Washtenaw Health Initiative marks 10 years of improving health care for all county residents

The collaborative of more than 200 stakeholders formed in 2011 to help implement the Affordable Care Act, but has expanded far beyond its initial mission.
When Sharon Moore was asked to become a co-chair of the Washtenaw Health Initiative (WHI), she says she'd only heard of WHI "in a roundabout way" as a board member of Packard Health. But there was no question in her mind about coming aboard after she took part in a WHI meeting to learn what the organization was all about. 

"Everyone around that table talked to each other about what they were doing, what they needed, and where they were being successful. When information is shared like that in a community, that community can only become better for it," Moore says. "WHI wasn't asking me to a be co-chair. They were giving me an opportunity to be a co-chair." 

Co-sponsored by Michigan Medicine and St. Joseph Mercy Health System, and supported by the Center for Health and Research Transformation (CHRT), WHI is a voluntary collaboration between more than 200 individual and organizational stakeholders. All are bound by a mission to improve the health of low-income, uninsured, and under-insured populations across Washtenaw County.  
Ginny Creasman, director of the VA Ann Arbor Healthcare System, speaks with Washtenaw Health Initiative communications chair Liz Conlin at a 2019 stakeholders meeting.
The collaborative was formed in 2011 to help implement the Affordable Care Act (ACA), which had been passed a year earlier. However, WHI has expanded far beyond its initial mission, continuing to provide a vital structure for county stakeholders to collaborate on strengthening health care in the county. WHI celebrated its 10th anniversary this year, and highlights of the past decade are outlined in WHI's 2019 Impact Report

"Ten years later, we still have work to do, and there could always be work to do," says Norman Herbert, one of WHI's founding co-chairs.

Early days

The ACA dramatically expanded access to health coverage for uninsured Americans who were not covered by their employers, widened Medicaid eligibility, and created the Health Insurance Marketplace, among other things. The sweeping reforms came with many questions and challenges.

"In Washtenaw County we recognized that a template was not going to be provided by Washington as to how the various communities around the country were actually going to deal with the changes and meet the needs of the increased number of people eligible for Medicaid," Herbert says. "A group of us who were all interested in national health care reform, and improving the system of delivery of chronic and primary health care services, wanted to find solutions."

For instance, at the time, enrolling for Medicaid involved filling out over 40 pages of paperwork. It was also anticipated that many county residents who would be newly covered under the new health care plan would opt to access health care through hospitals' emergency departments. Knowing that was going to be costly, WHI determined that something needed to be done to encourage newly insured individuals to use their primary care physicians instead. 

"We knew that the population that we were concerned about did have primary care providers, but these providers were only open from 8 to 5, and that meant people would have to take time off work," Herbert says. 

He says people explained that going to the emergency room meant convenience and no loss of income. Plus, they reported that when they left the hospital, they had a complete analysis of their health care issue and a prescription to go forward.

When Herbert was asked to be a co-chair all those years ago, he and everyone else involved thought they were signing up for a very short, six-month initiative. They anticipated having to work on five main challenges, but Herbert says that "turned out to be enough work for 11 different initiatives." 

Herbert has since stepped down from his WHI position and is anticipating the collaboration's future successes. He's confident that both the WHI and the health care of the county's most vulnerable residents are in good hands under the direction of the current co-chairs. 

"It was the continued interest in serving the community that made me see the value of the Washtenaw Health Initiative. The Washtenaw Health Initiative has proved their value over the years by being able to look at a problem, taking initiative, and figuring out solutions," Moore says. 

Addressing the opioid epidemic

Matthew Hill, substance use disorder program manager for CHRT and staff rep to the WHI Opioid Project, says a key to WHI's success is "the unique collection of people at the table." 

"It allows us to keep a pulse on different things, so we don't replicate something that's already going on, and identify gaps where we need to make progress," he says. 

Hill notes that the number of opioid overdose deaths in Washtenaw County decreased from 95 in 2019 to 85 in 2020.

"We don't know specifically why that is, but we do know that our efforts are having an effect," he says.

The Opioid Project's work includes the recommendation of 19 strategies to address root causes of Washtenaw County’s opioid crisis. Three subcommittees are carrying out that work. They also spearheaded an opioid summit that focused on the negative effects of stigma surrounding substance use disorders. More recently, input they provided to Washtenaw County Prosecutor Eli Savit, encouraging decriminalizing the possession of medications used to treat opioid use disorder, has resulted in some new policies. 

Eve Losman, an emergency room physician for Michigan Medicine and member of the Opioid Project, was tasked with examining pain management in the emergency department. When she started attending Opioid Project meetings, Losman was floored. She joined a table that included pharmacists, health advocates, law enforcement, and even non-professional members of the community. 

"The conversations we were having in the medical center were very much focused on prevention, but this group was thinking about how to take care of individuals who have substance use disorder and thinking about social determinants of health and their influence on substance abuse disorder," she says.

Not every organization values including the voices of those with lived experience, says Sara Szczotka, co-chair of the WHI Opioid Project and program manager for the Washtenaw Recovery Advocacy Project (WRAP) at Home of New Vision. When the Opioid Project decided to address stigma within the community and its impact on service delivery, WRAP was created. Szczotka is not only the program manager, but also a program participant.  

"It's hard to discount someone's life experiences when they're sitting with you," she says. "When people see me – a person in recovery who is also a valued team member and a co-chair – it personalizes things for the rest of the community." 

The journey to 100% insured

For Alena Hill, current co-chair of WHI's Medicaid and Marketplace Outreach and Enrollment (MMOE) workgroup, it would be a dream come true if Washtenaw County's uninsured rate were 0%.

"It's ultimately a person's choice, but we want to give residents the information they need to make that choice and support them in the process of getting insured," says Hill, who is also senior director of revenue cycle pre-services at Michigan Medicine. 

MMOE has been working relentlessly for a decade, helping the county's most vulnerable residents secure health insurance. As an indicator of MMOE's impact, Hill points to the county's 6.1% uninsured population rate. 

"Between 2008 to 2019 the uninsured rate decreased by 45%, which is pretty significant," she says. "The numbers haven't been going up and down, but have been steadily decreasing. So our public outreach and services are helping."
Kimberly Hulbert, MMOE's current co-chair and manager of benefit advocacy for St. Joseph Mercy Health System - Ann Arbor, seconds Hill's wish for a 100% insured rate. 
"We don't just help with submitting applications. We can actually help with getting documents that are needed, such as proof of income or citizenship," she says. "... In the beginning, there was a bit of resistance and a lot of questions that our uninsured residents had, but that's gotten better."
Recently, to further education and community outreach, MMOE members trained college students to distribute more than 10,000 flyers in low-coverage neighborhoods. The flyers contained contact information for local agencies that can assist with Medicaid, the Healthy Michigan Plan, and Health Insurance Marketplace applications.
The group won't be resting on its laurels anytime soon, stresses Jeremy Lapedis, an MMOE member and executive director of Washtenaw Health Plan
"There are 13,000 more people on Medicaid now than there were in March 2020, in part due to the pandemic," he says. 
He notes that states have been required to keep people on Medicaid throughout the federal public health emergency (PHE) declared for the COVID-19 pandemic, which is currently set to expire this month. When the PHE ends, all Medicaid enrollees will have their eligibility redetermined and many are likely to lose coverage.
"There's going to be a lot of work to do next year," Lapedis says.
Supporting healthy aging
Another WHI workgroup that is expecting a busy 2022 is the newly formed Healthy Aging Collaborative, whose mission is to support the community health needs of older adults and their caregivers in Washtenaw County.
Being less than a year old has meant that many of the group's efforts have been centered on organizing and coordinating with the county's newly appointed Commission on Aging, says Ann Davis, a co-chair of the Healthy Aging Collaborative and a retired administrator for Chelsea Community Hospital.
Ann Davis speaks at a 2019 Washtenaw Health Initiative stakeholders meeting.
"I think the win for this year is that we have been able to harness the service providers in the aging sector to start to have one voice," she says. "We've developed a good working relationship to be able to have a really strong voice to represent the older population of Washtenaw County."
Monica Prince, co-chair of the Healthy Aging Collaborative and director of the Ypsilanti Senior Center, explains that part of addressing healthy aging in Washtenaw County means looking at the social determinants of health. 
"Are they physically, emotionally, socially healthy? Can older people in our community live in their homes if they want to, or can they move into assisted living if they want to?" she says.
The group's efforts are very timely and have great potential, says Amanda Sears, a collaborative member and the grant manager for the Area Agency on Aging 1-B
"As the amount of older adults who are healthy and living longer lives increases, we will end up having a smaller pool of people who are available to care for them," she says. "This could have a bit of a snowball effect. It's not all gloom and doom, but we want to get out in front of it."

Making a case for older adults and the services they need should be a priority, now more than ever, stresses Deana Smith, program manager at WHI and staff representative to the Healthy Aging Collaborative. 

"We know that our community-based organizations and nonprofit organizations that serve adults are often resource-challenged, and we are aware of the American Rescue [Plan Act] funds that have come in the county," she says. "But we're unclear about whether the county is prioritizing older adults in the allocation of those funds."

As a new co-chair for WHI, Moore has no doubt that all of WHI's workgroups will make deep inroads in their efforts, perhaps even more so than they have over the past decade. WHI is striving to expand its membership to include more community groups that are focused on social service delivery. The group will also be looking at emphasizing diversity, equity, and inclusion in its steering committee and operating principles.
Washtenaw Health Initiative co-chair Sharon Moore.
"It's a time of growth and transition for us that will continue to make the whole community better," Moore says. "We're acknowledging and celebrating not just what we've done, but anticipating the good work we'll be doing and where we'll be in the future."

Jaishree Drepaul-Bruder is a freelance writer and editor currently based in Ann Arbor. She can be reached at jaishreeedit@gmail.com.

Sharon Moore portraits by Doug Coombe. Stakeholder meeting photos courtesy of WHI.
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