MPHI Annual Report - Systems Transformation

Advancing a Culture of Quality in Public Health & Human Service Agencies

With a vision for improved quality, the Michigan Department of Health and Human Services (MDHHS), MPHI, and partners began the process of statewide accreditation for Michigan’s local public health departments in 1998. MPHI has played an important role in the Michigan Local Public Health Accreditation Program (MLPHAP) since the beginning, coordinating operations, collecting and analyzing data, and supporting program improvements.

In 2005, MDHHS and MPHI built on the MLPHAP experience through the Robert Wood Johnson Foundation-funded “Multi-State Learning Collaborative” (MLC), continuing to build a culture of quality in Michigan’s public health system and contributing to national public health accreditation efforts. MPHI gained experience and expertise in quality improvement through the MLC, and has built on this work through numerous projects in Michigan and across the nation.

Our aim is to continue to support the use of quality improvement methodology and build greater capacity for public health agencies to meet national accreditation standards for quality. Our trained and experienced staff are dedicated to working with public health agencies and other organizations to help them implement best practices in accreditation and quality improvement, and to translate research into practice through training, technical assistance, coaching, and project consultation and management.

MPHI is currently supporting quality improvement efforts in public health and human service agencies.

Coordinating quality improvement efforts with Home Visiting programs in Michigan and nationally
- In Michigan, MPHI has worked with MDHHS to convene quality improvement learning collaboratives of local Home Visiting programs, which are designed to support use of quality improvement
- Additionally, MPHI provides training workshops and coaching to facilitate completion of Plan-Do-Study-Act cycles for Home Visiting programs in the state and across the nation.
Supporting improvement of early childhood outcomes through work with Michigan’s Early Childhood Comprehensive Systems grant and the Great Start to Quality initiative, providing quality improvement training and ongoing coaching
Facilitating quality improvement projects in collaboration with Tribal Health Centers in Michigan, with the aim of increasing breast and colorectal cancer-screening rates and completed referrals for health and human services
Working with the MDHHS Office of Performance Improvement and Management to increase quality improvement capacity in the state’s public health system by facilitating projects with MDHHS programs, providing technical assistance at no cost to local and Tribal public health departments, and coordinating a mini-grant program to support local and Tribal efforts to meet national standards for public health
Working with the Local Lead Collaborative, including four local health departments in southeast Michigan, completing quality improvement efforts to address lead poisoning from non-paint sources
Providing training in quality improvement at Michigan’s Premier Public Health Conference
Working with state, local, and Tribal health and human service agencies to support their quality improvement efforts

Supporting Healthy Families and Babies

“Home visiting” is a prevention strategy that supports effective parenting and the healthy development of children. The federal Health Resources and Services Administration and the Administration for Children and Families developed the “Maternal Infant and Early Childhood Home Visiting Program” in 2010.

All home visiting models connect expectant parents or parents of young children with a professional or paraprofessional home visitor, who provides parents with education, builds family support systems, and creates connections to services. Home visiting can achieve positive outcomes that can impact a child’s life course, including improved health and development, prevention of abuse and neglect, and improved school readiness.

MPHI has supported Michigan’s program in many ways over several years including:

Benchmark data collection and reporting; quality improvement; evaluation
Expanding staff capacity
Event business planning and continuing education services
Webcasting and virtual meeting support
Database development

Benchmark Data Collection and Reporting; Quality Improvement; Evaluation

The Home Visiting program reports performance in six benchmark areas.

Maternal and newborn health
Child injuries and maltreatment and reduction in emergency department use
School readiness and achievement
Crime or domestic violence
Economic self sufficiency
Coordination and referrals for other community services and supports

Benchmark data are used to monitor performance and ensure quality at federal, state, and local levels. MPHI supports this process from the point of defining measures through data collection, analysis, and reporting.

Continuous Quality Improvement

To ensure improvement in each benchmark area, as well as the quality of the program, MPHI developed Michigan’s Continuous Quality Improvement (CQI) plan. Staff provide QI training, coordinate learning collaboratives, host quarterly virtual QI webinars, offer a QI advisor to each local program, generate quarterly CQI data reports for state and local teams, facilitate CQI projects, and support national CQI initiatives.

Evaluation Research

MPHI designed and implemented two studies of strategies to improve the quality of the program. The first was an evaluation study of the learning collaborative model as a mechanism to improve program implementation. The second, which is currently in progress, is a validation study of Michigan’s Home Visiting Quality Assurance System.

Expand Staff Capacity

MPHI employees supplement the state’s Home Visiting staff; they provide technical assistance and training across models, create communication networks, and provide updates to the field.

Event Business Planning and Continuing Education Services

Since September 2014, MPHI has planned and implemented 11 instructor-led trainings and a 600+ person, two-day Home Visiting Conference.

Over the past 18 months, the trainings have provided current evidence-based best practices to 884 home visitors through skill-building sessions that support their professional development. Our Continuing Education Solutions unit awarded continuing education credit hours to 189 nursing professionals, 97 social workers, and nine teachers. Topics included substance abuse assessment, domestic violence awareness and prevention, motivational interviewing techniques and theory, health equity and social justice concepts, and infant safety topics.
The conference provided information on home visiting models and included topical sessions, including: reflective practice, Collaborative Improvement & Innovation Network1 (CoIIN) panels, domestic violence awareness, substance abuse prevention, trauma-informed care, retention techniques, parental involvement, home visitor compassion fatigue, engagement strategies, data study techniques, mandated reporting, breastfeeding updates, teen parent topics, building healthy homes, and much more.

Webcasting and Virtual Meeting Support

MPHI recorded the Home Visiting Conference and hosts a rich-media webcast recording of the event, which is available on demand, 24-7. MPHI also provides support for virtual meetings to allow those who cannot be present in person to virtually connect to the meeting from their location. Audio and video technology is integrated throughout MPHI’s conference center to replicate meeting dynamics.

Database Development

MPHI also developed Michigan’s Home Visiting website, www.mihomevisiting.com , which allows families to search for programs and local implementing agencies to maintain information on the site. We also developed the Michigan Home Visiting Provider Portal, https://www.mihomevisiting.org , which provides information for grantees, program and provider information, and “learning communities.”

Keeping Patients Engaged and Healthy

MPHI is working with Michigan’s Medicaid program to develop a Consumer Engagement Plan that is focused on increasing consumer involvement in their own health by using health information technology (HIT). Both organizations are collaborating with state and national partners to assess the current consumer engagement landscape, research engagement strategies, and determine consumer attitudes.

When patients have access to treatment plans, tools to help them make better choices, and a strong understanding of their health needs, health outcomes improve and health costs decrease. With the majority of Americans owning smartphones or other Internet-enabled devices, mobile and web-based technology can give health care providers the opportunity to engage patients in a format that is comfortable, efficient, and convenient.

With Michigan’s Medicaid program, MPHI is utilizing multiple strategies to leverage HIT to keep the public informed, engaged, and healthy.

Beginning in 2013, MPHI hosted Michigan’s first series of consumer engagement stakeholder meetings, during which HIT experts, state government leaders, consumer group representatives, and provider groups worked with analysts to identify ways HIT can be used to promote patient engagement.
Throughout 2014, staff worked with providers to better understand what they need to engage their patients in health.
Currently, MPHI is conducting a survey with Medicaid and Healthy Michigan Plan beneficiaries to learn about technology habits, their engagement in health, and how they would like to be engaged by providers. We are also creating partnerships with additional stakeholders who have direct access to the Medicaid population, including federally qualified health centers, local public health departments, and parks and recreation organizations.

In the future, MPHI will continue to advise partners at the Michigan Department of Health and Human Services on innovative and practical HIT-based consumer engagement strategies. For more information, visit www.MiEngagement.org .

Testing Michigan’s “Blueprint for Health Innovation”

Michigan is receiving $70 million in federal funding from 2015-2019 to support innovative health care system enhancements that benefit families. The U.S. Department of Health and Human Services is funding the testing of Michigan’s “Blueprint for Health Innovation,” a plan that is guiding the state as it pursues better coordination of care, lower costs, and improved health outcomes. Special attention is being paid to building linkages to safety-net settings, integrating primary care and behavioral health, engaging populations, promoting person-centered care, reducing population health risks, and coordinating human services and health care to address social determinants. The blueprint calls for prioritizing improvement efforts for three target populations: at-risk pregnant women, high utilizers of emergency departments, and people with multiple chronic conditions.

The funding supports multi-payer payment and health care delivery system transformation to improve health system performance and reduce costs. The model also recognizes that better health requires a comprehensive approach involving safe and healthy communities, workplaces, homes, and lifestyles. Efforts are concentrated on establishing effective Accountable Systems of Care and Community Health Innovation Regions that advance these goals, as described in the Blueprint.

MPHI previously assisted the state in developing the blueprint by engaging partners, convening workgroups, helping to identify common ground, and supporting drafting of the document. MPHI continues to support the state in project implementation, which includes developing program materials and supporting participating Accountable Systems of Care and Community Health Innovation Regions in achieving success.

Helping Michigan’s Women, Infants and Children

MPHI has provided services for the Michigan Department of Health and Human Services’ (MDHHS) “Women, Infants and Children” (WIC) program since 1998. WIC provides nutritional education and counseling, supplemental food, referrals, and breastfeeding promotion to more than 240,000 families each month; 90% of these families live below the 150% federal poverty level.

MPHI's Services to WIC over 17 Years

Developing and evaluating training needs assessments
Providing continuing education (CE) administration services for professionals in local agencies; awarding CE certificates to nurses, lactation consultants, and social workers
Developing and managing WIC’s Training & Resources website, which is housed at MPHI
Managing the online registration portal for registrants of educational programs
Planning and coordinating logistics for educational programs for more than 1,000 WIC local agency staff annually
Developing online web-based training modules
Providing a technical assistance/customer service line for users of WIC’s electronic benefits transfer system
Providing financial and contractual support for the WIC Administration and Nutrition project
Providing 18 kick-off and skills-development trainings in 2015 to support a focus on client-centered care and roll-out of the program’s brand, Client Centered Services (supported by a USDA Operation Adjustment Grant); the next phase will involve mentorship training and supports

Every WIC dollar spent on a pregnant woman saves over $3.50 in federal, state, local and private health care costs.
Source: WIC and the Nutrient Intake of Children, Victor Olivera and C. Gunderson, FRED, ERC, USDA, FANRR #5. March, 2000

53% of babies born in Michigan are enrolled in WIC

Source: Michigan Department of Health & Human Services

Benefits to Families for Participating in WIC

The program has a positive effect on pregnancy outcomes and child growth and development.

Support and duration of breastfeeding – 63.6% of infants are breastfed
Increase in the number of women receiving adequate prenatal care
Lower infant mortality among Medicaid beneficiaries
Improvement in pregnant and postpartum women’s dietary intake
Decrease in the incidence of low birth weight and pre-term births
Lower rates of anemia among children ages six months to five years
Improvement in children’s intake of vitamins and nutrients, without an adverse effect on fat or cholesterol, through the WIC Food Package and WIC Project FRESH; Project FRESH provides produce from Michigan’s farmers markets to low-income consumers who are nutritionally at risk
Better vocabulary and digit memory scores in four and five year olds who participate in WIC in early childhood
Improvement in rates of immunization against childhood diseases, through collaboration and coordination with the MDHHS Immunization Program

WIC’s Five-Year Goals

It is MPHI’s aim to continue to partner with WIC as they work toward the following goals.

Increase first trimester entry into the WIC program from 36.9% to 42.0%
Increase ideal prenatal weight gain from 30.7% to 33.5%
Reduce the percent of low-birth-weight infants born to women enrolled in Michigan WIC from 8.7% to 8.0%
Increase breastfeeding initiation rate from 63.1% to 67.0% and the six-month duration rate from 17.7% to 20.5%
Decrease the prevalence of early childhood obesity in children aged 2-5 from 14.1% to 13.5%
Decrease the prevalence of low hemoglobin level from 17.5% to 15.0% among children younger than 5 years old

Project Categories

Systems Transformation

Advancing a Culture of Quality in Public Health & Human Service Agencies

Supporting Healthy Families and Babies

Supporting Coordination of Care

Keeping Patients Engaged and Healthy

Testing Michigan’s “Blueprint for Health Innovation”

Helping Michigan’s Women, Infants and Children