Nancy Baum is the health policy director with the Center for Health and Research Transformation (CHRT) at the University of Michigan. She leads CHRT’s health policy projects and research in health care reform, health status improvement, local public health, and behavioral health.
In this Q&A, Baum discusses CHRT’s latest research projects, behavioral health legislation, and the future of Medicaid enrollment in Michigan.
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State of Reform: What is the most important thing happening in your work right now? What can we expect from CHRT in 2022?
Nancy Baum: “The public health emergency is what’s driving so much of what we all work on today. It’s really important to think about the impact when the public health emergency ends. When a public health emergency is declared, we both have an economic downturn—which makes people more Medicaid-eligible—and we also have a law that states that all who are currently covered by Medicaid must continuously be covered during the emergency.
So when the emergency ends, what’s going to happen to the people who have been continuously covered who haven’t been through their redeterminations? When people end up going through this redetermination process, there may be a very high disenrollment rate. This is to the tune of hundreds of thousands of people in the state of Michigan alone. Some people are going to be eligible for marketplace coverage, but some people aren’t. For some people, it’s just very difficult when they go through the redetermination process to be able to get all the things they need in order to qualify. So we’re really worried that a lot of people are going to become uninsured.
I think a lot about our behavioral health system and the system changes that are being proposed in the legislature. Currently, Medicaid dollars flow through our PIHPs (Prepaid Inpatient Health Plans) and there are ten of those in the state, and then they fund the [community mental health centers]. Senator Shirkey has proposals in the Senate now that would essentially privatize that public behavioral health program. We are already seeing evidence of negative impacts on behavioral health because of the pandemic. I think about whether the state is going to go through with that particular change and what that’s really going to mean for the people who receive services.
We also work on a lot of projects that are related to addressing social determinants of health (SDOH). So we’ve had incentives in Michigan for physician organizations and health systems to begin to collect some data from patients about what their social needs are. We’re just starting to really put some shape around how we share that SDOH data and how we coordinate care between people in community based organizations.”
SOR: How is CHRT trying to minimize the impact of this mass Medicaid disenrollment we might see? How might this affect policy this session?
NB: “At the end of the public health emergency, states have 12 months where they can figure out exactly who is no longer going to qualify for Medicaid. During that time, there are opportunities for communities to come together to try to keep as many people enrolled as possible. They can try to move those who don’t qualify for Medicaid into the marketplace where they might be able to get a private plan that’s quite subsidized. Hopefully, the economy will pick up and many people get jobs that have health insurance associated with [their] job.
We at CHRT also try to do things like this to get information out to a broader swath of people so that more members of the public understand that at the end of the public health emergency might come with some struggle. We can help people get the information that they need for folks who are doing the enrollment so they can stay involved if they still qualify.”
SOR: How are you thinking about the specialty integrated plan legislation being discussed?
NB: “There’s decades of evidence that show integrating physical and behavioral health care services for individuals really matters. It has a very positive impact on health outcomes. What these bills are talking about is financial integration. So, whether there’s a direct connection between creating the best financial integration that then turns into the best physical and behavioral health services integration is the question. I think that what you see here is an important philosophical difference between whether there should be a publicly funded behavioral health system or whether Medicaid health plans could do a better job in terms of ultimately getting that care integrated at the delivery level.
You have individuals who have been receiving this care and have very deep and long-term relationships with providers. They worry that if the system changes, they couldn’t still get the care from the providers with whom they have those relationships. That the patient-provider relationship may not be retained in the same way. On the other side, I think there are some studies that point to the ability for Medicaid health plans to deliver high quality care.”
SOR: Can you tell me more about CHRT’s meaningful projects you’re working on around setting up care coordination systems around the social determinants of health?
NB: “Years ago, some federal dollars came to the State of Michigan that was referred to as the state innovation model, to fund programs to coordinate health and social services. So, we are working very hard to sustain that work in many communities. In Washtenaw and Livingston Counties, together as one community, we have a program that we call My Community Care that is really helping to bring care managers together.
Care managers in a community based organization, managers based in housing, or transportation for the elderly are brought together to create an electronic platform where they can talk to each other about caring for the individual that they both care for. If we can coordinate that work better, and help all understand what needs need to be addressed, we feel like we can do better work as a community for people with the highest needs.”
This interview was edited for clarity and length.