Ten Michigan health plans from across the state submitted 25 ground-breaking programs to the Michigan Association of Health Plans Foundation Annual Pinnacle Awards, demonstrating creative approaches to innovation in the commercial, Medicare and Medicaid sectors to improve health care and lower costs for Michigan citizens.
The winners were presented at a reception on Tuesday, Sept. 18 at the Radisson Hotel in Lansing. Meridian Health Plan captured five awards and Health Alliance Plan received two in the competition. Other winners include Physicians Health Plan and McLaren Health Plan.
MAHP shares the winning programs among members, helping them adopt best practices throughout the state’s health plans. This year’s winners address issues from alcohol and substance abuse disorders to improving patient outcomes through community based partnerships.
“As our members face the challenges associated with an uncertain and changing landscape, they continue to innovate, improve and inspire,” said Dominick Pallone, executive director of MAHP. “The people of Michigan are the big winners, as these innovations provide better care, reduce costs – or, often, do both. The Pinnacle Awards continue to serve as an emblem of excellence to the member plans that are recognized with the award.”
Health plans submit new programs to a judging panel comprised of health care experts, leaders of other Michigan associations, and Lawmakers. The panel reviewed submissions in depth before choosing winners in various categories for commercial, Medicaid and Medicare health plans.
Full details on each winner are available below:
2018 Business Operational Performance – Commercial
In 2016 Physicians Health Plan implemented an innovative model combining the use of evidence-based guidelines with a clinical decision support system, to provide timely authorizations for outpatient rehabilitation visits. An analysis of outpatient rehabilitation data revealed utilization 150 percent above industry benchmarks and significant variance in practice patterns between providers. This initiative resulted in a streamlined process at PHP, a reduction in utilization variances between rehabilitation providers, and a closer alignment to industry utilization benchmarks that saved over $250,000 in health care spend.
2018 Business Operational Performance – Government Programs
Using innovative population health strategies and advanced integrative technology, MeridianHealth launched the Member Clinical Profile (MCP) as a tool for Care Coordination to utilize while assisting our members. The profiles have streamlined the process of member case investigation and provide a holistic view of the member. This helps decrease the amount of time spent and increases the quality of case reviews. The MCP saves Care Coordinators 15 minutes per case investigation and amounts to a $4,375 savings for Meridian each day.
2018 Clinical Service Improvement – Commercial
In 2016, HAP implemented an NICU Care Management Program to improve health outcomes of premature and medically complex newborns. This partnership improved the care coordination process, including prenatal engagement, by focusing more attention on medically complex newborns, and providing them and their families with at-home and hospital care from birth to first birthday. Since implementing this program, HAP has seen a decrease in NICU readmissions of 60 percent, which resulted in cost savings of $1.02 million in the first year of this program.
2018 Clinical Service Improvement – Government Programs
In 2017, MeridianCare, Meridian’s Medicare line of business, facilitated a Colorectal Cancer Screening (COL) initiative by inviting members to complete this service conveniently within the privacy of their home. Fecal immunochemical test (FIT) detects small amounts of blood in stool, which may indicate pre-cancerous polyps, also known as colorectal cancer. Mailing kits directly to members is an alternative screening option and improves the likelihood of members being tested. Colorectal cancer symptoms are easy to overlook, therefore educating members about the benefits of routine screenings is essential. The success of the program is evident in the high response rate of 26 percent, resulting in an 18 percent improvement of the Medicare quality COL measure.
2018 Chronic Disease Management - Medicare
HAP realized that its 2018 one-star Osteoporosis Management in Women Who Had a Fracture (OMW) HEDIS score meant that older female members at-risk for osteoporosis weren’t receiving the best medical outcomes, primarily due to multiple bone fractures. After investigating, the team learned that educating members about the importance of bone mineral tests and other medical treatments within six months of their initial bone fracture reduced the chance of subsequent bone fractures.
As a result, HAP’s OMW rate for 2019 (based on July 2016 – December 2017 data) is projected to improve by two stars.
2018 Integration - Medicaid
MeridianHealth (Meridian) has implemented the Healthy Michigan Plan (HMP) Community Health Outreach Workers (CHOW) referral process for alcohol and Substance Use Disorder members who identify this healthy behavior via the HMP Health Risk Assessment. The CHOWs perform home visits to provide education, refer to community resources, and address barriers identified through the CHOW consultation. Members are provided with community resource information, support groups, and community agencies that will assist the member with their SUD and alcohol addictions. Over a12 month period, Meridian’s CHOW program had an overall cost impact of $51.96 per member per month.
2018 Communication and Public Relations Campaign
Providing a health insurance marketplace plan remains an affordable option for many individuals who may have not access to healthcare coverage. As a result, MeridianChoice implemented a social media campaign with the ultimate goal of increasing awareness of the health insurance marketplace and promoting best practice health tips. Due to this, Meridian’s 170 social media posts in 2017 led to a considerable increase during open enrollment. Campaign results also revealed an increase in social media impressions, engagements and clicks. Overall, Meridian’s social media fan base increased by 367.9 percent, indicating a strong return on investment.
2018 Community Outreach by a Single Plan
MeridianHealth recognizes that the health of its members can be greatly impacted by circumstances outside of the traditional healthcare system. This can include food security, access to safe housing, having reliable transportation, and other social determinants of health. Meridian is actively integrating social determinants of health needs assessments to stratify members and geographic locations by health risks and social needs. A total of 6,755 members were referred to a CHOW in 2017, resulting in 921 successful connections to resources, a 13 percent success rate.
2018 Collaborative Community Health Initiatives
Better Together is a community-based collaborative partnership between the Health Department of Northwest Michigan and McLaren Health Plan, designed to help rural members establish a solid relationship with their primary care provider. The focus is on adults who over-utilize the emergency room, women needing preventive screenings, and children who need primary care. This population can be very difficult for the health plan to reach so the Health Department community health workers (CHWs) initiate face-to-face contact with members.