Partnership between county health plan and Department of Human Services (DHS) connects DHS workers with clients, improves Medicaid enrollment process

ANN ARBOR, Mich. — The Washtenaw Health Initiative—a collaborative group of Washtenaw County community leaders and organizations that has worked together on a voluntary basis over the past year to improve access to health care for the county’s low-income, Medicaid, and vulnerable populations—announced today that it has helped more than 700 people in Washtenaw County obtain or keep Medicaid coverage or obtain access to other critical social supportive services.

The WHI estimates that about 6,400 Washtenaw County residents are currently eligible for, but not enrolled in Medicaid, and as many as 25,000 residents could become newly eligible if the federal health care reform act remains in place.

Helping improve the Medicaid enrollment process ahead of the projected influx, two employees with the Washtenaw County office of the Michigan Department of Human Services (DHS) were selected to work out of the Washtenaw Health Plan (WHP) office, addressing issues that include enrolling clients for Medicaid and public assistance benefits to correcting client contact information. The DHS workers see clients at the WHP offices and make weekly visits to the Delonis Center, the county’s largest homeless shelter. The Corner Health Center was recently added to the workers’ weekly rotation of visits, with plans to expand to other clinics in the future.

“The amount of time that these DHS workers devote to solving the myriad issues clients face is staggering. They are getting to know the clients in ways not possible without their work in the community and they are sorting out very complex issues in the human services system. They’ve helped hundreds of people in some way,” says Ellen Rabinowitz, executive director of the Washtenaw Health Plan. “This has been a phenomenal partnership.”

The move gives the DHS workers—Tiffany Gore and Liz Ahrens—direct access to community members who are at risk of losing their Medicaid coverage or public assistance benefits as well as those who may be eligible for assistance but not yet enrolled. Through remote access to the DHS eligibility system, Gore and Ahrens can make immediate updates to an individual’s file or identify eligibility for other assistance.

Among other things, Gore and Ahrens’s efforts since September 2011 include:

• Helping more than 200 single, childless adults at risk of losing Medicaid coverage maintain that coverage.
• Enrolling more than 200 people in the state’s Food Assistance Program.
• Helping 261 people apply for medical assistance, 69 for state disability assistance, and 22 for emergency relief for services like heating and utility assistance.
• Assisting more than 200 people at the Delonis Center.

The Washtenaw Health Plan is the envy of every other county health plan because our Adult Medical Program numbers are increasing; this is unprecedented in a period of closed enrollment. Because of the systems put in place by the two DHS workers and the Washtenaw Health Plan enrollment staff, we are able to contact members well before their enrollment is terminated, and as a result, help them stay enrolled,” says Rabinowitz.

While the fate of the Patient Protection and Affordable Care Act (the federal health care reform act) will be decided by the U.S. Supreme Court later this year, the success of the DHS and Washtenaw Health Plan partnership shows that there is a lot communities can and should do today to improve the health of residents, according to Robert Guenzel, retired Washtenaw County Administrator and co-chair of the effort.

“If federal health care reform is repealed, there will still be community members who can’t access the care they need. There will still be those who are eligible but not enrolled in programs like Medicaid. There will still be a need—and perhaps it will be even greater—for communities to work together on improving care for its citizens,” says Guenzel.

Guenzel, along with retired Saint Joseph Mercy Health System chief executive officer Robert Laverty and retired University of Michigan treasurer Norman Herbert, spearheaded the WHI; the initiative is sponsored by the University of Michigan Health System and Saint Joseph Mercy Health System, and staffed by the Center for Healthcare Research & Transformation based at the University of Michigan.

The WHI kicked off in January 2011 with an evaluation of the county’s current demographics, Medicaid eligibility and enrollment process, and health care delivery systems with a focus on primary, mental health, dental, and substance use care. Results were released in July 2011 as the group moved into identifying recommendations to close the identified gaps.

Recommendations were completed by September 2011. In addition to this enrollment outreach partnership between the WHP and the Washtenaw County office of the Michigan Department of Human Services, the group is in the process of implementing 10 other recommendations focusing on both helping people obtain and keep insurance coverage as well as getting access to needed primary care, dental, substance use, mental health, substance use, and human services.

Since the group’s official formation, WHI membership has expanded from 40 individuals representing 20 organizations to 70 individuals representing more than 30 organizations. The WHI includes representatives from the Ann Arbor-based Center for Healthcare Research & Transformation, U-M Health System, Saint Joseph Mercy Health System, VA Ann Arbor Healthcare System, health plans, county government, community services, physicians, and safety net providers.

For more information on the WHI, visit www.washtenawhealthinitiative.org.

The Washtenaw Health Initiative is a voluntary, county-wide collaboration focused on how to improve access to coordinated care for the low-income, uninsured, and Medicaid populations. The work of this group is on both how to improve care today for these priority populations and on 2014, when federal health care reform is expected to be more fully implemented. The effort is facilitated by the Center for Healthcare Research & Transformation and includes representatives from the University of Michigan Health System, Saint Joseph Mercy Health System, VA Ann Arbor Healthcare System, health plans, county government, community services, physicians, and safety net providers. Members are focused on building partnerships and identifying collaborative action that can move the county toward its ultimate goal: improving the health of its citizens now and in the future. For more information, visit www.washtenawhealthinitiative.org.

Voluntary group shares information, ideas for closing health care gaps for county’s low-income, uninsured, and Medicaid populations.

ANN ARBOR, Mich. — Thanks to a new initiative, low-income residents, Medicaid recipients, and the uninsured in Washtenaw County could see current gaps in accessing health care start to shrink before 2014, when health coverage expands nationwide under federal health care reform.

A voluntary effort by local leaders aims to make health care more accessible and also improve coordinated care today for low-income, uninsured, and Medicaid populations by identifying and, where possible, closing service gaps for these individuals. Members of the collaborative group, known as the Washtenaw County Health Initiative (WHI), also are preparing for 2014, when provisions of the federal Patient Protection and Affordable Care Act that expand Medicaid eligibility and establish health insurance exchanges go into effect. WHI group members estimate as many as 50,000 Washtenaw County residents may become newly insured in 2014—an influx that the county is not equipped to handle today, according to the group’s findings.

We know that Washtenaw County’s current health care delivery systems and community services–while providing excellent care–don’t fully meet the needs of these individuals today, and won’t be sufficient in 2014,” says Robert Guenzel, former Washtenaw County Administrator and a co-chair of the effort. “There is a lot that can and needs to be done now to improve our citizens’ health, regardless of what happens with health care reform.”

Guenzel, along with former Saint Joseph Mercy Health System chief executive officer Robert Laverty and former University of Michigan treasurer Norman Herbert, spearheaded the creation of the WHI. The group now includes representatives from many health providers in the county.

Beginning in January 2011, group members examined the county’s current demographics, Medicaid eligibility and enrollment process, and health care delivery systems. The group found that:

• Half of the estimated 50,000 residents who will become newly insured in 2014 are expected to become eligible for Medicaid, and the other half to purchase coverage through health insurance exchanges.
• The Medicaid enrollment system is under stress, with 42 different Medicaid eligibility categories, more than 55,000 total public assistance cases in progress (as of January 2011—and just 59 workers to process them.
• Approximately 54,000 additional primary care visits may occur annually when the newly insured begin to seek care in 2014. The current primary care work force may not be able to absorb these additional visits.
• About 27,000 residents (10 percent of all adults) reported poor mental health for 10 or more days in one month in 2005, but only one quarter were being seen by a mental health professional. Access to mental health care is limited for the low-income, uninsured, and Medicaid populations.
• More than 2,700 county residents with substance abuse or co-occurring mental health and substance abuse disorders received treatment in hospital emergency departments in 2010—one of the costliest settings to receive medical care—but it’s estimated that more than 800 patients could have been treated in the community if medically-supported substance abuse detoxification programs had greater capacity.
• Only 15 percent of community dentists surveyed in 2007 reported accepting Medicaid insurance benefits and just 8 percent (five practices) said they were accepting new Medicaid patients. Restrictions on who can receive care at such clinics further limits dental care options for these individuals, particularly for low-income adults.

In the near future, the group will shape a set of recommendations for future implementation strategies, pilot programs and planning efforts to address capacity challenges and close service gaps.
The U-M Health System and Saint Joseph Mercy Health System are joint sponsors of the effort. In addition, the WHI includes representatives from the Center for Healthcare Research & Transformation, health plans, county government, community services, physicians, and safety net providers.

The collaborative spirit of this group is impressive. Already, our work has shown that the needs in Washtenaw County are great, and that we must work together to address them,” says Doug Strong, CEO of the University of Michigan Hospitals and Health Centers, part of the U-M Health System. “It will take an unprecedented collective effort but we have started on the journey.”

Strong’s counterpart at the county’s other major health system agrees…

St. Joe’s is honored to be a part of such an extraordinary effort to better serve our community. As we move forward, it is crucial we look for where we can re-direct and re-invest health care resources to provide access to primary, preventive, dental and mental health care to all Washtenaw County residents,” says Robert Casalou, president and CEO of the Saint Joseph Mercy Ann Arbor, Livingston and Saline hospitals, part of the Saint Joseph Mercy Health System.

The facilitator for the WHI is Marianne Udow-Phillips, the director of the Center for Healthcare Research & Transformation — a joint venture of the University of Michigan and Blue Cross Blue Shield of Michigan. She says…

This remarkable effort reveals the challenges facing Washtenaw County leaders in improving access to care today and in the future, but the significant gaps we found are not unique to this community or Michigan. We hope our process in Washtenaw County will spark groups in other communities, both locally and nationally, to start similar discussions, with the Washtenaw County Health Initiative serving as one example of what can be done now to meets residents’ health care needs.”

For more information on this effort, including a list of all participants and a document detailing current gaps in Washtenaw County health care, visit www.WashtenawHealthInitiative.org.

The Washtenaw County Health Initiative is a voluntary, county-wide collaboration focused on how to improve access to coordinated care for the low income, uninsured, and Medicaid populations. The work of this group is on both how to improve care today for these priority populations and on 2014, when federal health care reform is expected to be more fully implemented. The effort is facilitated by the Center for Healthcare Research and Transformation and includes representatives from the University of Michigan Health System, Saint Joseph Mercy Health System, health plans, county government, community services, physicians, and safety net providers. Members are focused on building partnerships and identifying collaborative action that can move the county toward its ultimate goal: improving the health of its citizens now and in the future. For more information, visit www.WashtenawHealthInititative.org.