Norman Herbert on the origins and impact of the WHI and Washtenaw’s response to COVID-19

An interview with Norman Herbert, founding co-chair of the WHI, on the origins and impact of the organization, the health policies and practices that trouble him, and Washtenaw’s response to the COVID-19 pandemic.

Q. What inspired your passion for community health?
Herbert. I served on the board of Ann Arbor Area Community Foundation for nine years and participated in the distribution committee process, which allocates proceeds from the funds that donors have endowed and distributes those dollars each year to local initiatives that meet donor interests. Sometimes the community foundation donors specifically designate the use for their funds, like supporting a particular charity, but sometimes they express an interest in education, housing, human service needs, the environment, or another philanthropic endeavor. In those cases, the distribution committee would aggregate proceeds from funds with similar interests to offer grants to local social service agencies that address specific community needs in the area.

Later, a funding model was introduced that is called the Washtenaw Coordinated Funders–a collaboration initially between the Ann Arbor Area Community Foundation, Washtenaw County Office of Community and Economic Development,  and the United Way of Washtenaw County. By pooling resources from all these organizations, we could have an even bigger impact, and it was eye opening in terms of the many issues that affect our community. From issues of homelessness, transportation, and affordable housing to mental health and accessible health care. 

All this work made me realize that more could be accomplished if we had more collaboration between local service organizations. Ann Arbor has always had a lot of nonprofits, but a limited amount of resources. If they could work together, they could be more efficient and accomplish so much more.

Q. When and why did you join the WHI, and how has it been helpful?
Herbert. In 2010, with the Affordable Care Act on the horizon, Bob Laverty, who was CEO of the St. Joseph Mercy Health System, had the vision to see that the ACA would present many opportunities to help the underserved in Washtenaw County. He asked me and county administrator Bob Guenzel if we were interested in helping to spearhead community engagement for a six-month trial. Ten years later I am still involved.

The Affordable Care Act was going to increase access to health care for low-income, uninsured, and underinsured members of the community, but Washington was not going to be providing a template for how that care was to be provided. We knew that Washtenaw County, like every community, had its own profile, culture, and interests and that we needed to work with the county’s health providers to address these reforms and needs at the local level. So we started the Washtenaw Health Initiative in 2011 and quickly began identifying the barriers for entry and then ways that we could help people understand how to take advantage of the opportunities that the ACA would provide. It was a very exciting time because we received commitments from St. Joe’s and Michigan Medicine and later the Ann Arbor VA, as well as most of the community service organizations in the county. 

For the first few years, the WHI focused on mental health and substance use disorders, issues people encountered while trying to access care, capacity issues for primary care practitioners who needed to be ready to serve more people, and dental care. Then from those four areas we began to see other needs as well. 

Q. Which health challenges keep you up at night?
Herbert. I believe everybody should be provided healthcare, and that healthcare should not be accessed through emergency rooms because I’ve always understood that to be the most expensive way. What I’ve come to appreciate through the WHI is that low-income, uninsured, and underinsured individuals are worried about their jobs and income, and will only take time off from work when they can’t get to work because they’re too ill. So their use of the emergency room is actually pretty astute. You come in, get all sorts of tests while you’re there, and when you leave you have a prescription. 

Still, safety net providers play an essential role for low-income, uninsured, and underinsured populations because they offer not only primary care but also social workers who can help people access counseling, housing, food, transportation, education, and other services they need. They deal with the needs of people more holistically.

While volunteering, I had an opportunity to work with Success By Six, the Rotary Foundation, and others on programs designed to ensure children were well prepared for education by the time they got to kindergarten. We knew that 20 percent of children were entering kindergarten without the preparation they needed to succeed and that there were many reasons why that was so. Individual business policies aren’t always parent friendly – supportive of parents participating in their students’ educational endeavors. Parents might lack access to medical care, might need housing assistance, mental health counseling, or food. If they are suffering in any of those areas, they’re not going to be focused on supporting their children’s development of literacy skills needed to thrive in kindergarten and in life.  

From the beginning, I worked with WHI colleagues to begin to talk to Michigan policymakers about the convergence of social and health care issues that affects many in our community, When the state received funding to address those needs in an integrated way, we at the Washtenaw Health Initiative immediately came together to request funding to do so here, in Livingston and Washtenaw Counties. We succeeded in our request, and over the last three years have helped hundreds of individuals with complex medical, social, and behavioral health needs. We’ve seen the impact on individuals, and have carefully tracked the results. Now, I am very interested to continue that work so that we can collect the data required to demonstrate how resolving a person’s social determinants of health needs can be integrated with their clinical care, leading to better outcomes. We are working to continue to fund this intervention so that ultimately health plans might pay for integrated care because it saves on health care costs and improves the wellbeing of their members.

Q. What’s your proudest moment?
Herbert. There are too many to pick just one!

One of the first of relevance to the WHI is that early on, before the Affordable Care Act was launched and expanded in Michigan, we recognized that Washtenaw County residents who qualified for Medicaid weren’t enrolling. There was a 26-page application for coverage, and any time work conditions changed, they had to go back and refile that same 26-page application. If they weren’t doing it, they weren’t insured.

We reached out to the Michigan Department of Health and Human Services and asked them if they could send staff to the field rather than have them sit in their offices and wait for applicants to come in. They located staff in agencies that served low-income clients and in the first three months, more than 100 Washtenaw County residents had been able to close their cases. 

One of the most recent is how Washtenaw Health Initiative members and stakeholders are working together to respond to the coronavirus pandemic. When we first began to develop this initiative, we didn’t have an epidemic of this proportion in mind–of course. But we knew that our community could benefit from the connectedness we were hoping to foster.

Now, as this virus disrupts schools, day care centers, jobs, incomes, insurance, transportation, and housing for our county’s low-income, uninsured, and underinsured residents, our frontline health, mental health, and social service agencies are rallying and pooling resources. It’s times like this, in the midst of the coronavirus, that we can see the impact of the WHI in fostering the kinds of connections that allow our community to respond and collaborate in real-time, addressing community needs as they are emerging.