Policy, Planning & Legislative ServicesPolicy, Planning & Legislative Services Presentation to the 43rdAnnual MARO Spring Leadership Conference Wednesday, June 7, 2017 Matt Lori, Senior

Policy, Planning & Legislative Services Presentation to the

43rd Annual MARO Spring Leadership ConferenceWednesday, June 7, 2017

Matt Lori, Senior Deputy Director

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Mission The Michigan Department of Health and Human Services

provides opportunities, services, and programs that promote a

healthy, safe, and stable environment for residents to be

self-sufficient.

Vision Develop and encourage

measurable health, safety and self-sufficiency outcomes that reduce and prevent risks, promote equity,

foster healthy habits, and transform the health and human services system to improve the

lives of Michigan families.

Our Guiding Principles

To ensure that MDHHS policy development, implementation, and legislative priorities are aligned

with the department’s strategic goals.

Mission

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• Obtained a Health Professional Shortage Area designation from the federal government allowing us to expand the State Loan Repayment program in Flint to encourage more pediatric providers to practice in that area

• Nurse Professional Fund is providing nurses, nurse practitioners, and nursing students to provide clinical services and public education in Flint. This efforts targets:

o Latino Community

o Deaf and Hard of Hearing

Action on Flint Declaration of Emergency

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Overview

• Policy

• Planning

• Michigan Rehabilitation Services

• Bureau of Community Services

• Legislative Affairs & Constituent Services

Policy, Planning & Legislative Services

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Overview• State Innovation Model (SIM)• Health Information Technology• Health Disparities• Integrated Service Delivery• Other Policy Initiatives, including:

o Human Trafficking Health Advisory Boardo Prescription Drug and Opioid Abuse Task Force Implementation o Mental Health and Wellness Commission Implementationo People Group o NGA Super Utilizers Policy Academy Participant

Policy

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Background

• $70 million Michigan State Innovation Model (SIM) began February 2015

• Develop and test state-led, multi-payer healthcare payment and service delivery models to improve health outcomes, increase quality of care, and reduce costs

• Rolling out multiple initiatives to support patient-centered healthcare that coordinates with community organizations to address social determinants of health

State Innovation Model

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Patient Centered Medical Home Launched January 1, 2017, statewide

• Nearly 360 primary care practices• Over 2,100 primary care providers• Over 350,000 Medicaid beneficiaries• Sustain and expand foundation developed through the Michigan Primary Care

Transformation (MiPCT) demonstration• Enhancements:

o Transitions of careo Managing costo Creating clinical-community linkages to address social and other wellness

factors


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Health Information Exchange Implement the Relationship and Attribution Management Platform (RAMP)

• Includes the following information sharing use cases:o Health provider directory (HPD), registering providers in the

information exchange networko Active care relationship service (ACRS), attributing patient records

with registered providerso Common key service (CKS), consolidating patient records under a

common patient identifiero Quality measure information (QMI), standardizing quality measures

and reporting process across payers• Forms information sharing and exchange foundation to build care

coordination and value-based payment efforts in the future


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Community Health Innovation Regions

• Piloting development of local, multi-sector infrastructure to improve population health

o Governance to include healthcare payers and providers along with public health, mental health, and other community groups

o Consolidate disparate community needs assessment and improvement planning efforts into single effort

o Operationalize clinical-community linkage partnerships and processes to inform ongoing and upstream decision making to address social determinants of health and health inequities

• State Program Guidance released in November 2016


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• Five regions developing and submitting local operational plans in April:

o Muskegon

o Jackson

o Washtenaw/Livingston

o Genesee

o Northwest Lower Michigan


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Health Information Technology• Support the Health Information Technology Commission created by PA 137-06

• Coordinate MDHHS activities with the State Designated Entity for Health Information Exchange and the Trusted Data Sharing Organizations in Michigan

• Offer recommendations on strategic alignment and direction on policy issues related to health IT and secure date exchange

• Coordinate and align health IT and data sharing efforts with statewide transformation initiatives

• Align federal health IT priorities with MDHHS health IT policy to ensure the right data for the right person is at the right point of care

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• Established in 1988 to provide a persistent and continuing focus on eliminating health disparities among Michigan’s populations of color

• Designated MDHHS lead for PA 653 related activities, including the annual legislative report

• Initiates programs and policies to eliminate health disparities. Priority strategies include:

o Improve race/ethnicity data collection and data systems

o Strengthen government capacity to develop effective programs and partnerships

o Improve social determinants through public education and evidence-based interventions

o Ensure equitable access to quality healthcare

o Strengthen community engagement, capacity, and empowerment

Health Disparities Reduction and Minority Health Section

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Brief Overview

• Integrated Service Delivery (ISD) is an enterprise strategy to bring together a diverse set of benefits and services in a holistic, customer-focused experience aimed at impacting health, safety and self-sufficiency outcomes

Integrated Service Delivery

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ISD Strategy Includes Multiple Key Components

• Integrated Service Delivery Portal-Online needs assessment, connection to services, and development of goals to improve stability

• Universal Caseload Management-Assigns tasks to groups of staff members working on a specific part of the casework process, allowing casework to be shared across teams and offices and improving efficiency

• Contact Center-A streamlined customer contact point which better manages incoming phone calls and other contact types, offers self-service options over the phone and routes customer contacts

• Supporting Services- System and information integration strategies including both technological infrastructure and data sharing arrangements which support ISD


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MDHHS Activities to Date

• Developed a business process and technology roadmap to accomplish budgeting, procurement and high level requirements design

• Chartered the three key components of ISD being developed in FY17 and completed detailed discovery and business requirements processes for each component

• Currently designing and developing the technological systems, business processes, program policies and readiness supports needed to move forward with practical tests (i.e. pilots) of new ISD components in late 2017

• Preparing to pilot the ISD Portal with customers and community partners in one county beginning in September 2017

• Preparing to pilot the combined universal caseload and contact center components in two counties in January 2018


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Prescription Drug and Opioid Abuse Task Force Implementation

• 12 recommendations of the Prescription Drug and Opioid Abuse Task Force are the responsibility of MDHHS

• All 12 recommendations are either complete, in progress, or ongoing

• These recommendations include:

o Working to reduce doctor and pharmacy shopping

o Increase access to care

o Increase access to Naloxone

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• Coordination point on prescription drug and opioid abuse efforts for:

o All MDHHS administrations

o Other state agencies

o External stakeholders

• Efforts include:

o Program improvements

o Grant activities

o Public awareness campaign

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• Federal 21st Century CURES act will provide $16.37 to Michigan to enhance our opioid abuse efforts

• Treatment funding will be used to:

o Increased funding, promotion, training, and support for Medication Assisted Treatment

o Increased use of peer supports

• Prevention funding will be used to:

o Increase community prevention strategies

o Increase access to Naloxone 19

Section 298 Initiative

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Boilerplate Language in Fiscal Year 2017 Appropriations Act

“The department shall work with a workgroup to make recommendations regarding the most effective financing model and policies for behavioral health services to improve the coordination of behavioral and physical health services for individuals with mental illnesses, intellectual and developmental disabilities and substance use disorders.”


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Time Period Event or Activity

February 2016 Executive Budget Proposal

March 2016 – June 2016 Lieutenant Governor’s Workgroup

July 2016 Creation of 298 Facilitation Workgroup

September 2016 – November 2016 Affinity Group Process

November 2016 – December 2016 Development of Policy Recommendations

January 2017 Submission of Interim Report

January 2017 – February 2017 Financing Model Proposal Process

February 2017 – March 2017 Development of Financing Model Recommendations

March 2017 Submission of Final Report

March 2017 – Present Legislative Discussion of Report


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Components of the Final Report• 70 Policy Recommendations• 6 Financing Model Recommendations• Benchmarks for Implementation (a.k.a. Performance Metrics)• Transition Plan (a.k.a. High‐Level Process Map)


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Themes from the Section 298 Final Report• Improve the coordination of physical health and behavioral health services• Increase the availability of resources at the service delivery level• Achieve greater uniformity in access to services on a statewide basis• Strengthen the consistency of policies and procedures across the system• Encourage innovation and collaboration in service delivery at the local

level• Ensure transparency and accountability to local communities and the

greater public


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Ongoing Process• The legislature is considering different financing models as part of the

appropriations process.• House Proposal• Senate Proposal• Conference Committee

• The Department is also reviewing and evaluating the 70 policy recommendations to identify potential next steps for policy changes.

Overview

• Healthcare Workforce

• Certificate of Need

• Pathways to Potential

• Central Grants Management

Planning & Program Development

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• Increasing the Healthcare Workforce

o Provides state loan repayment for primary care providers located in underserved areas of Michigan

o Supports the recruitment and retention of international medical graduates

• Ensuring Access to Services Meets Demand

o Supports the development of community health centers

o Provides federal funds to Michigan’s free clinics

• Creating Health Planning Tools

o Designation and re-designation of healthcare shortage areas

o Identifies characteristics of the uninsured in Michigan

o Disseminates the annual County Health Rankings

Healthcare Workforce

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Health Professionals currently receiving federal or state loan repayment or other benefits for serving in health professional shortage areas as supported by MDHHS

International medical graduates able to serve MI citizens through the J1 Visa waiver as recommended by MDHHS

Federally Qualified Health Centers and Community Health Centers, rural health clinics, school based clinics new or expanded this year with support from MDHHS

Free clinics, providing care to residents that have no means to pay, that receive support from MDHHS

609

86

18

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Healthcare Workforce

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Healthcare WorkforceFocus: State Loan Repayment Program (SLRP)

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Incentivizes Recruitment & Retention of Primary Care Providers in Underserved Areas

• Repays up to $200,000 in medical education debt for eight years of service

• In 2016, SLRP targeted strengthening the primary care workforce in Genesee County by awarding loan repayment to 11 primary care providers in Flint, MI

• In 2017, SLRP will continue to focus on retaining Genesee County providers, and will focus on recruiting Inpatient Child/Adolescent Psychiatrists, which are in a critically short supply in Michigan

Healthcare WorkforceFocus: State Loan Repayment Program (SLRP) placements FY13-17

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65 MSLRP Provider awarded in 2017188 MSLRP Provider awarded 2013‐16

Certificate of Need

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Promotes the availability and accessibility of quality health care services

• The Certificate of Need Commission establishes standards for 15 types of health care services and equipment including hospital beds & nursing home beds

• Certificate of Need approval is needed to initiate, replace or relocate any of the covered services or equipment

• Strives to balance cost, quality and access of Michigan’s healthcare services

Michigan Certificate of NeedQuick Statistics FY16

Letters of Intent received

Applications filed

Projects approved

Facilities surveyed and data collected to gauge compliance

442

320

303

1,137

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Pathways to Potential

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• Pathways to Potential targets five outcome areas: attendance, education, health, safety and self-sufficiency

• Provides centrally located services with a network of supports and community coordinated services to create a positive impact on students and families

• Success Coaches placed in a school to meet with students and families to identify and remover barriers and to connect to a network of available services

• Pathways to Potential started in 2012 with 124 schools participating. Currently, Pathways to Potential has expanded to 259 schools in 34 counties

• At the end of the 2014-2015 school year, there was a reduction in chronic absenteeism of 37.23% in the 219 Pathways schools


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Pathways to Potential Success Coaches are Serving Families

in 259 School Statewide

Pathways to PotentialQuick Statistics FY16

Interactions Pathways to Potential Success Coaches had with or on behalf of students in Michigan

Barriers to academic success identified by Pathways to Potential Success Coaches

Referrals, resources or follow‐up initiated by Pathways to Potential Success Coaches

Interactions where the primary purpose was to address attendance issues

73,930

168,780

86,952

26,228

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Strategic Goals for 2017

• Maintain a continuous decrease in chronic absenteeism by 10% since the school begins participation

• Measure and monitor the overall success of program through student engagement

• Expand to more rural areas

• Partner with districts and the Michigan Department of Education to create and collect more meaningful metrics

• Increase connections with community partners to provide services and donations

Central Grants Management

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Goal: Ensure all grant funds are coordinated to meet the Department’s mission.

• Builds upon a process improvement initiative

• Streamlines Department approvals and internal communication

• Assists programs in finding new funding sources

• Acts as a liaison between all areas of the Department to link similar programs together

Michigan Rehabilitation ServicesOverview

• Michigan Rehabilitation Services partners with individuals and employers to achieve employment outcomes and independence for individuals with disabilities

• Serves applicants seeking employment by providing individual counseling based on individual experience, abilities, functional limitation, and the essential functions of a specific job

• Services business customers in providing expertise and resources to help locate, match, and accommodate employees with disabilities

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MRS performance data FY15Performance Measures Federal Standards MRS Performance

Number Employment Outcomes

Michigan Benchmark = 6,695

6,821

Percent Employed >55.8% 59.6%

Employed Competitively >72.6% 94.8%

Significantly Disabled >62.4% 81.2%

Earnings Ratio >0.52 0.6

Self‐Support >53.0% 70.4%

Minority Ratio >0.80 0.84

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Michigan Rehabilitation Services

Bureau of Community Services

Overview

• Housing and Homeless Services

• Crime Victims Services Programs

• Michigan Domestic and Sexual Violence Prevention and Treatment Board

• Community Action Agencies (CAAs)

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Housing and Homeless ServicesFY16 Outcomes

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Provided 827,056 bed nights of emergency shelter or motel

Assisted 35,463

people with housing assistance

Delivered permanent housing to 10,564 people

Crime Victim Compensation

Last resort for unpaid medical bills, loss of earnings, burial costs, counseling needs

The Sexual Assault Forensic Exam Program, also known as S.A.F.E. Response, allows sexual

assault victims to receive a forensic exam at no cost.

Crime Victim Assistance

Federal pass‐through dollars to local public and

non‐profit agencies engaging in direct services

to victims of crime through a competitive

grant process

Crime Victim Rights and Assessment

Revenue

Restricted funding to support Crime Victims Rights

ActivitiesFunds Prosecuting Attorneys

and Juvenile CourtsSupports mandatory

notification rights of crime victims including the

Michigan Crime Victims Notification Network

Provides advocate training to better assist victims

Crime Victims Services Programs

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Contracts, Partnerships & Funding

$19.03 million funding for local domestic/sexual violence and child advocacy services awarded in almost 180 contracts

Manage funds from 17 different Federal/State funding sources

Statewide partnerships with the Attorney General, Michigan Commission on Law Enforcement Standards, Prosecuting Attorney’s Association of Michigan and the Michigan Coalition to End Domestic/Sexual Violence

Client Services Provided in FY 2016

273,399 Emergency Shelter Nights

9,949 Adults/Children were provided Emergency Shelter

2,139 Adults/Children received SANE services

8,411 Children received forensic interviews

84,289 Domestic violence and 10,198 sexual assault crisis calls

23,614 Adults/Children were provided non‐residential counseling

Key Initiatives in 2016Michigan Sexual Assault Evidence Kit Tracking and Reporting Commission

MiTEAM DV/Enhancement Safe and Together Model Training

Staff support for:Campus Sexual Assault and Title IXDetroit Sexual Assault Kit SummitMultiple OVW TrainingsFirst Lady of Michigan’s Campus Sexual Assault Summit

Michigan Domestic and Sexual Violence Prevention and Treatment Board

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Community Action Agencies (CAAs)

53,223children

56,727seniors

6,724deliverable fuel

assistance

1,573weatherized

units

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Summary of services and a sample of the populations served by Michigan CAAs included:

201,864 low‐income individuals

Human TraffickingHuman Trafficking Health Advisory Board

• Created in 2014

• Includes mental health professionals, child trauma specialists, ER nurses, physicians, hospitalists, and survivors

• Mission:

• Coordinate the sharing of information about health services available to survivors of trafficking in Michigan

• Partner with local health agencies to improve health services for survivors

• Improve the awareness, education, and training of health professionals about the issue of human trafficking

• Make recommendations to the legislature to improve state laws and rules related to health services for survivors

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Human TraffickingOther Related Projects

• 2016 Statewide Public Awareness Campaign

• Targeted ads and materials in airports, buses, malls, and doctors offices across the state

• Human Trafficking Emergency Room Protocol Pilot

• Grant with Genesys Health in Genesee Co. to develop and implement an emergency room protocol for identifying, treating, and connecting victims of trafficking with community resources

• Four health systems are participating in the pilot (Genesys, Hurley, St. Mary’s Standish, & St. Joseph)

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25 Most Common Diagnoses for ED Visits for High Utilizers (All Diagnoses)April 2014 – March 2015 Uses All Header‐Level Diagnosis Codes V‐Codes Not Included Number of Visits Diagnosis Code Long Description 162,595 3051 Tobacco use disorder 122,855 4019 Unspecified essential hypertension 60,737 25000 Diabetes mellitus w/out mention of complication, type II or unspecified, not stated as uncontrolled 55,786 30000 Anxiety state, unspecified 53,333 49390 Asthma, unspecified type, unspecified 49,486 78900 Abdominal pain, unspecified site 49,090 33829 Other chronic pain 47,558 53081 Esophageal reflux 46,967 311 Depressive disorder, not elsewhere classified 41,545 7840 Headache 40,380 78650 Chest pain, unspecified 37,240 7862 Cough 35,930 7245 Backache, unspecified 35,612 78701 Nausea with vomiting 32,394 78909 Abdominal pain, other specified site 30,030 7295 Pain in limb 29,692 2724 Other and unspecified hyperlipidemia 27,181 29680 Bipolar disorder, unspecified 26,797 7242 Lumbago 26,189 5990 Urinary tract infection, site not specified 26,009 496 Chronic airway obstruction, not elsewhere classified 23,698 78605 Shortness of breath 23,145 4280 Congestive heart failure, unspecified 22,258 33819 Other acute pain 20,557 34590 Epilepsy, unspecified, without mention of intractable epilepsy 47

High and Super High Utilizers

Number of ED Visits % of High Utilizers

5 ‐ 9 80.08%

10 ‐ 14 11.97% Total High Utilizers 67,634

15 ‐ 19 3.85% Total Super High Utilizers 2,770

20 ‐ 39 3.30%

40 ‐ 99 0.73%

100+ 0.07%

Number of ED Visits by High Utilizers

100+ 0.07%

40 ‐ 99 0.73%

20 ‐ 39 3.30%

15 ‐ 19 3.85%

10 ‐ 14 11.94%

5 ‐ 9 80.08%

*High Utilizer definition: 5 or more ED visits and 6 or more months of continuous Medicaid coverage between April 2014 and March 2015

*Super High Utilizer definition: Same criteria as High Utilizer, but with 20 or more ED visits

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High and Super High Utilizers

High Utilizer Super High Utilizer

Has MH Diagnosis 70.09% 96.39%

No MH Diagnosis 29.91% 3.61%

Percentage With at Least One Mental Health

Diagnosis on an ED Claim or Encounter, by Utilization

Category

High Utilizer Super High Utilizer

70.09% 96.39%

Note: Includes those that had at least one claim of encounter with some diagnosis involving mental health 49

Super High Utilizers and High UtilizersSuper High Utilizers High Utilizers Overall

In Managed Care 75.13% 75.32% 75.17%In Healthy Michigan Plan 24.37% 20.84% 27.64%PIHP Contact 49.86% 29.56% 8.65%In MIChoice During Year 1.16% 1.52% 0.52%Were Pregnant During Year 3.39% 7.43% 2.81%In NF During Year 3.75% 3.23% 1.69%

Other Characteristics Among Categories

80.00%70.00%60.00%50.00%40.00%30.00%20.00%10.00%0.00%

In Managed Care In Health

Michigan Plan

PIHP Contact

In MIChoice During Year

Were Pregnant During Year

In NF During Year

Super High Utilizers High Utilizers Overall50

Policy, Planning and Legislative Services Senior Deputy Director: Matt LoriPhone: (517) 241-4040Website: http://www.michigan.gov/mdhhsLegislative Service Bureau: http://www.legislature.mi.gov/(S(n4rbq4jwj2dfwz1qybtu01cu))/mileg.aspx?page=home

MDHHS Contact Info and Useful Links

Documents

Policy, Planning & Legislative ServicesPolicy, Planning & Legislative Services Presentation to the 43rdAnnual MARO Spring Leadership Conference Wednesday, June 7, 2017 Matt Lori, Senior