University of Michigan Health System 2013 Implementation Plan Logic Models

University of Michigan Health System 2013 Implementation Plan Logic Models These logic models supplement the UMHS 2013 Implementation Plan which can be found at http://umhealth.me/chna13. Please direct questions to the UMHS Department of Health Services at 734.998.2156. 2013 UMHS Implementation Plan Logic Model: Access to Care Adults reported a drop in health insurance (private or governmentsponsored) from 92.9% in 2005 to 89.1% in 2010. Assist individuals and families in enrolling in health insurance. Residents between 25-34 years reported a decrease in insurance from 92% to 78.8% between 2005 and 2010. In 2010, two rural regions observed 10-11% decreases in coverage, down to 87.1% and 86.8% respectively in five years, a greater drop than more urban areas. Between 2005 and 2010, high school graduates without any college education reported a drop from 95.2% to 78.5%. In 2010, 62% of those with no insurance did not have their teeth Currently there is a significant number of Medicaid-eligible but unenrolled Washtenaw County residents. In addition, several thousand community members in Washtenaw County will likely become newly eligible for Medicaid in 2014. There is a shortage of primary care providers within safety net clinics where many of the newly eligible Medicaid patients will be seen for care. Acute oral health diseases are not always seen in the appropriate health care setting. Increase the availability of primary care providers. Develop a process to triage acute dental problems from the ER towards oral health clinics. UMHS is a key partner in the Washtenaw Health Initiative (WHI), a voluntary, county-wide collaboration focused on how to improve access to coverage and 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 will be fully implemented. WHI will actively connect Medicaid enrollees with primary care providers and community resources through the Blue Cross Complete Pilot. WHI will develop and implement an infrastructure in which to quickly enroll patients into Medicaid and reach out to businesses that provide employee insurance. UMHS will continue providing financial assistance counselors to help community members enroll in insurance plans. WHI will launch a pilot to increase the 1

2013 UMHS Implementation Plan Logic Model: Access to Care cleaned in the past year. number of primary care providers in safety net clinics across the county. 47% of those earning less than $35,000 per year in 2010 had dental insurance. WHI will launch a pilot to provide acute dental treatment for patients that have come or might otherwise resort to emergency departments for an acute dental need. In 2010, 30% of African Americans reported having between one and five teeth removed due to decay. 2 Barriers to primary health services and medical homes for health and social issues specific to adolescents exist. The reimbursement rate for Medicaid patients discourages oral health providers from seeing this population. Navigating the health system and connecting with appropriate and diverse health providers is challenging, especially for vulnerable populations. Community members, patients and families may lack transportation services to and from clinical care or Offer school-based health programs and clinical services for adolescents Create a process by which dental providers will be incentivized to see Medicaid patients. Provide assistance and coordination of health services to community members. Provide assistance and coordination of services to patients and their families of a non-medical nature that Continue making available school-based health clinics and programs for adolescents through the Regional Alliance for Healthy Schools (RAHS), a UMHS partnership with local school districts in underserved areas which includes six locations at middle and high schools in underserved areas of the county. A pilot program that provides access for low income adults without dental insurance to community dental providers through a reduced fee program will be implemented by WHI. WHI will institute Washtenaw County s new Care Navigation Network which brings Care managers from clinics across the county together to coordinate access to health services for community members receiving care at safety net clinics and to receive training. UMHS will continue providing free transportation to individuals being discharged from the Emergency Department.

2013 UMHS Implementation Plan Logic Model: Access to Care need assistance connecting to community resources in the face of unfamiliar health care situations. often act as barriers to accessing care. The Department of Social Work s Guest Assistance Program will continue helping alleviate non-medical issues patients and families of patients have when dealing with a health care situation. Social Workers problem-solve, and assist with providing resources to meet various needs that arise for patients and families during medical treatment such as with transportation, gas and lodging. The Child Advocacy Clinic, a partnership between the UM Law School and UMHS Social Work will continue helping the community at large resolve legal and Community members may lack resources for or access to clinical services, health screening and education. Hold community-based health fairs, health screening, and safety net health clinics for the community at large. medical issues on a pro bono basis. Continue making the Ypsilanti Health Clinic and migrant health clinics which provide health services to the uninsured and underinsured available. Many UMHS departments will continue offering free health fairs and screenings in the community. 3

2013 UMHS Implementation Plan Logic Model: Mental Health What UMHS programs and specific strategieswill be implemented? Problem Reasons for this problem How will it be addressed? Adults having ten or more poor mental health days per month increased from 9.7 to 14.4% between 2005 and 2010. In 2010 22.3% of the adult population was diagnosed with depressive disorder and 15.9% with an anxiety disorder. From 2007 to 2010, suicide rates increased for all ages. Insurance, financial, and transportation barriers to accessing primary care and mental health services exist. Increase access to insurance, primary care, medical homes and interventions that prevent and reduce mental illness. Please see Access to Care Logic Model. UMHS has made a $1 million commitment to Psychiatric Emergency Services (PES) to put money back in the community to support access to needed services. The Department of Psychiatry will continue to provide 24-hour Emergency/urgent walk-in evaluations for all ages. Additionally, UMHS will continue extending its ongoing participatory leadership, guidance and support to the Washtenaw Community Health Organization in order to coordinate mental health care for uninsured and underserved community members. Through the Washtenaw Health Initiative, UMHS will work to connect Medicaid enrollees and the uninsured with support for mental health services, seeking to optimize available mental health collaborative care systems. The first step of optimization will be piloted at 4 safety net clinics in Washtenaw County starting around July 2013. The Regional Alliance for Healthy Schools will continue offering risk assessments and interventions to high-risk students for mental illness and those with suicidal ideation in underserved middle and high schools. The UM Depression Center will keep providing two-hour single-session family psycho- 4

2013 UMHS Implementation Plan Logic Model: Mental Health What UMHS programs and specific strategieswill be implemented? Problem Reasons for this problem How will it be addressed? Patient, peer, family, and social support may be lacking. Build and enhance social supports to isolated individuals. educational workshops for mentally ill adolescents and family members for a minimal fee to the community. The UM Depression Center will again offer free depression screening and education for the community at large. Community Programs and Services will continue offering Ann Arbor Meals on Wheels. Volunteers deliver meals at no charge six days a week to the homebound. They conduct wellness and safety checks and provide a human connection and social support that these isolated community members may not otherwise have. The UM Depression Center will continue its free mental health support sessions for families in the community whose child has a mental illness. The Peer-to-Peer Depression and Suicide Awareness campaign offered in partnership by the UM Depression Center and school districts in vulnerable communities will be expanded. 5

Binge drinking increased in 18-24 year olds from 19.3% in 2005 to 29.9% in 2010. From 2005 to 2010, adults without health insurance reported increased alcohol consumption in the past month from 30.1% to 50.6%. For 2009-10, avg. rate of high school students taking prescription drugs in past 30 days without a prescription was 6.2%. Females were four times more likely than males to report that their drug use interferes with their lives. 2013 UMHS Implementation Plan Logic Model: Substance Abuse What UMHS programs and specific Problem Reasons for this problem How will it be addressed? Insurance, financial, and Increase access to insurance, transportation barriers to primary care, medical homes, accessing primary care and substance abuse and substance abuse prevention and treatment prevention and treatment interventions. services exist. Individuals needing acute medical detoxification services are not adequately assessed and connected to medically appropriate detoxification services. Enhance the process by which individuals are assessed and connected to detox services. Please see Access to Care Logic Model. UMHS has made a $1 million commitment to Psychiatric Emergency Services (PES) to put money back in the community to support access to needed services. The Department of Psychiatry will continue to provide 24-hour Emergency/urgent walk-in evaluations and crisis phone services for all ages in partnership with the Washtenaw Community Health Organization. Specific strategies include psychiatric evaluations and treatment recommendations, crisis intervention, screening for inpatient psychiatric hospitalization, and mental health and substance abuse treatment referral information. RAHS will continue Project S.U.C.C.E.S.S. which offers substance use prevention and early intervention services including community and environmental approaches, information dissemination, and normative and prevention education to build both resistance and social competency skills. Through the Washtenaw Health Initiative, UMHS will work to connect Medicaid enrollees with support for substance abuse treatment and implement a county-wide protocol for patients who need substance abuse detoxification services (primarily alcohol) which will be introduced at the Ypsilanti Health Center, a UMHS safety net clinic. 6

2013 UMHS Implementation Plan Logic Model: Obesity Insurance, financial, transportation Increase access to Please see Access to Care Logic Model. and other barriers to accessing insurance, primary care, primary care and obesity medical homes, and obesity prevention and treatment services prevention and treatment exist. services. Adult overweight/obesity rates have risen to 59.1% in 2010, up from 44.4% in 2005. In 2010, about half of overweight/obese adults were advised by a health professional to lose weight. In 2010, 13.4% of 6-11 year olds were overweight/obese, as were 10.6% of 12-17 year olds. Only 17.6% of adults consumed at least 5 servings of fruits and vegetables/day in 2010. In 2010, those most likely to be overweight/obese included veterans, disabled, self-employed/unable to work, African Americans, those with a high school education but no college. In 2010, 44% of adults attained at least 30 minutes of moderate activity five Barriers to learning about, practicing and maintaining healthy behaviors exist. Barriers to accessing healthy food environments and places to be physically active exist. Both UMHS and greater Washtenaw County lack a comprehensive and coordinated Introduce/impart strategies that increase individual knowledge, change behavior, or develop supportive relationships. Support making healthy food more accessible and places for physical activity more accessible. Increase coordination and collaboration both within the health system and Expand Project Healthy Schools, a middle school-based physical activity, nutrition, and environmental change initiative to 33 schools over the next three years which includes locations in underserved communities. The Regional Alliance for Healthy Schools will continue offering its Nutrition and Physical Activity Program, a school-based obesity intervention to educate, support, and facilitate behavior change in middle and high school students in underserved areas. Continue offering low-cost nutritious and healthy cooking group education classes to the community through MHealthy. Increase the number of healthier dietary choices in UMHS hospital cafeterias for patients, employees, and the community in partnership with the Michigan Health and Hospital Association Healthy Food Hospitals Program and similar programs. Convene a task force representing faculty and staff from UMHS to develop recommendations for a strategic 7

2013 UMHS Implementation Plan Logic Model: Obesity approach to preventing and across the County. treating patients who are overweight or obese. days or more per week. In 2010, 10.5% of children 6-11 yrs reported consuming 5 or more fruits/vegetables/day, while 25.2% of 12-17 year olds reported the same. Barriers to awareness of existing services and resources in the community exist. There is a lack of local, state, and national policies that optimize the prevention, early identification and treatment of obesity. Increase awareness of obesity prevention and treatment resources available at UMHS and in the community. Increase awareness of policies that optimize the prevention and early identification of obesity. approach to preventing and treating obesity across the lifespan. Join forces with other local health systems, the county public health department, and other service agencies to increase alignment, partnerships, and strategies for the prevention and reduction of obesity. In collaboration with the Washtenaw County Public Health Department develop and disseminate a guide to obesity prevention and treatment programs and services available in Washtenaw County. Continue advocacy activities with local and state partners. 8

2013 UMHS Implementation Plan Logic Model: Pre-conceptual and Perinatal Health The rate of African American infants in the county born at a low birth weight was 11% in 2005 and 12.3% in 2010, while the White rate was nearly 3 times as low. Lack of access to adequate pre-conceptual and perinatal care for women of a childbearing age and their children. Increase access to and offer interventions that improve the health status of women of childbearing age before, during, and after pregnancy, and their children. Using a rolling average for 2007-2009, African American infant death rates in the County were 11.5 per 1,000 while White rates were 4.4. The proportion of low birth weight infants increased from 74.8 per 1,000 live births in 2000 to 84.1 in 2010. 9 Increase access to and offer interventions that improve parenting and caregiver skills. Please see Access to Care Logic Model. Continue to conduct the Adolescent Risk Behavior Assessments, health counseling, and referrals to community resources for middle and high school students through the Regional Alliance for Healthy Schools school-based clinics. UMHS will continue providing the Maternal and Infant Health Program, a statewide Medicaid-funded program that takes a multi-disciplinary approach to reduce risk factors for infant and maternal morbidity and mortality. The Women s Health Program will continue offering free Papilloma tests, pelvic exams, physical breast exams and access to mammograms (where indicated) to uninsured and underinsured women as part of the Women s Clinic, located at The Student Run Free Clinic in Pinckney. Continue offering to the underserved the Breastfeeding Moms Peer Support group, and connecting breastfeeding mothers to community resources through the Health Education Resource Center. Continue UMHS participation in the Washtenaw County Breastfeeding

2013 UMHS Implementation Plan Logic Model: Pre-conceptual and Perinatal Health Coalition which advocates for breastfeeding friendly policies. The Health Education Resource Center will continue low-cost group education for the community that teaches safe and healthy parenting and caregiving skills such as Baby Care Basics, Realities of Parenthood and The Joys of Grandparenting. Lack of access to resources Offer tobacco cessation to quit smoking. interventions. Smoking rates of Ypsilanti females, ages 18-49 in 2010 was 14.4%. In 2010, the proportion of overweight or obese African American females was 52.4%. Females, ages 18-49 had an increase in having ten or more poor mental health days per month from 14% in 2005 to 18% in 2010. Please see Obesity Logic Model. Please see Mental Health Logic Model. Provide interventions including individual, behavioral, environmental, and policy strategies to prevent, reduce, and treat obesity. Help establish environments and policies that increase access to mental health services, promote health, resiliency and build social support. Continue offering MHealthy Tobacco Consultation Services free to community members comprising group or individual counseling, skill acquisition and six weeks of follow-up support. Please see Obesity Logic Model. Please see Mental Health Logic Model. 10

2013 UMHS Implementation Plan Logic Model: Immunizations Insurance, financial, and Increase access to insurance, transportation barriers to primary care, medical homes, and Please see Access to Care Logic Model. accessing primary care and immunizations. immunization services exist. The rate of adults receiving an influenza vaccine in the past 12 months in 2010 was 50%. Young adults (35.5%) and Ypsilanti residents (58.6%) had the lowest annual Influenza vaccine rates in 2010. In 2010, 64% of children ages 19-35 months completed the 4:3:3:1:3 series, a 10% reduction from 2008. 22% of 16 year old females received the HPV vaccine in 2010. Immunizations may not be affordable for those either underinsured or without insurance. Myths about negative consequences of childhood immunizations have spread. Increase access to affordable immunizations. Educate the community to dispel myths and connect them with affordable immunization services in the community. The UMHS Department of Community Programs and Services will continue offering influenza immunizations free to community members at easily accessible locations such as faith organizations and senior centers. Continue offering immunizations through the Regional Alliance for Healthy Schools. The Department of Community Programs and Services will keep providing free Hepatitis B screening, education and vaccine to community members, especially those who have migrated to the United States from Asian countries and are more susceptible to contracting Hepatitis B. Through the Maternal Infant Health Program and the Health Education Resource Center, educating the underserved about the importance of childhood immunizations and helping to connect them to community resources will continue. 11

Physical abuse in children 0-17 yrs increased from 124 to 195 between 2008 and 2010. For 0-3 yrs it increased from 43 to 95. Neglect of all types increased from 382 in 2008 to 583 in 2010 for children 0-17 yrs. For 0-3 yrs it increased from 174 to 295. 12 2013 UMHS Implementation Plan Logic Model: Child Abuse and Neglect Lack of access to primary Please see Access to Care and Mental Health care and mental health Logic models. services. Lack of skills and knowledge regarding parenting and caring for a child. Health providers may not be aware of signs of child abuse or neglect or may be uncomfortable with the process for intervening and reporting. Increase access to insurance, primary care, medical homes and mental health services which may lead to prevention and early identification of suspected child abuse and neglect. Increase the safety of infants and children through education and outreach strategies. Increase health provider capacity to identify, intervene on, and report child abuse and neglect. UMHS will continue leading the Safe Kids, Huron Valley Coalition which brings together multidisciplinary members from across Washtenaw and Livingston counties with the goal of reducing injuries to children. They educate children and adults, advocate for effective laws, and work to create safe environments for vulnerable families. The UMHS Child Protection Team will continue to: Provide consultation to medical professionals and other professionals, such as Department of Human Service (DHS) personnel and law enforcement; interpret medical findings; assess risk factors; identify the need for intervention; and provide specialized medical evaluations of suspected victims of child maltreatment across the state. Help at-risk community members connect with community resources. Educate and train health care professionals, DHS Children s Protective

2013 UMHS Implementation Plan Logic Model: Child Abuse and Neglect Services workers, and law enforcement in the identification, management, treatment and prevention of child maltreatment. Sponsor an annual child abuse and neglect conference for health care professionals, DHS workers, law enforcement, court personnel and other child welfare professionals, on the prevention, assessment and treatment of child abuse and neglect. Partner with the Washtenaw Child Advocacy Center (WCAC) in order to provide medical evaluations and supportive resources in conjunction with services provided by the WCAC; forensic interviews and counseling/therapies. The WCAC and CPT work within a multidisciplinary team which includes law enforcement, DHS, prosecutors, and mental health professionals focused on the investigation, treatment, and prosecution of child abuse cases. 13