Fall 2009 | Vol 7#3
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2009-2010 MPCA Board of Directors Executive Committee
Chris Shea, President
Executive Director, Cherry Street Health Services, Grand Rapids, MI
Anthony King, FACHE, MHSA, President-Elect
Chief Executive Officer & President, The Wellness Plan Health Centers, Detroit, MI
Linda Shively, MPA, HCA, Secretary
Executive Director, Baldwin Family Health Care, Baldwin, MI
Michelle Styma, Treasurer
Executive Director, Thunder Bay Community Health Service, Inc., Hillman, MI
Laura Piascik, Health Center Board Member Committee Chair
Center for Family Health, Jackson, MI
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Upcoming MPCA Events
MPCA Marketing Network Webinar
Writing Effective Press Releases
November 17, 1 pm
Human Resources Network Conference Call
November 19, 10 am
Membership Committee Conference Call
November 19, 10:30 am
Health Policy Committee Conference Call
November 30, 4 pm
Executive Committee Conference Call
December 1, 4:30-5:30 pm
Corporate Compliance Training
December 1
Kellogg Hotel & Conference Center
East Lansing, MI
Click here for additional MPCA events, including committee, network, and workgroup conference calls and meetings.
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For up-to-date information about H1N1 and links to reliable sources of information like the Centers for Disease Control & Prevention and the Michigan Department of Community Health, click here.
Support Michigan’s Health Centers! Click here to sign up as a Health Center ADVOCATE today. Health Center Advocates receive e-mails about advocacy efforts, state and federal legislation affecting Health Centers, and Calls to Action to communicate with elected officials.
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From the Inside Out: Executive Director's Message
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by Kim E. Sibilsky, Executive Director, Michigan Primary Care Association
.jpg) Understanding the Term "Medical Indigency"
This is one of the most challenging economic periods I’ve witnessed. No one is untouched in this recession. If it’s not me, it’s a close friend or family member. And if it’s not unemployment, or lack of insurance, it’s illness.
I don’t know if it is my age, being just on the sunny side of 60, but I have begun to see economically stable friends and family stare medical indigency square in the face. Because I have advocated for universal coverage for three decades, I naively thought that lack of health insurance was the greater evil. Now I have come to understand that severe physical and mental illness result in loss of employment that then results in loss of income and insurance. This is the fast track to medical indigency.
I can now recount tales of injury resulting in Workman’s Comp, under which there is no insurance coverage and little income to pay down debt. There is a woman with a recent diagnosis of terminal cancer. If she doesn’t go back to work after 6 weeks of chemotherapy, she’ll lose her job and her insurance. Another has a rare autoimmune disorder that keeps her from working as a therapist. Her income falls as her high cost indemnity insurance premiums increase. And her debt grows. The reality of short term disability, unemployment and Social Security disability create a very gappy, episodic and skimpy economic safety net.
I have often joked that when universal coverage is implemented, I would then turn to rural economic development as the next frontier. Now I am thinking that my next frontier will be the broader challenge of medical indigency, with or without universal coverage. Many of us are really just one diagnosis away.
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Legislatively Speaking: A View of the State Capitol
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 by Douglas M. Paterson, MPA, Director of State Policy, Michigan Primary Care Association
In order to avoid a state government shut down at the end of fiscal year 2009 (actually in the early hours of the new year), the Michigan legislature passed a continuation budget for FY 2010 because lawmakers could not come to agreement on major cuts necessary to balance a $2.8 billion deficit. This gave the legislature and Governor Granholm a 30-day window to finalize all state budgets. The Governor had proposed addressing the deficit through $684 million in new revenues, $862 million in spending cuts, and the remaining $1.2 billion with stimulus funding. The House proposed $525 million in cuts with $2.2 billion to be covered by stimulus funds, and the Senate proposed $1.2 billion in cuts with $1.6 to be covered by stimulus funds.
After some negotiation, House Speaker Dillon compromised with Senate Majority Leader Bishop to direct conference committees to use the $1.2 billion cut figure as the target, with the belief that after this level of cut was understood, there would likely be softening on the need to address some level of increased revenue as the cuts would be “drastic”. The budgets were then passed, cutting $1.2 billion.
After attempts to pass revenue bills, the most contentious being the 3% provider tax, it became obvious there would not be support for increased revenue and the final budgets were signed by Governor Granholm on October 30 – just short of another possible shut down.
What do these cuts mean for families in Michigan? Some of the broad stroke cuts include:
- Cuts to child care subsidies for low income families which allow people to work
- Overall funding reduction for foster care (children who are abused and taken care of by others)
- Elimination of funding for zero-to-three child abuse prevention services
- Cuts to before and after school programs
- Reduction in per pupil funding for schools
- Reduction in Intermediate School District funding
- 50% funding cut to the Great Start Readiness program
- 25% funding cut to adolescent Health Centers
- Elimination of funding for dropout prevention
- 8% funding cut to Medicaid reimbursement
- Continued elimination of optional Medicaid benefits including adult dental services
- Reduction in funding to local health department
- Elimination of the Nurse Family Partnership program in the state's highest risk communities
- Reduction in funding for the Healthy Michigan Fund from $25 million to $11 million (the only monies dedicated to health PREVENTION) and elimination of funding for 16 of 27 programs including infant mortality reduction, lead poisoning prevention, and physical fitness and nutrition
- $40 million cut to mental health funding for people not on Medicaid
- Elimination of funding for respite care for families with children with serious emotional disturbances
- Increased fees for families in the Children’s Special Health Care Services program and elimination of transportation services for these families to get to specialists
- 75% funding reduction for protection and advocacy services for persons with mental illness and developmental disabilities
Look at this list - who is most affected? It appears to be many of the same families we serve in Community Health Centers. Many programs that have PROVEN to be effective in helping families in Michigan and to save money to our public systems over the long run are being sacrificed. The worst news is that next year will be even more problematic. The federal stimulus monies that have been helping us avoid even more cuts will be dwindling and no longer available after 2011.
What must be done to keep this state from totally uninvesting in the education, health and protection of our citizens? We need legislators who will implement meaningful reforms and modernize the current tax structure.
Reforms must include:
- Elimination of tax credits, exemptions, and incentives for companies or industries failing to create and retain jobs or otherwise proving the cost effectiveness of the credit, exemption, or incentive (Michigan currently gives away $37 BILLION in such measures)
- Consolidation of jurisdictions and operations such as health departments, school districts, townships, police and fire, and road commissions, where possible
- Conducting performance audits on government contracts for efficiencies and accountability
The tax structure considerations must include:
- Moving to a graduated income tax structure by adjusting the tax base and more fairly distributing the tax burden on our state’s citizens
- Expanding the state’s sales tax to include luxury and non-essential services which would generate as much as $1.65 billion in new revenue; this would not include business-to-business, health care, legal or child care services
- Reforming Michigan’s tax code to enable collection of taxes on estates over $2 million by de-linking our state income tax from the federal estate tax, generating $160 million more per year
What keeps this from happening? It's the perception on the part of some legislators that most voters don’t want their taxes raised even if it means cuts such as these and even worse cuts in the near future. Many don’t believe the public cares if our state begins to deteriorate our education, health care, safety and other governmental infrastructure.
It is ultimately up to US to convince them otherwise. We must have conversations with all those we can influence to hold our elected officials accountable for where our state is headed. We need them to hear that we will not re-elect them if they continue to ignore what has to be done. The future of our state is truly in our hands for what we have them do. They cannot allow our state to continue on the course we are currently on and we will hold them accountable for changing that course. If things don’t change, we will elect people who will seek the change we need. They must hear this from you!!!
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Community Health Centers Ready to Play Key Role in Reformed U.S. Health Care System
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As the health care reform debate heads into the home stretch, Community Health Centers stand ready to serve as the health care home of choice for millions of U.S. residents seeking quality, comprehensive, accessible health care they can afford.
The nationwide network of 1,200 Community Health Centers located in communities from coast-to-coast and border to border have a track record of success in reducing health disparities and reducing cost. Their doors are open to the young and the old, the rich and the poor, the healthy and the sick, the insured and the uninsured, and their fees are based on patients’ income.
One of the primary goals of reforming the U.S. health care system is to ensure that more people in America have health insurance. Those who lack health insurance often go without preventive and primary care they need to stay healthy. Others also go without ongoing care of chronic conditions like diabetes, asthma, and heart disease. No one should have to suffer without the health care and prescriptions they need to live quality, productive lives.
However, even if everyone in America woke up with a health insurance card tomorrow, they’d still need a place to go to for care—a health care home. Community Health Centers are being recognized as that place. Thirty-two Community Health Centers in Michigan are already serving as the health care home for over half a million of the state’s residents—and the numbers are likely to continue to grow.
Community Health Centers address all the needs of a patient, including primary, preventive, oral, pharmaceutical, and mental health/substance abuse services. They even provide translation, transportation, and eligibility assistance—all in a culturally sensitive way—to remove common barriers to accessing health care. Even if insured, many patients remain isolated from health care due to where they live, the language they speak, and their complex health care needs. Through their comprehensive nature, Community Health Centers are committed to increasing the quality and years of healthy lives for all U.S. residents. The prescription is simple - treat people before they get sick and require care at a hospital.
So a key component of heath care reform should be to ensure that there are enough Community Health Centers for the growing number of people who need them.
Michigan Primary Care Association applauds the House leadership for recent passage of its landmark health care reform legislation (HR 3962), including U.S. Rep. John Dingell (D-MI) who was the bill's lead sponsor. He has advocated for health care reform his entire career, continuing his father's legacy by introducing a national health care reform bill each year he has been in Congress. MPCA also thanks Michigan's House members who voted in support of HR 3962: Reps. John Conyers (D-14), Dale Kildee, (D-5), Carolyn Kilpatrick (D-13), Sander Levin (D-12), Gary Peters (D-9), Mark Schauer (D-7), and Bart Stupak (D-1).
HR 3962 includes new guaranteed funding for Health Centers over the next five years through a Public Health Investment Fund, which would allow Health Centers to dramatically expand their primary health care capacity and enable them to serve up to 20 million new patients by 2015. A recent study by George Washington University showed that if Community Health Centers were expanded nationwide to accommodate an additional 20 million patients, the health care system would save $212 billion over the next decade. And the savings isn’t realized at just the federal level. A Michigan-specific study found that Michigan Community Health Centers saved the State of Michigan over $42 million in 2007.
MPCA also applauds Sen. Debbie Stabenow (D-MI) for supporting Community Health Centers as partners in health care reform. She voted in favor of amendments to the Senate Finance Committee's health care reform legislation, America's Healthy Future Act of 2009, which are critical to strengthening Community Health Centers and expanding access to health care for their patients. Passage of these amendments signals solid support for the role Community Health Centers will play in health care reform and this nation's future health care system.
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Health Centers Are on the Map
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Community Health Centers were among the first recipients of stimulus funding through the American Recovery and Reinvestment Act (ARRA) earlier this year. Twenty-nine Michigan Community Health Centers have received a total of nearly $35 million in one-time funding to enable them to quickly begin responding to increased demand for health care from people who are unemployed, uninsured, or underinsured in today's economic crisis. The goal: Helping those in need access quality health care that they can afford where they need it, when they need it.
"Since ARRA was signed into law by the President, many stimulus checks have been cut and cashed, and Health Centers have moved forward with a burst of plans, expansions and new staff hires," said Amy Simmons, Communications Director, National Association of Community Health Centers. "Now that the dust is settled, the big question remains: Is the stimulus working or did funds build another bridge to nowhere?"
To show how Health Centers are using the stimulus dollars, Michigan Primary Care Association released a report in August titled, "The Right Medicine at the Right Time, But Not the Cure," and the National Association of Community Health Centers launched a dynamic Health Center stimulus map that provides data and stories from Health Centers across Michigan and the country about how they used the funding to expand access to care and create jobs. Some other examples are listed in the article "Michigan Health Centers in the News," found below.
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Two Michigan Health Centers Chosen to Participate in Innovative Patient Care Improvement Initiative
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Michigan Primary Care Association is pleased that Altarum Institute has selected two Michigan Community Health Centers from a remarkable pool to participate in its Community Health Center (CHC) Innovation Mission Project.
Community Health Centers, which provide quality, comprehensive primary and preventive health care using a highly decentralized and community-centered model, represent a rich source of examples of health innovation in practice. Through the CHC Innovation Mission Project, Altarum Institute will partner with Baldwin Family Health Care (Baldwin) and Cherry Street Health Services (Grand Rapids), in addition to two other Health Centers from other states, to improve care and enact lasting changes among these Community Health Centers.
“In the nonprofit world – that frequently focuses its scarce resources on remediating low-performing programs – it is refreshing and exciting to see Altarum Institute’s Mission Projects focus expertise and resources on developing in situ laboratories in high performing Health Centers like Baldwin Family Health Care and Cherry Street Health Services to foster cutting-edge innovation,” said Kim Sibilsky, Executive Director, MPCA.
During the year-and-a-half project with Cherry Street Health Services, Altarum staff will support the Health Center in its efforts to employ a team-based approach to managing chronic health conditions with the goal of achieving full integration of behavioral health and primary health care services. According to Cherry Street Health Services’ Executive Director, Chris Shea, “With the expertise of Altarum, we will unite professional staff towards a unified treatment plan in which differences between medical and behavioral components will be nearly transparent.”
The partnership between Altarum and Baldwin Family Health Care (BFHC) is designed to improve patient care and further the advancement of BFHC's ongoing efforts to implement the patient-centered medical home model. This model aims to achieve better patient outcomes at a lower cost by coordinating care, emphasizing prevention, and integrating behavioral health and public health services with medical practice. By implementing “lean” process tools, the goal is to reduce patient wait times and increase provider productivity.
“The opportunity to partner with a national leader in research-based innovations that can help us improve care for our patients doesn’t come along very often,” said Linda Shively, President and Chief Executive Officer of Baldwin Family Health Care. “We are very pleased to have been selected by Altarum to be part of this effort.”
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MPCA Receives Funding to Find, Enroll Children in CHIP and Medicaid
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Michigan Primary Care Association is among 69 grantees in 41 states to receive new funding from HRSA to find and enroll children who are uninsured but eligible for either Medicaid or the Children’s Health Insurance Program (CHIP).
“The facts in Michigan are clear – the number of uninsured children in our state is on the rise. From 2006 to 2007, the percentage of uninsured children in Michigan rose from 4.7% to 6.2%; for the youngest in our state, the rate jumped from 4.6% to 7.8%,” said Rebecca Cienki, Director of Policy & Planning, MPCA. “Additionally, the latest KIDS Count data shows over 450,000 children are living in poverty in Michigan, of which 202,325 are uninsured.”
Using the $915,079 in grant funding it was awarded, MPCA in collaboration with the Michigan Association of United Ways will enroll approximately 12,000 children eligible for Healthy Kids, Michigan’s Medicaid program for children, or MIChild, Michigan’s CHIP, through a statewide grassroots enrollment initiative over the next two years.
Outreach specialists will conduct enrollment activities in schools, homeless shelters, migrant camps, faith-based organizations, food banks, businesses, and other locations in order to reach eligible but uninsured children. Identified children will be enrolled through the comprehensive benefit access system, a “one stop” enrollment tool that enables families to apply not only for MIChild and Healthy Kids benefits, but also for other public benefits such as food assistance, child care, and earned income tax credits.
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MPCA Receives Funding to Expand Use of HIT in Health Centers
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With the end goal of expanding health care services to low-income and uninsured individuals, the U.S. Health Resources and Service Administration has awarded $27.8 million under ARRA to Community Health Center-controlled networks and large multi-site Health Centers to implement electronic health records and other health information technology innovations.
The Michigan Primary Care Association Health Information Technology (HIT) Network is among 18 grant recipients, receiving $1,863,409 to support electronic health record implementation.
“Michigan Primary Care Association will use the funds to match technology through its application services provider, Virtual CHC, with Community Health Centers through the MPCA HIT Network to provide Health Center staff with an excellent user-friendly Electronic Health Record system and sophisticated data warehousing systems,” said Fay Thiel, Director of Network Development, MPCA. “This will enable Health Centers to provide their patients with the highest quality care, while enabling them to meet their unique management and reporting requirements.”
Five Michigan Community Health Centers will participate in this project that includes health outcomes benchmarking and ongoing evaluation of diabetes, cardiovascular disease, and childhood immunizations. Baldwin Family Health Care (Baldwin, MI), Cherry Street Health Services (Grand Rapids, MI), Family Medical Center of Michigan (Carleton, MI), and Ingham County Health Department (Lansing, MI) will integrate functions, share data to improve Health Center operations, and maximize efficiencies.
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MPCA Launches New Web Site
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Michigan Primary Care Association recently launched a new web site at www.mpca.net, complete with new bells and whistles (like a Health Center locator and searchable keywords) in addition to old favorites. Please check back often to learn about Michigan Community Health Centers and subscribe to our RSS feeds to stay up-to-date on events, news, blog posts, and career opportunities.
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