Posts for UPHP Brief
UPHP Programs Update
2018 Upper Peninsula Community Health Needs Assessment
UPHP partnered with local health departments, hospitals, community mental health departments, and other health care organizations in the U.P. to help form the 2018 UP Wide Community Health Needs Assessment. This report brings together data and analysis from a regional community health needs assessment led by Western U.P. Health Department in conjunction with all other U.P. local public health departments and 26 additional partners who care deeply about the health of the Upper Peninsula’s more than 300,000 residents. All partners, including the project’s largest funder, the Michigan Health Endowment Fund, have contributed their energy, ideas and dollars to make this regional health needs assessment possible on an unprecedented scale – across 15 counties.
This report is intended to inform health practitioners, planners, policymakers, and the public. It can be read as a snapshot of the region’s health status and used to identify priorities for community health improvement. If knowledge is power, it is hoped that this report will empower citizens and health care professionals alike to work effectively for improved health and wellbeing in the Upper Peninsula.
Workforce Engagement Requirements Summary
This past June, Governor Snyder signed a new law requiring Healthy Michigan Plan (HMP) enrollees to satisfy a workforce engagement requirement in order to maintain coverage. Below is a summary of the requirements:
- Able-bodied adults age 19-62
- 12 exemptions, includes good cause temporary exemption
- Qualifying work and/or education events: employment, self-employment, or income similar to employment (yet to be defined), job training, vocational training, education directly related to employment, unpaid workforce engagement (i.e. internship), tribal employment programs, participation in substance use disorder treatment, community service with a 501 (c)(3) or 501 (c)(4) for up to three months, job search directly related to job training
- Average 80 hours per month, requires monthly self-attestation
- Audit process required (misrepresentation of compliance will result in coverage lock- out for one year)
- Three months of noncompliance allowed in a 12 month reporting period
- After three months of noncompliance, beneficiaries will lose coverage for at least one month and will be required to come into compliance before coverage is reinstated
- January 1, 2020 implementation
The workforce engagement requirement is part of the proposed amended changes to the HMP §1115 Demonstration Waiver Extension Request. Additionally, there are significant changes to member cost-sharing requirements, including:
- Once an individual above 100% federal poverty level (FPL) hits 48 months of cumulative enrollment they will be required to pay a premium of 5% of their income (no co-pays required) and complete or commit to an annual healthy behavior
- Includes medically frail exemption
- After 48 months of cumulative HMP eligibility, individuals will not be eligible for any cost-sharing reductions (FPL 100%-133%)
- Individuals not meeting the programs healthy behavior or cost-sharing requirements will have their coverage suspended until they come into compliance with the healthy behavior and cost-sharing requirements (re-enrollment the 1st day of the next available month)
- No change to those under 100% FPL, except eliminating gift cards for health risk assessment completion
- The Michigan Department of Health & Human Services (MDHHS) estimates that 1,500 individuals are above 100% FPL and have been on the program for 48 months that are not medically frail (figure doesn’t include those who have met a healthy behavior or take into account anyone in continuous failure to pay)
- July 1, 2019 implementation
- Requires amendment to waiver renewal (covering revisions and workforce engagement)
- Healthy Behaviors must be incrementally more challenging over time (likely policy/procedure review)
Additional information can be found on the MDHHS website.
Medicare Health Outcome Survey (HOS)
The Medicare HOS is the first patient-reported outcomes measure used in Medicare managed care. The goal of the Medicare HOS program is to gather valid and reliable clinically meaningful data that have many uses, such as targeting quality improvement activities and resources; monitoring health plan performance and rewarding top-performing health plans; helping beneficiaries make informed health care choices; and advancing the science of functional health outcomes measurement by assessing a members perceived health improvement or decline over time. Managed care plans with Medicare Advantage (MA) contracts must participate.
During the most recent HOS administration (2017 Round 20), Cohort 20 was surveyed. UPHP’s MI Health Link (MHL) members were surveyed in 2017 as part of Cohort 20. They will be re-surveyed in 2019 and UPHP will receive the results in 2020.
In June of 2018, UPHP received the baseline study results. Baseline data shows that UPHP MHL members reported worse physical and mental health than other Medicare members at both a state and national level. Data is hard to compare at these levels as UPHP MHL Medicare members are also Medicaid recipients. These dual eligible members are often more fragile than members with only Medicare. With care management assessments, interventions, and monitoring the 2019 member follow up survey results will give UPHP a better understanding of the impact care management is having on the MHL members.
Upper Peninsula Town Hall Meeting – Monday, September 10th
MDHHS and the Maternal Infant Strategy Group (MISG), in collaboration with regional partners, will be hosting town hall meetings to garner community input and support for the 2019-2022 Mother Infant Health Improvement Plan. The meetings will be held in 4 regions of the state, with invitations to anyone interested in improving the health of mothers and infants in Michigan. Goals for each meeting include introducing the plan, collecting feedback from the community to determine priorities and barriers to successful program implementation, and bridging community partners to work together to improve health outcomes.
UPHP Programs Update
Pregnant Women Dental (PWD) Benefit
Effective July 1, 2018, the Pregnant Women Dental (PWD) benefit is now available for our pregnant UPHP Medicaid Members. Female members between the ages of 21 and 55 were notified of this benefit change via a letter that went out in June. Additionally, information about the PWD benefit was added to the UPHP website, and the Medicaid Member Handbook was updated (see section 5: Pregnant Women).
The benefit is modeled against the dental benefits currently available to Healthy Michigan Plan (HMP) members. With this additional benefit, pregnant women are eligible to receive dental services throughout the duration of their pregnancies until three months after their due date (for specific coverage details, see the Delta Dental PWD Member Handbook). Pregnant members must notify either their Michigan Department of Health and Human Services caseworker or UPHP Customer Service of their pregnancy and due date in order to receive dental services through UPHP.
The dental provider network for this benefit is the same as it is for HMP; HMP dental providers were also notified of this benefit change via a fax blast sent out the last week of June. Providers were encouraged to fill out the new Notification of Pregnant Member Form and return it to UPHP within five business days of a positive pregnancy test.
Medicaid work requirements and UPHP
Melissa Holmquist, UPHP CEO, was interviewed by TV6 in early June to discuss the new Medicaid Work Requirement Bill and its impact on Michigan residents using the Healthy Michigan Plan. About 670,000 people in Michigan are on the Healthy Michigan Plan, about 19,000 of those in the Upper Peninsula. If this bill is passed, those people will have to prove that they are meeting these requirements to continue having coverage.
Advance Care Planning in the news!
A new state-funded Advance Care Planning (ACP) program helps individuals decide in advance on the care they will receive if unable to speak for themselves. Upper Peninsula Health Plan Advance Care Planning Program Manager, Kate LaBeau; Family Medicine Physician and Advisor, Jim Heron of Marquette; and Elder Law Attorney Paul Sturgul of Hurley, Wisconsin were on the latest episode of Media Meet to discuss ACP.
Watch Media Meet: Advance Care Planning
UPHP Launches Healthy Kids, Healthy Futures Campaign
“Healthy Kids, Healthy Futures” is a joint effort between Upper Peninsula Health Plan and Upper Peninsula Health Group designed to highlight the importance of annual preventative care for kids of all ages.
UPHP Clinical Coordinator Chris Rhoades joined the Sunny Morning Show in Marquette to share some of the highlights of this initiative.
Rhoades explains how UPHP is teaming up with roughly 25 different primary care practices across the U.P. and promoting the campaign throughout the Upper Peninsula. The overall goal is to make sure area children get the regular health care they need for a healthy future. The campaign runs through August 31st and there will be prizes for the provider practices that can get the most kids through the door as well as drawings for the kids who go in and get the care they need.
LISTEN IN – UPHP Clinical Coordinator Chris Rhoades with more about the “Healthy Kids, Healthy Futures” initiative.
(Courtesy of Great Lakes Radio)
For questions or concerns please email HealthyKids@uphp.com.
UPHCS Supports Health Coach Certification of Healthcare Providers across the Upper Peninsula
This past March, UPHCS initiated a project funded through its HRSA Small Health Care Provider Quality Improvement grant to provide network partners the opportunity to become certified health coaches through the National Society of Health Coaches. Over the last 17 weeks, 16 trainees (RNs, LPNs, MAs) from nine different grant network partner clinics started working on the project.
Health coaching is the use of evidence-based skillful conversation, clinical strategies, and interventions to actively and safely engage clients in health behavior change. Promoting patient centered care and empowering individuals to better self-manage their health, health risk, and acute or chronic health conditions results in optimal wellness, improved health outcomes, lowered health risk, and decreased healthcare costs. Some of the key core competencies trainees attained through the National Society of Health Coaches certification program include:
- Specialized, evidence-based health coaching skills of active listening, facilitating behavior change, and motivational interviewing
- Understanding change readiness and societal influences on behavioral change
- Goal setting processes and telephonic coaching techniques and best practices
The ultimate goal of this training project was to provide allied healthcare professionals across the U.P. with critical skills beyond their academic clinical training, degree, and credentials to better guide and support patients with acute or chronic conditions and/or moderate to high health risk.
Beginning in July, the newly certified health coaches will be further trained to panel manage a small “pilot” diabetic and/or hypertensive patient population. The panel management system will allow the coaches to actively monitor their patients’ preventative and chronic care needs. Health coaches will supplement their telephonic health coaching program by promoting patient participation in tobacco cessation, weight loss and maintenance, and stress management programs. Promoting the use of goal setting in current care management practices will ensure patients comprehend their care plans, and will allow healthcare staff to work collaboratively with patients on health care decisions to improve lifestyle choices and prompt behavior change. We will be measuring the impact of the health coach training program through patient satisfaction scores and clinical quality measures, which will be provided to us by clinic participants.
Health coaching gives healthcare providers a framework from which they can assist a patient to identify values, beliefs, and concerns that may support or hinder lifestyle change and one’s responsibility for health, wellness, and recovery. Health coaching replaces the traditional “do as I instruct you to do” model of healthcare and allows the patient to discover and explore why their ambivalence to health behavior change exists.
Please contact Claudia Chàvez-Krebs if you have any questions about the program.
Claudia Chàvez-Krebs, LPN
Quality Initiatives Program Coordinator
Upper Peninsula Health Care Solutions
Visit https://www.nshcoa.com/ to learn more about the National Society of Health Coaches program.
UPHP Programs Update
Dickinson County Healthcare System (DCHS) Update
In early June, Bellin Health, a Wisconsin-based health care system, announced it was terminating efforts to acquire Dickinson County Healthcare System (DCHS) after nearly six months of negotiations. The purchase agreement between the two entities was set to pay past debts, pension obligations and other financial liabilities. The final purchase price, however, was significantly more than what was originally estimated, resulting in the termination of the agreement.
This situation has left the people of Dickinson County with fear and uncertainty about the future of access to health care in their area. To help ease our members’ minds, we sent out letters last week to our Medicare and Medicaid members who see providers in Dickinson County. The letters ensured members that their Dickson County area provider is still in network with UPHP, and that DCHS is still providing services. This letter was sent to over 3,300 families and was done completely in-house.
In the meantime, DCHS is continuing its search for another partner. Until then, they will continue to provide care to the residents of Dickinson County and the Iron Mountain community.
Healthy Kids, Healthy Futures Campaign
The Upper Peninsula Health Plan (UPHP) and Upper Peninsula Health Group (UPHG) will promote the Healthy Kids, Healthy Futures campaign throughout the Upper Peninsula from July 1, 2018 through August 31, 2018. Various media such as radio, newspaper, Facebook, billboards and television will be utilized to promote the campaign. In addition, all participating practices will receive a participation packet with campaign and promotional materials for their individual practice use during the two month campaign.
The purpose of the Healthy Kids, Healthy Futures Campaign is to help keep children healthy by promoting well child visits. A well child visit is instrumental in the early detection of problems that could impact a child’s future.
For questions or concerns please email HealthyKids@uphp.com.
Neonatal Abstinence Syndrome – Supportive Care for Infants and Families
Upper Peninsula Health Care Solutions (UPHCS) recently received a $10,000 grant from the Superior Health Foundation to provide important education related to neonatal abstinence syndrome (NAS) and treatment of pregnant women with opioid use disorders to providers, allied health professionals, and public health and human services staff across the Upper Peninsula.
Through the UP Perinatal Collaborative initiative, UPHCS recruited three educator leads to travel the Upper Peninsula June 4th – 8th and provide training: Sandra Chapman, LBSW, CADC-M, Substance Use Disorder Coordinator at Northcare Network; Erika Osier, BSN, RNC-OB, C-EFM, Family Birthing Center & Neonatal Intensive Care Unit Clinical Educator at Upper Peninsula Health System – Marquette, and Kelly Kurin, MSN, RNCNIC, NNP-BC, IBCLC, Neonatal Intensive Care Unit Nurse Practitioner at Upper Peninsula Health System – Marquette. Over 150 people participated at the UP-wide events. Continuing Medical Education and Continuing Nursing Education credits were offered to participants and multiple sessions were held at the following locations:
- Marquette: Peninsula Medical Center / Upper Peninsula Health System – Marquette
- Hancock: Upper Peninsula Health System – Portage / Aspirus Keweenaw
- Ironwood: Aspirus Ironwood
- Escanaba: Island Resort and Casino
- Sault Ste. Marie: War Memorial Hospital
The incidence of NAS in the Upper Peninsula continues rise, and has emerged as an obvious focus area for quality improvement within the UP Perinatal Collaborative. A UP Perinatal Collaborative leadership steering committee will begin to review policies and procedures across Marquette County systems of care at a special meeting in June, and will be looking for ways to better coordinate services for mother with opioid use disorders during and post- pregnancy.
The CDC’s most recent data – from 2014 – indicates that NAS affects almost 12 out of every 1,000 U.S births, which is a dramatic increase from a rate of just over 1 per 1,000 births in 20001. According to the Michigan Department of Health and Human Services (MDHHS), NAS affects just over 4 out of every 1,000 births in Michigan. That rate has remained largely the same since 2010. The Upper Peninsula region has the highest incidence of NAS affected births with a rate hovering between 14 and 17 per 1,000 births since 2010; that is over twice the rate of almost every other region in the state. NAS and maternal opioid use in the UP was featured in a Detroit Free Press article released earlier this month: https://www.freep.com/story/news/local/michigan/2018/05/03/opioid-epidemic-drugaddicted-babies/335398002/
The objective assessment of newborns that have signs of NAS is essential for quantifying the severity of symptoms, providing guidance for pharmacologic treatment, and facilitating structured weaning. The Finnegan Neonatal Abstinence Scoring Tool (FNAST) is the most widely used assessment tool, which will also be a focus of the regional training sessions. The UP Perinatal Collaborative identified that standardization of this evidence-based assessment across birthing hospitals was needed. UPHCS and the Superior Health Foundation were happy to work together with the education team to fund and coordinate this training.
This region-wide training opportunity will help to standardize the way in which care providers and other service agencies address NAS in the Upper Peninsula. By improving the consistency with which babies suffering from NAS are assessed, our local health systems can improve care, increase the effectiveness of medication assisted therapy, and, ultimately, enhance the baby’s ability to grow and thrive.
UPHCS receives $65,000 from BCBS for Diabetic Retinopathy Project
UPHCS has been awarded a total of $65,000 in grant funding from the Blue Cross Blue Shield Foundation of Michigan – Investing in Upper Peninsula Health program, with $20,000 coming from a co-sponsorship provided by the Superior Health Foundation. The funding will be used to launch an initiative in Ontonagon, Houghton, Keweenaw and Baraga counties. Through partnerships with health care providers in the region (including Upper Great Lakes Family Health Centers, Upper Peninsula Health System-Portage, and Baraga County Memorial Hospital) the project will integrate telehealth technology into primary care clinics to increase access and availability of retinopathy screenings for diabetic patients in the region.
Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults in the United States. More than 40% of diabetics, aged 40 and older, have DR, many with a vision threatening form of the disease. Early detection and treatment of DR can significantly reduce vision loss. Although annual retinal screens for diabetic patients are recommended, the rate of diabetics in the UP who are getting their screens every year is below national benchmarks (as low as 23% in some populations). Many factors have been identified as contributing to these low rates, but the simplest explanation is that DR often has no symptoms until it is too late to treat and the shortage of eye care professionals in the region makes appointments inconvenient for patients.
The goal of the UPHCS DR Screening Telehealth project is to reduce the incidence of vision impairment from DR and other vision threatening illnesses among diabetics by reaching them in primary care clinics. Funding will be used to purchase digital retinal cameras and train staff in primary care clinics to acquire high-resolution digital retinal images from patients. Staff will then securely transmit relevant clinical data and images, for review by an off-site eye care professional, through a secure third-party network. These remote specialists then provide a report indicating the patient’s retinopathy level and make referral recommendations. Additionally, because it is not enough to simply identify patients with vision-threatening retinopathy, funds will be used to coordinate care and train local eye care specialists to screen the images so that they can take part in the process and help direct appropriate follow-up care for their patients in their communities. Primary care clinics benefit because the service is simple, inexpensive, and billable to most insurances. Eye care professionals benefit because they can conduct screens at their own convenience and bill insurances for the service. Most importantly, Patients benefit because they are more likely to get their annual DR screening and less likely to suffer vision impairment as a result.
UPHP Sees Changes at the Top
Transitions are happening in the leadership at the Upper Peninsula Health Plan organization.
Long-time Upper Peninsula Health Plan (UPHP) President and CEO Dennis Smith announced his retirement, effective July 1st, late last year, and as a result, COO Melissa Holmquist was named as Smith’s successor.
Smith and Holmquist both joined the Sunny Morning Show today to talk about the transition that is underway at the Marquette-based agency.
Smith talked about several of the key successes that have happened under his watch, including steady and consistent growth, and productive alliances in the U.P. health care landscape that have been facilitated by UPHP.
Holmquist shared some of her background with UPHP and what she hopes to see in the future of the group as she takes over the reins.
UPHP names Melanie Bicigo Chief Operating Officer
Upper Peninsula Health Plan announces Melanie Bicigo as Chief Operating Officer. Long-time Upper Peninsula Health Plan (UPHP) President and CEO Dennis Smith announced his retirement (effective July 1st) late last year, starting a waterfall of opportunity at UPHP. Melissa Holmquist was named Smith’s successor as CEO, leaving the position of Chief Operating Officer (COO) vacant. With extensive health plan experience, Melanie Bicigo brings invaluable knowledge and leadership to the COO position. Read more here.
UPHP Programs Update
Healthy Michigan Plan and Medicaid Work Requirements
As of April 2018, the Healthy Michigan Plan (HMP) had 689,724 enrollees or about 11% of the state population age 19 to 64. HMP enrollment in the Upper Peninsula is at 16,043. UPHP continues to make outreach calls to members (specifically HMP members) encouraging them to complete their Health Risk Assessment in the first 60 days of enrolling with their Primary Care Provider.
Senate Bill 897 would require able-bodied Medicaid recipients to work 29 hours per week. The bill does contain exemptions including those who are under age 18, older than 65, pregnant, have a disability, certain caregivers of dependents with disabilities, full-time students, medically frail or foster care youth age 20 or younger. The bill heads next to the House, where lawmakers in that chamber will debate it. It’s been referred to the House Appropriations Committee.
The bill would need to be approved by the full House and signed by Gov. Rick Snyder to become law.
The program would largely impact enrollees in HMP, which insures Michigan residents age 19 to 64 with an income below 133% of the federal poverty line, or about $16,000 for a single person or $21,600 for a two-person household (Gongwer, 2018).
Pregnancy Benefit Member Notification – Dental Services
Effective July 1, 2018, members who are or become pregnant are able to access dental services during their pregnancy and postpartum period directly through their Medicaid Health Plan. Pregnant members will be able to see dentists that are contracted as part the UPHP provider network. Members may also receive transportation to and from scheduled dental appointments.
To receive dental services the member must:
- Notify UPHP of the pregnancy and due date by calling the customer service number at
Members should also notify their caseworker of their pregnancy and due date.
Region 1 Perinatal Care System Collaborative Update
Upper Peninsula Perinatal Collaborative was formed in July of 2017 to support the Michigan Department of Health and Human Services’ (MDHHS) Regional Perinatal Care System goal of ensuring mothers and babies are healthy and thriving across in our region. A motivated and diverse group of stakeholders from across the region, representing Community Mental Health agencies, Federally Qualified Health Centers, Early Childhood Education and Early/Head Start Program agencies, the Michigan Public Health Institute, Tribal Health and Human Services, Health Departments, Planned Parenthood, Upper Peninsula Health Plan, Upper Peninsula Health Care Solutions and its network of member hospitals and hospital-affiliated clinics, are active participants of the Collaborative.
The Region 1 Collaborative is pleased to join the existing Regional Perinatal Care System Initiatives across the state, and support the shared goal of improving birth outcomes for mothers and babies, including the elimination of health disparities across its 15-county region. Neonatal Abstinence Syndrome (NAS) and maternal opioid use have emerged as key priority areas for our region, as the Upper Peninsula has the highest incidence of NAS in Michigan. The planning phase of the Regional Perinatal Collaborative, supported by funding from the MDHHS began in late 2017 and focuses on building a locally linked, coordinated network to support the highest standards of health for mothers and their babies in the UP.
2017-18 project activities include:
- Convening the UP Regional Perinatal Collaborative regularly and recruiting people, who represent organizations germane to our goals, to add to our roster of over 80 members.
- Researching, funding and promulgating workforce development opportunities that are pertinent to NAS and perinatal care for collaborative members.
- Through a partnership with the Michigan Public Health Institute, complete a multi-faceted cross-system needs, resources and opportunities NAS assessment for Marquette County.
Compilation, distribution and maintenance of resource directories targeted at mothers and families, health care providers, and service agencies in the Upper Peninsula.
Focusing on Social Determinants of Health and Building Our Resource Knowledge Base
Upper Peninsula Health Plan and Upper Peninsula Health Care Solutions worked together to coordinate an educational session with Community Action Alger – Marquette (CAAM) on Monday, April 23rd at UPHP. Corey Holcomb, Interim Director of CAAM provided UPHP and UPHCS staff with an overview of the nutrition, education, and housing services and supports CAAM offers to community residents. Research supports the increasingly apparent relationship between “upstream factors” (i.e. social determinants, such as income, education, occupation) and health status. Assisting UPHP members, UP residents, providers, and care teams in navigating social determinants of health (SDOH) supports will continue to be important in supporting quality healthcare delivery across our region.
Connected Communities for Health (CC4H) is Upper Peninsula Health Plan’s care initiative that aims to address its member’s social determinants of health in collaborating with community, state, faith based, and other non-traditional health care network partners to fulfil basic resource needs. UPHP Customer Service, Transportation and Clinical Departments also work with members on a daily basis, not only assisting members with their complex medical needs, but also resolving any social need(s) they may have. See more information about CAAM’s program offerings in Marquette and Alger Counties, prepared by Renee Anderton, Community Health Worker, CAAM program.
Are there other agencies serving UPHP members/UP residents that you would like to learn more about? Please contact Renee (firstname.lastname@example.org), and we may coordinate additional 1-hour education sessions in the near future.
Upper Peninsula Health Care Solutions Holds Telehealth and Opioid Forum