Dave Schneider is a managing principal at Health Management Associates’ Lansing office. He is an experienced public administrator with more than 30 years’ experience dedicated to improving specialty care.
Prior to HMA, Schneider worked as a behavioral health specialist at the Michigan Department of Health and Human Services (MDHHS) where he led the development of metrics projects and facilitated coordination of programs to improve Michiganders’ behavioral health.
In this Q&A, Schneider discusses the impact of the Omicron variant on Michigan health care, the 2022 long term care expansions, and the future of the specialty integrated plan legislation.
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Patrick Jones: What do you think is the most important thing going on in Michigan health care right now?
Dave Schneider: “Obviously right now it’s COVID, and with the growth and numbers we’ve been seeing. I saw a headline today [that cited] 25,000 new cases and 338 more deaths in the last two days in Michigan. So [we’re] trying to get that under control [though], still, our vaccination rates are not where we want them to be.”
PJ: With the new Omicron variant, what is Michigan planning to do to raise vaccination rates and handle this new variant? How does Michigan plan to combat this new strain?
DS: “We’ve seen a number of health systems have to start limiting elective services again, which is very unfortunate. We’re really seeing a lot of letters to the public from the medical directors from the heads of these big health systems pleading with [people] to get the vaccine. They’ve done a real public marketing effort to get people to get vaccinated.
One of the problems we’re facing in Michigan is much of what the governor did in 2020 to help beat the first wave and to help contain some of the spread. She’s no longer able to do that [since] the legislature took steps to stop her and took it to the courts. [While] we’re seeing [some recommendations and guidelines] from the administration, we’re not seeing limits on things. It’s really up to convincing people to get vaccinated. I know that all the Medicaid health plans are aggressively working to get all of their enrollees vaccinated. But, I’m hearing stories of [organizations] doing [vaccination] events where single-digit numbers of people show up.”
PJ: Can you tell me a little bit about what these Medicaid health plans are doing to get enrollees vaccinated? Are they using incentives?
DS: “I don’t know about the incentives firsthand. I know that they’re doing phone campaigns. They are calling numbers encouraging them to get vaccinated. They are also sponsoring events. I know one did an event at the Detroit Pistons practice facility, which still drew very, very few people. There’s so much misinformation and so much skepticism out there that we’re just having trouble getting people vaccinated.”
PJ: How has this last year changed the conversation around health equity, not only in the legislature but also in health systems, hospitals, and community based organizations?
DS: “The way COVID played out right from the very beginning highlighted the disparity in health care for a number of reasons, from employment issues, to living situations, to any number of things. But, the disparity in access to treatment, and the disparity in access to the vaccine early on, really raised a lot of awareness. It’s now generally accepted that there are disparities in access [to health care and insurance]. It’s not argued as much anymore. So what do we do about it?
We’re seeing this all over the country in Medicaid, where the state is requiring that health plans address health equity [including] efforts to provide greater transportation to provide greater access. These disparities are not just racial, they are not just economic, but they are geographic as well, especially in a state like Michigan where you’ve got a lot of large rural areas. Most things have large rural areas and access in those areas can be very challenging.”
PJ: What is the need for expansions of community based organizations for the elderly? What is the current problem there and what are people in Michigan doing to solve it?
DS: “Michigan right now has a My Choice waiver, which is a home and community-based service (HCBS) waiver for disabled and aged, but mostly for elderly [people]. But, there’s not adequate access to and coverage for HBCS for the aging population. The governor put money in the budget this year to expand the number of slots on the My Choice waiver, but it still isn’t going to get where we need to be.
The state had a plan developed back in 2018 to look at how to move towards a managed long term services and supports (LTSS) service. That included five global recommendations which the state was working on. Then COVID hit and all that got put on hold. So in Michigan, unfortunately, under Medicaid, your option very quickly becomes a nursing home. Michigan has a higher number of beds than a lot of states and the skilled nursing facilities are very strong.
COVID showed us nationally that we have to find a better way to care for our aging population. I think we’re going to see changes in that. There’s a lot of talk that LTSS will be a focus for the state next year. But I think until we get better progress on COVID, COVID is occupying too much of everyone’s time. Hopefully the state will start to address LTSS in 2022.”
PJ: Where do we stand with specialty integrated plan (SIP) legislation? Where do you see that discussion heading into the next session?
DS: “I think there’s a lot of discussion going on and a lot of bargaining. I think that we’ll see action probably in February, maybe in March. I think there are some other bills that need to see action as well. There’s the pharmacy benefit management bill that is in the house. I think you’ll see some action on that first and then I think you’ll see action on the SIP bills. I think there’s a fairly good chance that it can come out of the legislature successfully with some bipartisan support.
I think [passage] more likely than it’s ever been because there is widespread discontent, displeasure and unhappiness with the behavioral health system. Some of our unhappiness is directed to the wrong people. [Also], what we’re seeing is too much at [emergency department (ED)] boarding. We’re seeing inadequate access, and we’re seeing inadequate crisis continuum. Is this ED boarding because of Medicaid individuals or is it commercial insurance? It’s all of the above, typically, but what they see is there’s problems. I think there’s enough money in the American Rescue Pan Act (ARPA) money and other funds—one time funding—to help address a lot of these things. I think what happens is, people want to see some change. They don’t really know necessarily what it has to be, but if they see a proposal that comes out that promises to change this and improve prices response and improve access, I think it gets support.”
PJ: Do you think that these plans will bring that change, that needed access, and improvement to costs?
DS: “That depends on a lot of variables. I think what really matters is how the state goes about integrating care at the service delivery level. Just because the financing is integrated doesn’t mean the care is. We’ve seen in other states where after years of integrated financing, they’re having to address integrated service delivery. That takes creativity, a willingness to support some infrastructure, better data sharing, and information sharing. It takes better models for care coordination. It takes an understanding of different practice models. Primary care offices have a very different business model than a behavioral health office. I think the key to solving a lot of this has to do with taking the steps to create systemic integration at the service delivery level. If that happens, I think you’ll see a lot of the issues get resolved.”
This interview was edited for clarity and length.