Lansing, Mich. – Nine Michigan health plans from across the state submitted 28 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. 24 at the Radisson Hotel in Lansing. UnitedHealthcare Community Plan and Physician’s Health Plan each captured two awards the competition. Other winners include McLaren Health Plan, Meridian Health Plan, Health Alliance Plan, Upper Peninsula Health Plan, Priority Health and Total Health Care.
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 integration to raising awareness of antibiotic prescribing practices.
“As our members face the challenges associated with an uncertain and changing landscape, they continue to improve and innovate,” said Dominick Pallone, executive director of MAHP. “These innovations provide better care and reduce costs – or do both for Michiganders. 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 selecting winners in various categories for Commercial, Medicaid and Medicare health plans.
Full details on each winner are available below:
2019 Business Operational Performance – Commercial
Physicians Health Plan embarked on a course to streamline the pharmacy prior authorization process through their Prescription for Palatable PA’s program and reduce the volume of status calls received by customer service staff. The pharmacy turnaround time was shortened incrementally over six months. This was accomplished by aligning a pending log with each shortened timeline, creating daily reporting, analyzing the impact of workload on staff and streamlining the authorization process.
Improved communication between pharmacy and customer service, as well as realignment and automation of processes, greatly reduced the time spent on PA requests and responding to inquiries from providers and members. This created a palatable solution to a necessary process and realized an approximate annual savings of $100,000.
2019 Business Operational Performance – Government Programs
Imagine the challenges of coordinating health care for a child with special health care needs. These children have overwhelming disabilities that affect their entire family. Often, these families are lost in the health care system with no support for their conditions which require specialized care. McLaren Health Plan’s “Move on Up” program, helps children move up from their current Medicaid benefits by qualifying for additional benefits through MDHHS’ Children’s Special Health Care Services (CSHCS).
The goal of “Move on Up” is to help these families meet their challenges on a daily basis. A child in “Move on Up” receives open access to their own McLaren nurse, availability to a broad range of medical care facilitated by their primary care physician, coordinated collaboration between medical professionals, Community-based services to help care for the child at home and assistance navigating the health care system.
2019 Clinical Service Improvement – Government Programs
The Long-Term Services and Supports (LTSS) Waiver program of the Ml Health Link Medicare-Medicaid Plan (MMP) dual demonstration project provides services that allow members to remain independent and live safely at home rather than in a skilled nursing facility. Understanding the importance of helping this vulnerable population, HAP invested in additional highly skilled staff, resources and enhanced processes to maximize the impact to its members in Wayne and Macomb counties.
As a result, HAP has excelled at identifying members who qualify for these services, with 100 percent of its waiver submissions being approved by the state. HAP leads the state in number of total waivers approved by the state as well as percentage of approved waivers (compared to total MMP membership), which has increased from 66 waivers/1,000 members to 146.2/1,000 since 2017. Every HAP member with a waiver is living at home.
2019 Chronic Disease Management – Medicaid
Utilizing a Housing + Health, a Housing First Plus model to provide stable housing for highly vulnerable, complex Medicaid members with incorporation of trauma-informed principles and person-centered planning is showing improvement in utilization and health outcomes. UnitedHealthcare Community Plan and those who work with our members utilize the same care philosophy for engaging members in behavior changes. The program was evaluated by monitoring claims data and member stories which show an 83 percent decrease in member cost, a 20 percent reduction in inpatient admissions and 17 percent reduction in ER visits. While the cohort is comprised of six members this approach and model is promising and something that can be replicated to larger groups or other geographic areas.
2019 Chronic Disease Management – Medicare
MeridianCare implemented Better Health Together, a multidimensional Medicare Community Engagement campaign, focused on improving the quality of life for Medicare members. This campaign concentrated on simplifying access to care, reducing health disparities for African Americans in Metro Detroit, and improving chronic conditions. Meridian hosted four events in 2018 where health services such as functional status assessments (FSAs), pain assessments (PAs), medication reviews (MRs), and chronic condition management were provided.
This campaign combined health services with education to improve chronic conditions and saw a 22.54 percent improvement in controlled blood pressures (CBP). Additionally, the campaign saw the FSA disparity rate decrease by 14 percent, PA disparity rate decrease by 18 percent, and the MR disparity rate decrease by 21 percent for African American populations. The Medicare Community Engagement campaign completed 591 services throughout Metro Detroit and effectively reduced average event costs to $13.72 per care gap.
2019 Integration – Medicaid
United Healthcare Community Plan (UHCCP) has established a care management team that is dedicated to improving the health of our most vulnerable members experiencing both behavioral and physical health challenges. This team works with members who have chronic health conditions and serious mental illness and/or substance use disorders including a focus on members with diabetes and either schizophrenia or bipolar disorder. Our clinical culture is based on the foundation of person-centered care in which our care managers apply the concepts of harm reduction, trauma informed care, adverse childhood experiences, and the stages of change model.
UHCCP continually measures the impact of the Behavioral and Physical Health Integration work, looking at Total Medical Cost PMPM, inpatient and emergency department (ED) utilization, and HEDIS performance on two key measures – diabetes screening for people with schizophrenia or bipolar disorder who are using antipsychotic medications (SSD) and diabetes monitoring for people with diabetes and schizophrenia (SMD).
Upper Peninsula Health Plan (UPHP) launched a remote patient monitoring (RPM) program to demonstrate the clinical and economic impact of RPM to its Medicaid members with at least one chronic disease diagnosis and comorbidity.
UPHP partnered with care managers across six primary care clinic sites to select members for program participation, evaluate biometric data, and encourage treatment intervention and member behavior change based on real-time biometric data and trends. UPHP’s approach to RPM program management promotes close health plan and provider collaboration, which has presented opportunities for refinement of individual care plans to better meet members’ health care services, pharmacy, and social determinants of health needs.
Deployment of RPM devices in the primary care setting has been a successful tool to improve clinical outcomes and decrease overall medical costs. Across UPHP’s cohort analysis, the total 2018 cost savings attributed to the program is $24,451.
2019 Communication and Public Relations Campaign
In 2016, Physicians Health Plan embarked on an initiative, Promoting Antibiotic Awareness—A Community Education Initiative, to raise awareness regarding safe antibiotic prescribing practices. Efforts encompassed providers, members and the community. PHP developed targeted initiatives, incentives and education utilizing newsletters, health-system television, social media and health fair settings. Success was tracked through HEDIS measures: Appropriate Testing for Children with Pharyngitis, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, and Appropriate Treatment for Children with Upper Respiratory Infection.
PHP experienced significant improvement in all HEDIS measures demonstrating a positive change in the perception regarding antibiotic use. Increased awareness of appropriate antibiotic use is a major step toward decreasing antibiotic resistance; reducing unnecessary health care spend and improving the overall health of the Greater Lansing community.
2019 Community Outreach by a Single Plan
In working closely with our medically complex children the Children’s Special Health Care Services and their families, Priority Health quickly identified the needs and gaps in knowledge related to care coordination between these families and the community providers that serve them. In response, they launched the Medically Complex Children’s Information Sharing Events. These quarterly events were created to provide a venue for health care providers and community partners that specifically work with the CSHCS population, to network, share information, establish referral pathways and work collaboratively. The outcome is greater care coordination and the ability to access the many resources that are available and often underutilized within our community
2019 Collaborative Community Health Initiatives
Research has shown that patients experiencing housing instability have limited access to preventive care and are more likely to have chronic conditions and high medical costs. Total Health Care (THC) teamed up with Detroit Medical Respite to address housing instability issues for members of the Detroit community through the Salvation Army Medical Respite Program.
THC makes referrals and pays claims to the program so they may offer assistance to enrollees who are at risk. Since implementation, 82 members have been referred. Of those members, THC analyzed the utilization data of eight members who have been out of the program at least 12 months. THC paid $42,450 in claims to the respite program. However, in the 12 months after exiting the respite program, these members have greatly reduced their utilization of emergency and inpatient services. For those eight members, THC has shown a cost savings of $320,748 in that short period of time.