2018 Annual Report

Michigan Primary Care Transformation (MiPCT) Demonstration

Michigan was an early adopter of PCMH models to make high-quality primary care accessible throughout the state. MiPCT, the first multi-payer PCMH program in Michigan, was the largest participant in the national Multi-Payer Advanced Primary Care Program. MiPCT operated from January 2012 to December 2016. MPHI was the state selected evaluator for MiPCT and in 2018 finalized a deep dive into the Medicaid data, analyzing five years of encounter data on over 500,000 beneficiaries served by over 1,000 primary care practices. MPHI’s analysis was especially important because it included Medicaid patient data. To date, few rigorous and large-scale evaluations of multi-payer PCMHs have included Medicaid patients in their analysis; although future evaluations of State Innovation Model (SIM) demonstrations will focus on Medicaid.

The study results among high-risk adults suggest that MiPCT was effective at reducing costs and inpatient hospitalizations while maintaining quality. The MiPCT Medicaid general adult population also started to see cost and hospital utilization reductions in 2015. In addition, MiPCT was equivalent to or better than comparison groups on most pediatric quality metrics across years (although the differences were narrowing over time).

MPBH is aligned with MPHI’s core values, as it seeks to eliminate social barriers to health care as well as providing education on managing chronic health conditions. Not only were clients provided with highly valued services, there was a reduction in medical expenditures on healthcare costs, such as hospitalization. Overall, these savings covered the cost of the intervention for net cost neutrality. Study results may be used to inform future strategies, particularly those related to the impact of social determinants of health on client experience and health care utilization and spending.

The application also provides for a publicly available Lead Information Registry, which empowers the public to search for lead hazard information for rental properties that have been investigated or abated. MICLEAR adds transparency and enables renters to feel confident that they are keeping themselves and their families safe.

In 2018, the MICLEAR project was able to complete integration with MILogin (the State of Michigan's single sign-on application). MILogin integration increases application security and enables partner communities to access the application form without being on the State of Michigan’s network. Our work with MDHHS on the MICLEAR project directly impacts and protects Michigan residents against the threat of lead in their homes. MPHI has partnered with MDHHS for over 25 years on multiple technology-based projects. We work closely with the Department to design, develop, implement, and help manage solutions that work with MDHHS' technical infrastructure.

MPHI worked with MDHHS to design, build, and test the MIDAP application. MIDAP is integrated with MILogin to provide single sign-on and is hosted at the State of Michigan. The system manages new applications, six-month renewals, and annual recertifications for over 2,500 program participants. The online system replaced a paper application process, streamlining application processing from an average of 12 days down to three days. Additionally, the on-time processing (14 business days) of applications has risen from 90% to 99%. Applicants have fewer lapses in coverage and incomplete applications are more quickly processed.

A presentation about the MIDAP system was delivered by MDHHS staff at the National Ryan White Conference on HIV Care and Treatment in Washington, D.C., in December 2018. MPHI and MDHHS continue to work collaboratively to support and enhance the system and respond to feedback from users and applicants.

MPHI also serves as the national technical assistance provider for 19 cities across the US as part of the BUILD Health Challenge. BUILD Health Challenge is a national program focused on increasing health equity for underserved populations by strengthening partnerships between community-based organizations, hospitals and health systems, local health departments, and others.

The Guy Thompson Parent Advisory Council

In the spring of 2018, MPHI's Center for Health Equity Practice (CHEP) partnered with MDHHS in the development, implementation, and coordination of the Guy Thompson Parent Advisory Council (GTPAC) for Child Protective Services (CPS) policy. The GTPAC is a statewide council comprised of birth parents who have participated in services within the Child Welfare System. The goal is for GTPAC members to use their experiences and provide input regarding child welfare programs and policies. The development of the GTPAC consisted of working with MDHHS to create the purpose for the council, membership requirements, a recruitment process, and plan for the 2019 year. We facilitated the implementation and coordination of the council meetings. As part of the project, MPHI provides reimbursement to council members for their time, travel, and childcare. The GTPAC also has provided support for members to represent themselves and the council in outside opportunities throughout the state to ensure the inclusion of the voices of birth parents. The council sponsors members to participate in the Parents Partnering for Change Training, a two-day leadership training. Currently, the council includes 23 members and will meet quarterly in 2019 to continue their work.

Parent Leadership in State Government

MPHI's Parent Leadership in State Government (PLISG) initiative provides training and support to a diverse group of parents, helping them become more effective advocates who can use their own experiences and voices to impact program planning and policy development. Parents participate in trainings that provide them with the skills to serve on advisory boards, committees, and other decision-making bodies. PLISG utilized a Michigan density map to represent the locations of trainings since 2008 to inform the recruitment process and target Michigan residents who were not traditional participants in past trainings. Outreach to diversify training participants included partnering with local and community-based organizations. MPHI’s targeted efforts increased participation of Black or African American participants from 13.6% in 2017 to 49% in 2018. Additionally, MPHI’s recruitment approach doubled the number of fathers trained from 10% in 2017 to 20% in 2018.

MPHI delivers the most current capabilities in online training, including continuing education and skill building options, allowing WIC to gain efficiency and maintain compliance without having to take on the financial and administrative burden of managing these processes. We work closely with WIC staff to ensure that we meet needs in real time.

In addition, MPHI supports WIC Division education, training, evaluation activities, subcontractor administration, technical assistance, and programmatic initiatives. The scope of our work is inclusive to all facets of WIC operations with the State of Michigan, WIC Division and its contractual relationships within the state.

During 2018, MPHI partnered with WIC on 51 educational trainings, 13 online courses, and the annual WIC Training and Educational Conference. A total of 2,455 participants across the state attended these activities, earning a total of 1,389 hours of continuing education in the areas of Nursing and Lactation Consultants.

MPHI's Quality Improvement (QI) Train-the-Trainer Workshop and Accreditation Readiness Mini-Grants help support a robust public health infrastructure in Michigan. Beginning in 2016, MPHI and MDHHS partnered to convene public health practitioners from state, local, and tribal public health agencies for QI Train-the-Trainer Workshops. These three-day workshops are provided at no cost for participants and are based on MPHI's Embracing Quality in Public Health: A Practitioner's Quality Improvement Curriculum Guide. Nearly 100 public health practitioners in Michigan have completed the workshop.

MPHI also administers a $10,000 Accreditation Readiness Mini-Grant and has awarded 16 mini-grants to local health departments in the past five years. In 2017, five health departments joined together to use mini-grant funding to support spreading QI capacity throughout each agency. Participants used what they learned in the Train-the-Trainer Workshop to lead groups of staff at each participating health department through QI projects, improving the efficiency and effectiveness of their processes.

By creating solutions that leverage our resources, relationships, and unparalleled public health perspective, our partnerships with local public health departments enable them to focus on the health and well-being of the communities they serve.

MPHI’s strong partnership with MDHHS has allowed for the increased sharing of critical knowledge across the state and throughout the nation. The MPHI Child Death Review process serves as the national model, replicated by many states.

MPHI’s expertise extends to the National Center for Fatality Review and Prevention, a national resource and data center for Fetal and Infant Mortality Review and Child Death Review - part of MPHI’s Center for National Prevention Initiatives.

MPHI also houses one of Michigan’s Citizen Review Panels (CRP) and hosted the annual, National CRP Conference in 2018, bringing together volunteer members, staff, and child welfare employees from across the nation to engage in a national dialogue on the mechanics of implementing the congressional mandate, discuss challenges and opportunities, and exchange best practices.