From Data to Action: A Michigan MCH Story

1. From Data to Action: A Michigan MCH Story Alethia Carr, RD, MBA Director - Bureau of Family, Maternal & Child Health Michigan Department of Community Health CarrA@michigan.gov Sheryl Lowe, RN, MA Director of Health Policy and Social MissionBlue Cross/Blue Shield of Michigan SLowe@bcbsm.com MCH Epidemiology Conference December 10-12, 2008 Atlanta, GA

2. Overview • Michigan’s Data Defined the Issue • Process Reflects Political Will • Professional Guidelines Development • Guideline Distribution • Lessons Learned

3. Modified from CityMatCH website

4. Michigan Demographics, 2006 • Total population: 10,095,643 - White: 82% - Black: 14.8% - Native Americans: 0.7% - Asian Pacific Islander: 2.5% • Female: 50.8% - 18-44 yrs. old: 35.9% • Live births (#): 127,537 • Birth rate (live births per 1,000 population): 12.6 • Fertility Rate (live births per 1,000 women 15-44): 61.8

5. Prevalence of intended and unintended pregnancies, 2006 MI PRAMS • Nearly half (47%) of the women with an unintended pregnancy reported not using contraception, underscoring the need for education about family planning and the benefits of contraceptive use.

6. Why is this important? • In FY 2000, the state Medicaid program paid for prenatal, delivery and post-natal care of about 26,000 unintended births1 • Each birth cost Medicaid $11,000, which translates to $286 million in costs for Michigan1 • If Michigan can reduce the number of unintended pregnancies by just 10%, > $27 million in Medicaid expenditures would be saved annually1 • Every $1 spent on family planning services saves an estimated $3 in medical costs. 2 • Michigan Department of Community Health • Guttmacher Institute, http://www.guttmacher.org/pubs/tgr/06/5/gr060507.html

7. The Vision • If all pregnancies were intended… • Reduction in infant mortality • Reduction in child abuse & neglect • Reduction in MA costs • Reduction in abortion

8. Governor’s Blueprint for Preventing Unintended Pregnancies 4 Initiatives • Plan First MA waiver for contraceptive coverage • Talk Early & Talk Often Helps parents of young children discuss sex • Contraceptive Equity Includes birth control in script coverage • New Clinical Guideline

9. Public-Private Partnership: Provider Task Force • 40-member statewide advisory group • Convened by Michigan Surgeon General Dr. Kimberlydawn Wisdom in September 2006 • Key State Staff leadership - Brenda Fink, Dir. Div. of Family and Community Health, MDCH • Chaired by Dr. Thomas Petroff, CMO of McLaren Health Plan & chair of Michigan Assoc. of Health Plans Medical Directors • In partnership with Michigan Quality Improvement Consortium

10. Laurie Bechhofer, HIV/STD Education Consultant, MDCH Maxine Berman, Dir. of Spec. Proj. – Gov. Off. Patty Cantu, Director, Off. of Career & Technical Preparation – Mi. Dept. of Labor and Economic Growth Jean Chabut, Chief P. H. Admin. Officer-MDCH Nancy Combs, Program Manager Off. of the MI Surgeon General – MDCH Brenda Fink, Director, Div. of Family & Community Health-MDCH Kyle Guerrant, Supervisor Coordinated School Health & Safety Prog. - Michigan Department of Education Gilda Jacobs, Senator Huntington Woods, District 14 Judy Karandjeff, Dir. MI Women’s Comm. Jackie Prokop, RN, BSN Fed. Reg. & Hospital Reimb. Sect.-MSA, MDCH Marilyn Stephen, Dir.of Child Support- Michigan Department of Human Services Carrie Tarry, Adolescent Health Coord. Div. of Family and Comm. Health - MDCH Jocelyn Vanda, Dir. of Interagency and Comm. Serv. – MI Dept. Human Serv. Kimberlydawn Wisdom, MD, Surgeon General – MDCH Pam Yager, Policy Advisor on Health Care and Financial Services –Govr. Office Interagency Work Group Members

11. Michigan Quality Improvement Consortium Working Together to Achieve Better Health Outcomes

12. Background • Leadership of Blue Cross Blue Shield of Michigan, HMO’s and other Michigan health care organizations commit to working together (Fall ‘99) • MQIC Vision: • To reduce health care costs and improve quality of care delivered to Michigan residents • To achieve consistent delivery of evidence-based medicine and services

13. Goals • Identify, adopt and promote common evidence-based clinical practice guidelines • Facilitate change in the process of care • Establish standard ways of collecting and reporting performance information • Develop tools to support implementation of guideline recommendations • Communication and coordination with concurrent quality improvement initiatives and organizational efforts

14. MQIC Structure Medical Directors’ Committee • Develop common evidence-based clinical practice guidelines • Provide direction and final decisions for MQIC • Establish common definitions of populations • Establish common measurement protocols consistent with MQIC guidelines • Coordinate MQIC communications • Coordinate health plan and physician activities that are complementary to MQIC activities Measurement Workgroup Implementation Workgroup

15. MQIC Participating Organizations • 13 Michigan health plans • Michigan State Medical Society • Michigan Osteopathic Association • Michigan Association of Health Plans • Michigan Department of Community Health • Michigan Peer Review Organization • University of Michigan Health System

16. Guideline Development Process • Clinical Topic Selection • Medical Directors’ Committee • Data demonstrating relevancy to the health plans’ population • Scientific evidence • Potential use of subject matter by primary care practitioner • HEDIS® measures • Internal/external requests for guideline development. • Research Literature • Computer database searches for published studies, existing protocols and/or national guidelines

17. Guideline DevelopmentProcess (Cont’d) • Draft Guideline • Several iterations may be required before consensus is reached on a final draft • Feedback Process • Feedback form • MQIC member organizations (e.g. health plans, Michigan Department of Community Health) • Medical Specialty Societies (e.g. Michigan Academy of Family Physicians, MI Chapter American College of Physicians) • Standard Disclosure

18. Clinical Guideline Development to Date • Acute Bronchitis • Low Back Pain • Unintended Pregnancy Prevention in Adults • Diabetes • Asthma • Tobacco Control • Depression • Heart Failure • Osteoarthritis • Osteoporosis • Substance Use Disorder • Hypertension • Hyperlipidemia • Deep Vein Thrombosis • Acute Pharyngitis in Children • Adult and Pediatric Preventive Services • Chronic Kidney Disease • Adult and Childhood Obesity • Routine Pre and Postnatal Care

19. MQIC Guidelines • MQIC guidelines are available on the National Guideline Clearinghouse (NGC) website www.guideline.gov • For more information on MQIC go to www.mqic.org

20. Provider Task Force Composition • Physicians- OB/GYN, Family Practice, Internal Medicine • Nurses/nurse practitioners/nurse midwife • Community-based/Medicaid and Title X providers • MDCH, MDHS, local public health • Health plans and health systems (medical directors, quality management, IT, provider education) • Universities/medical schools • School-based health care • Psychology/social workers • Those working with cultural minorities and underserved

21. CDC Recommendations “Recommendations to Improve Preconception Health and Health Care – United States,” Posner et. al., MMWR, April 21 2006 http://www.cdc.gov/MMWR/preview/mmwrhtml/rr5506a1.htm • Individual responsibility across the lifespan • Consumer awareness • Preventive visits • Interventions for identified risks • Interconception care • Pre-pregnancy checkup • Health insurance coverage for women with low incomes • Public health programs and strategies • Research • Monitoring improvements

23. Distribution and Sharing of Guideline • Key Target Audiences • Key Communication Partner types • Key Communication strategies • Communication Vehicles / Methodology • National Campaign

24. Lessons Learned • Measurable Objectives needed • Evaluation Plan developed at the beginning • Continued Data Analysis required