Washtenaw Health Initiative

STATEMENT OF ORGANIZATIONAL AND OPERATIONAL PRINCIPLES

TITLE

The name of the organization is the Washtenaw Health Initiative (WHI).  WHI is a voluntary collaboration among more than 175 cross-sector individual and organizational stakeholders, co-sponsored by Michigan Medicine and St. Joseph Mercy Health System. WHI is hosted by the Center for Healthcare Research & Transformation (CHRT). CHRT and WHI are independent organizations working together to improve health and health care delivery in the community.

MISSION

The mission of the WHI is to improve health and healthcare in Washtenaw County with an emphasis on the low income, uninsured and underinsured[1] populations.

The WHI brings together organizations to:

  • Generate innovative ideas to improve health and healthcare in the county
  • Identify and share information on gaps and opportunities
  • Coordinate and leverage resources
  • Provide strategic planning and direction

SCOPE

WHI projects meet all of the following criteria:

  • Addresses an identified gap or unmet need;
  • Has a primary need for planning and/or strategic direction;
  • Requires multi-organization coordination and/or effort;
  • Is not in the purview of another entity or where that entity requests WHI leadership;
  • Where possible, has clearly defined program goals or outcome measures;
  • Aligns with the goals of the WHI, listed below.

ORGANIZING PRINCIPLES

In all of its activities, WHI adopts the following guiding principles.  WHI is:

  • A voluntary collaboration of cross-sector stakeholders;
  • Non-operational: WHI does not operate any programs, but supports organizations by convening, coordinating, and assisting the development of worthy ideas and initiatives;
  • Non-regulatory;
  • Non-funding: WHI does not directly fund programs, but assists in assessing financial credibility of programs, if asked, and assists in seeking funding for programs that meet WHI criteria.

GOALS[2]

With a primary focus on the low income, uninsured, and underinsured people within Washtenaw County, WHI, working in collaboration with the Stakeholders Group and other community organizations, will work to:

  1. Increase insurance coverage of uninsured individuals.
  2. Help those with Medicaid coverage and/or those who are underinsured maintain that coverage, understand it, use it more effectively, and/or find access to care.
  3. Improve coordination and integration for health care services.
  4. Align entities engaged in delivery of health-related services to more efficiently and effectively utilize resources.
  5. Strengthen community wide efforts to improve care and services for mental health and other select health issues and/or select populations.
  6. Strengthen community-wide efforts to improve health equity by working closely with Washtenaw County Public Health.
  7. Connect community resources to health care organizations and to each other.
  8. Explore opportunities to partner with Livingston County partners.

APPROACH AND ORGANIZATIONAL STRUCTURE

The WHI takes a collective impact approach to improving health and healthcare in Washtenaw County, with a special emphasis on the low income, uninsured and underinsured populations.  WHI members work together on specific projects and functions with a long-term commitment to a common agenda, shared measures of success, and effective community engagement strategies.

For example, WHI also serves as the governing body for the State Innovation Model (SIM) project—a joint federal-State funded project covering Washtenaw and Livingston counties—to develop new pathways linking residents/patients to clinical care and social services interventions. The SIM’s goal is to address the social determinants of health, with an initial focus on emergency department utilization.

The WHI is not a separate legal entity, but it has an organizational structure with clearly defined roles. Three major groups, the Steering Committee, Stakeholders Group, and Work Group, are involved in carrying out the WHI’s work.

  • The Steering Committee provides strategic oversight and sets program priorities.
  • The Stakeholders Group consists of local individuals, community-based organizations, and governmental agencies that share WHI’s mission and goals.
  • Various Work Groups, organized around themes to improve health and health care, implement WHI’s strategic vision.

LEADERSHIP AND MEMBERSHIP PROCESSES

As a voluntary organization, WHI does not have a formal, legal structure in place. But it has developed a process for selecting members to serve on WHI’s key components and how the components work together. Since its inception, WHI’s structure has included the Steering Committee, the Stakeholders Group, and the Work Groups. Acting as a catalyst under a Memorandum of Understanding, the Center for Healthcare Research & Transformation (CHRT), provides expert administrative, operational, and analytical support to WHI, coordinated by the WHI Project Manager.

A Memorandum of Understanding between CHRT and WHI outlines a process that will ensure continuity while simultaneously allowing WHI to evolve naturally to effectively represent the community and our constituent membership.  To facilitate WHI’s sustainability, it is important to solicit feedback and support from our members in all facets of WHI’s activites. In keeping with WHI’s commitment to inclusiveness, the entire process will be based on consensus to the extent possible rather than a formal voting process.

The Steering Committee

The Steering Committee provides strategic oversight and sets program priorities. Every three years, the Steering Committee will assess what, if any, changes need to be made to Steering Committee membership. In addition, the Steering Committee will also review the structure and composition of the WHI overall. The Steering Committee consists of no more than 22 members divided into two groups, Organizational and Community members. The groups are not required to be equal in size. The Steering Committee Roles tables below show the proposed arrangement.

Organizational Members.  One group consists of members representing, at present, eight specific organizations that remain essential to WHI’s mission.  For this group, the organization will designate its Steering Committee representative, who will serve until the organization chooses to select another representative.

This process allows the Steering Committee to adjust for changes in which organizations are designated as permanent members.  As WHI’s initiatives change over time, new organizations may become increasingly integral to Steering Committee activities.  When that occurs, the Steering Committee may add an organization or replace an organization whose emphasis may have shifted away from WHI’s mission.

Community Members.  The second group consists of community-based members who will represent sectors with many organizations that could contribute to the Steering Committee, such as the business and philanthropic sectors.  Thus, these members will serve rotating, three-year terms, renewable up to three times.  Currently, there are nine community-based representatives—some members unaffiliated with a specific organization, one academic member, one business community member, a religious-affiliated member, and one member representing a local philanthropy.  In this category, we anticipate having at least five members from the community, including local businesses.  To recruit community-based members, the Steering Committee will consult with the Stakeholders Group to ensure a collaborative process in identifying WHI’s leadership.

 

Steering Committee Roles

Organizational Positions

Organizational Role Current Member Current Member Title & Organization
1.     Community Mental Health Director Trish Cortes Director, Washtenaw Community Mental Health
2.     IHA Representative Marti Walsh Chief Quality and Population Health Officer, Integrated Health Associates
3.     Livingston County Representative Connie Conklin Community Mental Health Services of Livingston County
4.     Washtenaw County Public Health Department Director Ellen Rabinowitz Public Health Officer, Washtenaw County Public Health; Executive Director, Washtenaw Health Plan
5.     SJMHS-Ann Arbor Executive David Brooks President and Chief Executive Officer, St. Joseph Mercy Ann Arbor and Livingston
6.     SJMHS-Ann Arbor Clinical Rosalie Tocco-Bradley Chief Medical Officer, St. Joseph Mercy Ann Arbor and Livingston
7.     SJMHS-Chelsea Executive Nancy Graebner President and Chief Executive Officer, St. Joseph Mercy Chelsea
8.     UMHS Executive Tony Denton Senior Vice President and Chief Operating Officer for University of Michigan Hospitals, Health Centers, and  Medical Group
9.     UMHS Clinical Brent Williams* Associate Professor of Internal Medicine, Michigan Medicine
10.  VA Ann Arbor Healthcare System Executive Open Open
11.  VA Ann Arbor Healthcare System Clinical Leo Greenstone Associate Chief of Staff for Ambulatory Care, VA Ann Arbor Healthcare System

* Denotes WHI Secretary

Community Positions

Community Member Role Current Member Current Member Title & Organization WHI Steering Committee Term
12.  Community Representative Jack Billi Professor, Internal Medicine and Health Management and Policy,  University of Michigan 6/2015 – 5/2018
13.  Community Representative Ann Davis Retired Administrator, Chelsea Community Hospital 6/2015 – 5/2018
14.  Community Representative Gregoy Dill County Administrator, Washtenaw County 10/2017 – 9/2020
15.  Community Representative Open Open
16.  Community Representative* Norman Herbert** Retired Treasurer, University of Michigan 1/2017 – 12/2020
17.  Community Representative* Doug Strong Retired Chief Executive Officer, Michigan Medicine 6/2015 – 5/2018
18.  Community Representative – Business David Sarns 360 Advisors, L.L.C. 6/2015 – 5/2018
19.  Community Representative George W. Waddles, Jr. Pastor, Second Baptist Church 6/2017 – 5/2020
20.  Academic Peter Jacobson Professor of Health Law and Policy;  Director of the U-M Center for Law, Ethics, and Health, University of Michigan School of Public Health 1/2018 – 12/2020
21.  Philanthropic Organization Representative Pam Smith President and Chief Executive Officer, United Way of Washtenaw County; Member, Coordinated Funders 1/2018 – 12/2020
22.  Community Representative Open

* Denotes WHI co-chair,  ** Denotes WHI Finance Committee Chair

The Steering Committee may have up to 22 total members at the discretion of the Steering Committee.

 Work Group Chairs

Ex Officio (Non-Voting) Position Current Member Current Member Title & Organization
1.     Community Coordination Work Group Chair Ruth Kraut Program Administrator, Washtenaw Health Plan
2.     Communications Work Group Chair Liz Conlin Account Director, re:group
3.     Medicaid & Marketplace Outreach & Enrollment Work Group Chair Cindy Bodewes Senior Director Patient Business Services, Michigan Medicine
4.     Mental Health & Substance Use Disorder Work Group Co-Chair Gregory Dalack Psychiatry Department Chair, Michigan Medicine
5.     Mental Health & Substance Use Disorder Work Group Co-Chair Nancy Siegrist Director of Behavioral Health Services, St. Joseph Mercy Chelsea
6.     Primary Care Work Group Co-Chair Brandie Hagaman Program Administrator of Health Services Innovations, Community Support & Treatment Services
7.     Primary Care Work Group Co-Chair Mark Jacoby Practice Administrator, Packard Health
8.     State Innovation Model Work Group Co-Chair Paul Valenstein Retired, St. Joseph Mercy Partners Clinically Integrated Network
9.     State Innovation Model Work Group Co-Chair Doug Strong Retired Chief Executive Officer, Michigan Medicine

 

Operational Processes

(1) Officers.  Once annually, at the first Steering Committee meeting of the calendar year, the Steering Committee shall elect Co-Chairs and Steering Committee members.  The Steering Committee will select two Community Members as WHI Co-Chairs.  The Steering Committee will also select an Organizational Member as Secretary.

(a) The Co-Chairs will preside at all Steering Committee meetings and will be ex officio members of all WHI committees, initiatives, and Work Groups.

(b) The Secretary will ensure that a record of all proceedings of the Steering Committee will be kept and will conduct the Committee’s correspondence.  The Secretary will preside at Steering Committee meetings in the absence of the Co-Chairs.

(2) Members and Terms.  The Steering Committee consists of no more than 22 members divided into two groups, Organizational and Community members. The groups are not required to be equal in size. To the extent possible, member terms will be staggered to ensure continuity.

(3)  Meetings and attendance.

(a) The Steering Committee will meet on a regular basis, usually monthly, but no less than 9 times per year.

(b) Attendance. Steering Committee members are expected to attend at least 75% of scheduled meetings either in person or via teleconference.  The Steering Committee may request the resignation of members not meeting the attendance expectations.

(c) The Steering Committee may invite and solicit input from non-Steering Committee members. In particular, Work Group Chairs are invited, non-voting guests for purposes of gaining a more comprehensive knowledge of WHI and its activities, and making reports on behalf of their Work Groups.

(d) A majority of the Steering Committee (in person or via teleconference) shall constitute a quorum.

(e) A Steering Committee member may resign at any time by notifying the Co-Chairs. Such resignation may take effect immediately or at such time as the Steering Committee member may specify.

(4) Standing-committees. The Steering Committee shall maintain two standing committees to facilitate WHI business. The Steering Committee may establish other committees as needed

(a)  An Executive Committee shall be comprised of the WHI Co-Chairs, the WHI Secretary, and the Finance Committee Chair, with support from CHRT leadership and staff.

  • The Executive Committee will develop the monthly Steering Committee meeting agenda and disseminate appropriate materials prior to the meeting.
  • The Executive Committee may conduct such business between meetings as necessary to meet WHI objectives.
  • At its discretion, the Executive Committee may cancel scheduled Steering Committee and/or Stakehlder Group meetings.
  • At its discretion, the Executive Committee may schedule special meetings as needed to conduct WHI business.
  • The Executive Committee will participate in the selection and annual evaluation of the WHI Program Manager.

(b)  A Finance Committee shall be appointed by the Co-Chairs and shall be comprised of the lead Steering Committee representatives from both Michigan Medicine and St. Joseph Mercy Hospital-Ann Arbor, the Washtenaw Health Plan Executive director, a WHI Steering Committee member representing a local philanthropy, and the CHRT CEO.

  • The Finance Committee is responsible for developing and reviewing fiscal procedures and the annual budget.
  • The fiscal year shall be the calendar year.
  • The Finance Committee also serves as the auditing committee to oversee the quality and integrity of the WHI’s accounting, auditing, and reporting practices.

(5) Project Development.  The Steering Committee sets priorities for developing WHI projects on core issues to improve health and health care in Washtenaw County.  The criteria for selecting new projects shall include the following:

  • Reviewing data to define a need, a problem statement, the nature of community engagement, and potential solutions.
  • Assessing how members of those most affected by the issues have been involved with the definition of the problem and solution proposed in the project.
  • Assessing gaps in how the project is currently being addressed.
  • Assessing opportunities for collaborating with appropriate community organizations and governmental agencies.
  • Obtaining qualitative or quantitative data to evaluate the project.
  • Obtaining input and appropriate collaboration from the Stakeholders Group.

(6) Steering Committee members are encouraged to participate in Work Group initiatives to ensure that the groups’ activities align with the WHI’s goals, and the chairs have the support and skills they need to facilitate a functional work group or project.  Steering Committee members are encouraged to participate in all WHI activities of interest or where their expertise can be beneficial.

(7) Annually, the Steering Committee will reassess the WHI’s scope, goals, and measures of success.  The Steering Committee will also develop a process for deciding whether and how to initiate new projects or Work Groups.  In conducting these activities, the Steering Committee will solicit feedback from the Stakeholders Group.  Ongoing communication between the Steering Committee and the Stakeholders Group is central to how the WHI functions.

 

Stakeholders Group

The Stakeholders Group consists of local individuals, community-based organizations, and governmental agencies that share WHI’s mission and goals.  As a collaborative endeavor, WHI welcomes individuals and entities willing to sign the Charter (below), setting forth the 2015-2019 Statement of Commitment. WHI also welcomes other invited guests at the Stakeholders Group quarterly meetings.

A key role for the Stakeholders Group is to provide feedback on WHI’s strategic direction and to participate in projects.  WHI relies on the Stakeholders Group to identify areas related to WHI’s mission that Work Groups should address.

Although the Steering Committee will have initial responsibility for selecting its membership, the recommendations will be submitted to the Stakeholders Group for input. The Stakeholders Group will also have the opportunity to suggest new organizations that should be represented on the Steering Committee.

 

Work Groups

The implementation of WHI’s strategic vision occurs through various Work Groups. The Work Groups are organized around themes to improve health and health care for uninsured and underinsured populations, such as access to primary care, mental health, and Medicaid outreach and enrollment.  Under the direction of a Work Group Chair or Co-Chairs, each theme involves several different projects.

The charge of the Work Groups is to share information among WHI member organizations in the theme area, identify gaps in the community that fall into that theme area, develop new projects to address those gaps, and monitor those projects. Work Groups usually meet between 4-12 times per year.

The Work Group Chair/s is/are selected for his or her expertise in the theme area. The Steering Committee will designate the Work Group Chairs.  Chairs agree to serve for a term of two years, renewable based upon mutual agreement with the Steering Committee leadership.  Work Group Chairs are responsible for assessing member engagement of their group, assigning action steps to members, and ensuring that action steps are carried out.  Work Group and project members should expect to leave meetings with action steps to complete in between meetings.

A significant aspect of the Work Group process is the opportunity to engage various segments of the WHI membership, along with community groups that are not WHI members.  For instance, projects that directly involve government processes and policies, such as Medicaid outreach and enrollment, can benefit from including governmental officials as participants.  Likewise, the projects can include consumer representatives with lived experiences in the various topics being addressed.

 

Other Roles and Responsibilities

(1) CHRT serves as WHI’s fiscal sponsor (i.e., a fiduciary agent for funding, office support, and project management). CHRT staff will coordinate meeting dates for all WHI activities.  Working with committee chairs, CHRT will distribute agendas, take meeting notes, create meeting summaries, and post these summaries to the WHI website.  CHRT staff members serve as support for WHI and are not expected to implement the majority of action steps on their own.

CHRT is responsible for:

  • Serving as a neutral convener to facilitate the WHI Steering Committee’s activities (including WHI’s overall strategic agenda).
  • Housing WHI’s Project Manager.
  • Serving as WHI’s project management and overseeing WHI’s numerous community-based projects.
  • Coordinating regular meetings of various subgroups, and managing WHI communications.
  • Hiring and maintaining appropriate administrative and project management staff.
  • Conducting data collection, analysis, and reporting for WHI program evaluation.
  • Providing additional support through data and policy analysis, work group project plan development, and evaluation.
  • Facilitating connections and discussions across multiple stakeholders.

CHRT also serves as the legal entity for WHI initiatives. This includes entering into contracts as jointly approved by CHRT and the WHI Steering Committee. All WHI funds are designated as restricted funds for the purpose of WHI program activities to be disbursed as authorized by the WHI Steering Committee. For its activities, CHRT may receive administrative funding for WHI facilitation and project management functions.

(2) WHI members work together on specific projects and functions with a long-term commitment to a common agenda, shared measures of success, and effective community engagement strategies.  For example, the WHI Steering Committee is the governing body for the State Innovation Model (SIM) in Washtenaw and Livingston counties. The SIM’s goal is to link human services with medical care to address social determinants of health, with an initial focus on emergency department utilization.

 

(3) WHI collaborates with CHRT to:

  • Generate innovative ideas to improve health and healthcare in the county.
  • Identify and share information on gaps and opportunities.
  • Coordinate and leverage resources.
  • Seek grant funding and donations to conduct work of mutual interest.
  • Ensure compliance with any grant requirements.
  • Develop formal agreements with other partners that clearly define roles and responsibilities.
  • Establish Work Groups on issues of mutual interest and mobilize WHI stakeholders to provide support (financial or in-kind resources).
  • Appoint Work Group Chairs and Co-Chairs.

 

[1] Underinsured individuals are those who have incomes below 250% of the Federal Poverty Level guidelines, and either: 1) have an unaffordable plan with high co-pays and deductibles; or 2) require medically necessary services not covered under their Medicaid or their private plan.

[2] The goals of the WHI are not hierarchical, nor are they mutually exclusive; WHI projects may be focused on achieving more than one, or all, of the WHI’s goals. WHI will develop appropriate measures of success for each goal, taking into account success to date.