meeting’s theme is “High-Value Care for All: Collaborative Approaches to Equitable Healthcare,” and will focus on how interdisciplinary collaboration can support efforts to reduce disparities and provide equitable healthcare.

This meeting will include presentations on health equity frameworks for quality improvement, insights from claims-based data, and inter-organizational partnerships to improve patient outcomes. MVC is thrilled to be joined by Renée Branch Canady, PhD, MPA, CEO of the Michigan Public Health Institute (MPHI), as its keynote speaker. Dr. Canady has extensive experience in diversity, equity, and inclusion (DEI) efforts, and was recognized as Crain’s 2021 Notable Executives in DEI. She received this honor for her work implementing incremental changes in health equity and social justice at MPHI. Under her leadership, MPHI established the Staff of Color Affinity Group, the Center for Health Equity Practice (CHEP), and the Center for Culturally Responsive Engagement (CCRE). She also recently published a new book titled Room at the Table: A Leader’s Guide to Advancing Health Equity and Justice.

The MVC Coordinating Center will also present MVC data linked with supplemental social determinants of health data sets, updates about the MVC Component of the Blue Cross Blue Shield of Michigan (BCBSM) Pay-for-Performance (P4P) Program, and other Coordinating Center updates.

MVC’s fall collaborative-wide meeting will also feature a new roundtable format with insights from a wide variety of guest speakers, including Nora Becker, Michigan Medicine; Diane Hamilton, Corewell Health Trenton; Matthias Kirch, Michigan Social Health Interventions to Eliminate Disparities (MSHIELD); Laura Mispelon, Michigan Center for Rural Health; Amanda Sweetman, the Farm at Trinity Health; Larrea Young and Noa Kim, Healthy Behavior Optimization for Michigan (HBOM); and Thomas West, U-M Health West. Attendees will rotate through several mini-presentations and discussions about specific health equity topics, such as demographic data collection and patient screening practices, developing and funding community benefit programs, addressing transportation access barriers, support programs within rural communities, tobacco cessation interventions, financial toxicity risks for patients, and more.

Attendees will have multiple opportunities to network and learn from their peers. The meeting includes a mid-day poster session to highlight success stories and research across the collaborative and the broader CQI portfolio. MVC is still actively accepting poster submissions through 10/5/2023 that feature first-hand experiences with quality improvement, related research, or the implementation of interventions and best practices. They can be on topics unrelated to health equity or MVC conditions/data, authored by clinicians and non-clinicians alike, or presentations already shared at a recent conference or event. Instructions for submitting a poster are available on MVC’s events page. The meeting also includes breakout sessions in the afternoon focused on regional trends and opportunities using MVC data and member insights, as well as an optional networking reception at the conclusion of the event, from 3-4 p.m.

Those able to attend MVC's fall collaborative-wide meeting may register here. MVC hosts two collaborative-wide meetings each year to bring together healthcare quality leaders and clinicians from across the state.

CME CREDITS AVAILABLE

The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 3.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Activity Planners

Hari Nathan, MD, PhD; Erin Conklin, MPA; Chelsea Pizzo, MPH; Chelsea Andrews, MPH; Kristy Degener, MPH

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.