By CARMEN HEREDIA RODRIGUEZ
Kathleen Hambleton once used to spend $100 a week on Marlboro Reds.
The 43-year-old nurse from Saxtons River, Vt., paid a high price for her addiction to smoking, undergoing multiple throat surgeries. The financial hit was also a big burden.

After lozenges, patches and hypnosis failed to help Hambleton quit, she tried vaping. She is convinced she is healthier now and spends less than $40 per month on her vaping supplies.

Vermont recently passed a 92 percent wholesale tax on vaping and e-cigarette products. Hambleton believes the sudden and sharp price hike is prohibitively expensive.

“When they imposed the 92 percent tax, I can’t affordably pay that,” she said. “No one can.”

Historically, taxation has been an effective tool in reducing the number of people who smoke.

The World Health Organization estimates that a 10 percent rise in prices causes overall smoking rates to drop about 4 percent in high-income countries. Some states are relying on this strategy to work again ― this time to discourage consumers, especially teenagers and young adults, from using e-cigarettes and vaping products.

Twenty states and the District of Columbia have passed those taxes, according to the Campaign for Tobacco-Free Kids, a nonprofit advocacy group. But whether taxes would be as effective in combating [Read More]

Get Real On Pre-authorizations: Interoperability Is Key

By EWE MATUSZEWSKI
There is much left unsaid in the discussion of new Michigan legislation (“Health Can’t Wait”) that would curb insurance pre-approval rules in health care. Pre-authorizations are used not only to keep costs down, but to ensure that unnecessary testing (and physician shopping) is not performed on patients, especially a repeat diagnostic test where the initial test results are available.

Our organization submits at least 1,500 requests for pre-authorizations to payers per quarter, and denials are rare, sometimes zero. That’s because we use the primary care physician to coordinate patient care with specialists, as directed by those who follow the principles of the patient-centered medical home. As much as we need and respect our specialty physicians, they have a reputation of not providing much needed supporting documentation in a timely fashion. Frequently, primary care physicians wait weeks to receive reports on consultations that were completed. Those are often the only items needed to receive the authorization for additional services. I must remind my colleagues that NCQA has specific turn-around times for payers to act on pre-authorization requests. Also, as a primary care physician recently admitted to me, she has some gaps in knowledge on more advanced and often new [Read More]

MAPS Policy Leads To Drop In Controlled Substances Dispensed In Michigan

By JESSE ADAM MARKOS, ESQ.
Wachler & Associates, P.C.
Required registration and use of the Michigan Automated Prescription System (MAPS) has proven helpful in decreasing the amount of controlled substances dispensed in Michigan. Beginning last year, physicians in Michigan are required to register with MAPS and review MAPS patient-specific data before prescribing or dispensing a Schedule 2-5 controlled substance to a patient in a quantity that exceeds a three-day supply. These requirements, combined with other efforts to fight the opioid epidemic, have led to a dramatic decrease in the amounts of controlled substances dispensed in Michigan.

The Department of Licensing and Regulatory Affairs (LARA) publicly releases the dispensing and prescribing data collected by MAPS in their annual Drug Utilization Report. The most recent findings from last year confirm that MAPS has proven remarkably effective in reducing the amount of controlled substances dispensed in Michigan. For example, compared to 2015, opioid prescriptions dispensed fell by 24 percent while the overall number of schedule 2-5 controlled substance prescriptions decreased by 18 percent. Moreover, a review of the data shows a sizeable reduction in the dispensing of seven of the most commonly abused controlled substances. For example, compared to 2015, [Read More]

Double Your Signing Bonus, Double Your . . . Prison Dentists?
If the prospect of polishing prisoner teeth is not tantalizing enough to get more dentists at the Michigan Department of Corrections, the state is now looking to sweeten the deal by doubling the bonus money available for new hires.

Dentists hired for state prisons have been allowed a $5,000 bonus for several years now, but the DOC is now seeking approval for an additional $5,000 to be available once dentists complete their initial one-year probationary periods, meaning they can earn an extra $10,000 within the first year of employment.

DOC spokesperson Holly Kramer said the bonuses would be funded out of existing appropriations. And, in addition to the bonuses, prison dentists remain eligible for a 5 percent performance bonus each year.

“While it’s still a challenge for us to compete with private sector pay rates, these are good careers within the MDOC and we are hoping this might provide some incentive,” Kramer said.

The DOC has been trying to attract more dentists, and seeking additional incentive money from the Michigan Civil Service Commission was one way to do it.

The move to allow the additional $5,000 bonus, which was also requested by the Michigan Department of Health and Human Services, [Read More]

Language added to the state budget to trigger the statewide implementation of blended physical and mental health services is designed to put to rest the debate about how the blending of care should be done, according to the state’s health plans that favor the language.

“Everybody is tired of the issue. They’re tired of the persistent debate. They want action, they want integration, and they want, more importantly, improved outcomes,” said Dominick Pallone, executive director of the Michigan Association of Health Plans (MAHP), adding later, “The boilerplate debate is getting pretty old for everybody.”

But the state’s community mental health (CMH) organizations see the language as paving the way to “a full state carve in to a privatized system” and the abandonment of the “core premise” of pilot programs testing the integration model that were approved last year.

Bob Sheehan, CEO of Community Mental Health Association (CMHA) of Michigan, said the “constant debate” is about the health plans wanting “to hold the money and walk away with the savings and walk away with the profit” and that is what is causing the “logjam.”

For the past few years, MAHP and the CMHs have been duking it out in a particular piece of boilerplate language deep within the Michigan Department [Read More]

By JORDAN RAU
Medicare cut payments to 2,583 hospitals Oct. 1, continuing the Affordable Care Act’s eight-year campaign to financially pressure hospitals into reducing the number of patients who return for a second stay within a month.

The severity and broad application of the penalties, which Medicare estimates will cost hospitals $563 million over a year, follows the trend of the past few years. Of the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83 percent received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that began Oct. 1.

Although Medicare began applying the penalties in 2012, disagreements continue about whether they have improved patient safety. On the positive side, they have encouraged hospitals to focus on how their patients recuperate, and some now assist them in procuring medications and follow-up appointments.

The hospital industry and some academics have raised concerns that some hospitals may be avoiding readmitting patients who require additional inpatient care out of fear of the financial repercussions, while others have said the program is not showing major benefits.
“A lot of hard work has gone into trying to reduce readmissions, and the needle has not moved very far,” said Dr. Karen Joynt Maddox, co-director [Read More]

Pay Raises For Health Workers Abound In DHHS Budget
A number of workers employed in state human services-related fields will be getting raises under the Fiscal Year 2020 budget approved for the Michigan Department of Health and Human Services by the Legislature Sept. 24.

SB 0139 earned the most Democratic support in the House, where it passed 64-44. The Democrats who crossed over to vote yes with Republicans were Reps. John Cherry (D-Flint), Abdullah Hammoud (D-Dearborn), Jon Hoadley (D-Kalamazoo), Rachel Hood (D-Grand Rapids), Leslie Love (D-Detroit), Laurie Pohutsky (D-Livonia), Karen Whitsett (D-Detroit) and Angela Witwer (D-Delta Twp.).

Rep. Steven Johnson (R-Wayland) voted no with most of the Dems. Reps. Brenda Carter (D-Pontiac) and Larry Inman (R-Williamsburg) did not vote.

The DHHS budget cleared the full Senate 24-14, with Sens. Winnie Brinks (D-Grand Rapids) and Sean McCann (D-Kalamazoo) joining the Republicans in voting yes.

Sen. Erika Geiss (D-Taylor) specifically flagged a $15 million cut in programs that fund medical services and juvenile justice facility maintenance. She also pointed at $15 million needed to get Michigan to comply with the new Lead and Copper Rule, saying those “lack of investments are additional missed opportunities for our children and our communities.”

The Legislature went along with Gov. Gretchen Whitmer’s’s request for $16 million to [Read More]

By ANDREW B. WACHLER & KAITLIN A. NUCCI
Wachler & Associates, P.C

The Centers for Medicare and Medicaid Services has released its final rule with comment period regarding the disclosure of affiliations in the provider enrollment process. This rule will take effect on November 4, 2019. This rule provides the authority to revoke or deny enrollment based on the disclosure of any affiliations that CMS determines poses an undue risk of fraud, waste, or abuse. Although the plan is to have this rule be applicable to all providers, CMS is starting out with a phase-in approach, where the rule will be applied to initially enrolling or revalidating providers that CMS has specifically determined may have one or more applicable affiliations.

The Final Rule requires providers and suppliers to disclose any current or previous direct or indirect affiliation with a provider or supplier that has a “disclosable event”:
• Has an uncollected debt;
• Has been or is subject to a payment suspension under a federal health care program
• Has been or is excluded by the Office of Inspector General (OIG) from Medicare, Medicaid, or CHIP; or
• Has had its Medicare, Medicaid or CHIP billing privileges denied or revoked.

If any of these affiliations are present, the Secretary is authorized to deny [Read More]

By ALLAN DOBZYNIAK, MD
We are developing new technological gimmicks to measure every activity throughout our day, blood pressure (BP), pulse (P), respirations, stairs climbed, walking time, calorie burn, sleep time, and on and on. Soon we will be device-covered from head to toe. To what end? There are shelves upon shelves of magical elixirs and pills to cure any symptom, prevent aging and definitely improve on God’s or nature’s original design. Can you imagine the size of the bag necessary to carry all of these magical medicinals?

Our health care providers are obsessing over preventive care, with hardly time anymore to treat sick people. Our government is determined to turn primary care into a lecture series on what is politically intuitive rather than scientifically based. Our elected and appointed officials are certain that the effort at demanding “good” personal behavior—as defined by bureaucrats, lobbyists for “healthy stuff,” global warming fanatics—will improve outcomes. I am never sure what “improved outcomes” means; does anybody, really? Of course, we must race forward to legalize pot, never wasting another opportunity to tax something else.

I know I am going way out on a limb here, but perhaps the path to good health and the best outcome for each unique individual is [Read More]

Gov. Gretchen Whitmer offered three emergency rules Sep. 4 banning all flavored vaping products from Michigan shelves amid what Chief Medical Executive Dr. Joneigh Khaldun said is a youth vaping “public health emergency.”

“This is a health crisis and in a health crisis, I have the ability to take action and we’re taking it,” Whitmer said. “There are 13-year-olds who are vaping fruit loops right now. They are doing life-long damage and have no idea they are engaging in a substance that they’re going to be addicted to maybe for the rest of their lives,” she said.

The governor said she is the nation’s first chief executive to move against the vaping industry, which she described as “an industry notorious for deceiving the public and for putting their bottom line before the public health.”

Her three-step ban includes taking all flavored e-cigarettes and vaporizing products off the shelves, including such flavors as bubble gum and apple sauce. She is going after the marketing strategies that she argues “are focusing on our kids and they are targeting and making money off of them and they’re hurting them.”

She reported products are sold next to candy on the store shelves.

The governor’s unprecedented action comes after she signed legislation earlier this year [Read More]

By PHIL GALEWITZ
For the first time in a decade, the number of Americans without health insurance has risen — by about 2 million people in 2018 — according to the annual U.S. Census Bureau report released this month.

The Census found that 8.5 percent of the U.S. population went without medical insurance for all of 2018, up from 7.9 percent in 2017. By contrast, in 2013, before the Affordable Care Act took full effect, 13.3 percent were uninsured. It was the first year-to-year increase since 2008-09, Census officials said.

Census officials said most of drop in health coverage was related to a 0.7 percent decline in Medicaid participants. The number of people with private insurance remained steady and there was a 0.4 percent increase in those on Medicare.

Many of those losing coverage were non-citizens, a possible fallout from the Trump administration’s tough immigration policies and rhetoric. About 574,000 non-citizens lost coverage in 2018, a drop of about 2.3 percent, the report found.

“Uninsured non-citizens account for almost a third of the increase in uninsured, which may reflect the administration’s more aggressive stance on immigration,” said Joseph Antos, a health economist at the American Enterprise Institute.

The increase in the number of uninsured people in 2018 was remarkable because uninsured [Read More]

By JESSE ADAM MARKOS, Esq.
Wachler & Associates, P.C

In the past few years there has been growing public concern about professional boundary issues in healthcare with the increase in reported cases of providers interacting inappropriately with patients. As a result, state licensing boards have become increasingly proactive in investigating such allegations. In fact, the Ohio Medical Board recently announced plans to review and potentially reopen nearly 2,000 closed cases of alleged sexual misconduct or impropriety by physicians in Ohio over the past 25 years to determine whether any credible evidence of criminal or otherwise inappropriate behavior had been previously overlooked.

The Ohio Medical Board’s review of cases that were previously closed without disciplinary action includes not only sexual assault investigations, but also allegations of improper, non-physical interactions. The relationship between a healthcare provider and a patient is a professional relationship based on trust. When a provider behaves in such a way that oversteps his or her professional role with the patient to create a personal relationship, a professional boundary has been crossed. When a provider inappropriately uses words or actions of a sexual nature with a patient, a sexual boundary has been violated. Violations of boundaries between a provider and his or her patient can include [Read More]

After 33 years of service as Executive Director of the Genesee County Medical Society, Pete Levine announced his retirement as of July 1, 2019. Levine said, “It has been an honor to serve as Executive Director of GCMS and work with such exceptional physicians and practice managers to improve healthcare in our community.”

During his retirement, Levine said he will enjoy more time with family, pursuing his personal interests, providing selected consultations, as well as continuing to represent GCMS at the Greater Flint Health Coalition.
Pete will also voice his insights and perspectives in these pages and continue as an editorial advisor to Healthcare Michigan.

“We are grateful for Pete’s many years of service to GCMS,” Edward Christy, MD, President of GCMS said. “We appreciate his dedication to patient and physician advocacy. His leadership was invaluable to our organization, and we wish him all the best for his retirement.”

Complete Eye Care Administrator Traci Kim said, “The significance of Pete’s role as a facilitator for the GCMS practice managers’ meetings cannot be overstated. He has been instrumental in bringing insurers to the table to address numerous complex reimbursement issues. We would not have this type of access to decision-makers without his advocacy. We are grateful for his leadership and [Read More]

By EWA MATUSZEWSKI
The circle of care is wide – and getting wider. With all the national conversation around diversity and inclusion, I think the healthcare field can give itself a pat on the back, at least on the inclusion side. I refer to a different kind of inclusion here – and that’s the inclusion of a broad spectrum of caregivers as an extension of the care team – and ultimately into the world of reimbursement.

For too long, the focus was chiefly on the physician when it came to care and reimbursement, but the value of the care team has grown too strong (based on supporting data and anecdotal evidence) to look back. With patient outcomes improving as the availability of care teams increases, especially interdisciplinary teams comprised of nurses, dieticians, behavioral health specialists, exercise specialists, pharmacists and care managers, the care experience continues to evolve in a positive direction.

In 2006, our organization assembled one of the state’s first care team efforts. We called it the Chronic Care Travel Team (CCTT) and launched the program with the aim of focusing on patients with co-morbidities including diabetes, hypertension and obesity, as part of their care team in the primary care physician’s office. The name ultimately morphed into [Read More]

By REESA N. BENKOFF, ESQ
Benkoff Health Law, PLLC
On August 22, 2019, the Department of Health and Human Services (HHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced proposed changes to the Confidentiality of Substance Abuse Disorder Patient Records regulations, set forth in 42 CFR Part 2 (Part 2). Part 2 protects and prevents access to patient records created by federally assisted substance abuse disorder (SUD) treatment programs. SUD is a defined term, and includes cognitive, behavioral, and physiological symptoms indicating that an individual continues using a substance despite significant substance-related problems such as impaired control, social impairment, risky use, and pharmacological tolerance and withdrawal, but does not include tobacco or caffeine use.(1)

Part 2 was initially designed to protect SUD patient records so that patients seeking SUD treatment would not be deterred from doing so. For that reason, Part 2 contains more restrictions on the disclosure of patient records than HIPAA. However, the outdated regulations have created clinical and safety barriers for providers seeking to treat such patients amid the opioid crisis, even despite recent updates to Part 2 in 2017. Thus, the proposed rule seeks to balance the need to both coordinate care among providers that treat SUD and maintain privacy [Read More]

House Votes To Put Warnings On Pot For Mothers, Breastfeeders
The House voted overwhelmingly Sep. 10 to put warning labels on recreational and medical marijuana products, to tell pregnant women and breastfeeding mothers that smoking pot can have harmful effects on their infants.

Members voted 105-4 on HB 4126 and HB 4127, sponsored by Rep. Thomas Albert (R-Lowell) and Rep. Daire Rendon (R-Lake City), to require labels in the same way tobacco and alcohol products carry warning labels now.

“There’s been some pretty alarming studies showing that in an unfortunate trend, a lot of women are continuing to use marijuana while they are pregnant,” Albert said. “It is pretty shocking that someone would make that choice and we want to make sure that they have the right information.”

Doctors believe that there could be some long-term developmental issues and it can cause low birth weight, he contended.

The warning would read: “Use by pregnant or breastfeeding women, or by women planning to become pregnant, may result in fetal injury, preterm birth, low birth weight, or developmental problems for the child.”

Rep. Beau LaFave (R-Iron Mountain) is not a fan of the idea.

“If we were to put a warning label on everything that is potentially dangerous, everything including Tim Skubick would have [Read More]

ALLAN DOBZYNIAK, MD
It is notable how the concept of “Medicare for all” has presently provoked such vigorous support by the Democrat leadership. With Obamacare moving the balance so close to single-payer via political muscle, to have a reversal of this embedded ideological goal is intolerable to the left. The thought of placing any entitlement back on the bargaining table and above politics, healthcare in particular, continues to be outside of mainstream Democratic mainstream ideological thinking. There is no guarantee an expanding welfare state can continue, despite emotional pandering that eclipses this reality. The weaponization of emotional issues to manipulate people, such as “virtue signaling,” is a despicable tactic. To create a public perception of, “I get mine no matter what the state of the country is when I get it,” is a formula for insolvency as the government goes broke. Look at Europe.

Free markets drive value to the goods and services we consume. In contrast, centrally planned government-run healthcare must rely on coercion. Of interest here is that this concept above all is the Achilles’s heel of Obamacare. It is obvious that millions of the young and healthy are forced into the exchanges and there exploited. The presidential rhetoric declaring you can keep your plan [Read More]

By JULIE APPLEBY & ELIZABETH LUCAS
When they started practicing medicine, most surgeons say, there was little or no information about just how many pain pills patients needed after specific procedures.

As a result, patients often were sent home with the equivalent of handfuls of powerful and addictive medications. Then the opioid crisis hit, along with studies showing one possible side effect of surgery is long-term dependence on pain pills. These findings prompted some medical centers and groups of physicians to establish surgery-specific guidelines.

But questions remained: Would anyone pay attention to the guidelines and would smaller amounts be sufficient to control patients’ pain?

Yes, appears to be the answer to both — in some measure — according to a study that encompassed nearly 12,000 patients in 43 hospitals across Michigan. The researchers published details of their work in a letter Wednesday in the New England Journal of Medicine.

Seven months after specific guidelines for certain operations were issued in October 2017, surgeons reduced by nearly one-third the number of pills they prescribed patients, with no reported drop in patient satisfaction or increase in reported pain, according to the research.

“We’re not trying to deny patients narcotics,” said Dr. Joceline Vu, one of the paper’s authors and a general surgery resident [Read More]

While most doctors in Michigan believe the state’s new rules for prescribing opioids will help to address the overuse epidemic, only 20 percent have been trained in Medication-Assisted Treatment and nearly two-thirds said they aren’t interested in getting trained.

Those were the results of a recent survey of some 600 primary care providers by the Center for Health and Research Transformation (CHRT) at the University of Michigan to gauge sentiment of the state’s 2017 efforts to deter over prescribing, including mandatory use of the Michigan Automated Prescription System (MAPS).

“CHRT’s physician survey shows that Michigan’s new requirements for MAPS reporting are generally supported by primary care physicians in Michigan. However, physician interest in Medication-Assisted Treatment is low, and more will need to be done in order for MAT to be a viable treatment option for the many Michiganders in need of help,” the report concludes.

“Between 1999 and 2016, the number of overdose deaths in Michigan increased 17 fold — from 99 to 1,699. In 2017, more deaths were due to overdose than car accidents,” the report states.

In 2017, state lawmakers passed several bills aimed at curbing the epidemic, notably limiting opioid prescriptions to seven days and requiring physicians to look up their patients’ prescription history on the [Read More]

By EWA MATUSZEWSKI
One of the most interesting aspects of writing a healthcare column is that the topics can be wide-ranging because the issues surrounding physical and behavioral health and the community of care providers are so vast and far reaching. That being said, I believe I am introducing a topic today that is rarely discussed: What are we to do with incarcerated physicians who happen to be qualified clinicians? For physicians who have not committed capital crimes or crimes related to physical, sexual and emotional abuse, should we be considering the establishment of guidelines and programs for acceptable use of their medical skills behind bars?

Over the course of my career in the physician organization field, I have personally known about five physicians who have been imprisoned – all for crimes related to wrongful prescribing/overprescribing prescription drugs in the pre-opioid focused era or billing/coding abuse. Illegal activity? Character flaw? Abhorrent behavior? Yes, on all three counts; but does that mean their actual clinical skills as a physician, which in all cases were not in question, must be wasted as they serve their time?

Michigan’s prison system shortage of healthcare providers in nearly all categories is well-documented; are we overlooking a potential solution to mitigate the physician shortage [Read More]

Allen Park Retirees Get 2nd Chance At Lawsuit Over Healthcare Benefit Changes

The Allen Park Retirees Association will get a second chance at pursuing its lawsuit against the city alleging retirees’ healthcare was improperly changed.
The Michigan Court of Appeals held it “makes little sense” to consider if the trial court erred when it dismissed APRA’s suit since a recent Michigan Supreme Court decision altered its argument, according to an opinion published Aug. 13 from Judges David H. Sawyer and Mark J. Cavanagh. Judge Deborah A. Servitto concurred in the result only.

“We prefer to have the trial court analyze the issue in the first instance,” the court’s opinion noted. “Accordingly, the better route is to reverse the trial court’s decision granting summary disposition to the city and remand the matter for reconsideration in light of the Supreme Court’s decision” in Kendzierski v. Macomb County.

The trial court also erred in relying on res judicata and collateral estoppel—which essentially prevents re-litigation of an issue—in dismissing the case, and on remand is to reconsider APRA’s motion to amend their complaint.
And, the trial court is not to consider former emergency manager Joyce Parker’s 2013 order that altered retirees’ healthcare because it is no longer in effect, the appeals court said.

The APRA [Read More]

By ROLF E. LOW
The Health Information Technology for Economic and Clinical Health Act (the HITECH Act) enacted as part of the American Recovery and Reinvestment Act of 2009 contains several provisions intended to strengthen Privacy and Security Rules in the Health Insurance and Portability Accountability Act of 1996 (HIPAA). One of these provisions gives state attorneys general (SAG) the authority to bring civil actions on behalf of state residents for violations of the HIPAA Privacy and Security Rules.

The Health and Human Services Office of Civil Rights, which has oversight of HIPAA violations at the federal level, is also involved in actions brought by SAGs. The Office of Civil Rights provides a training module to assist SAGs in investigating and seeking damages for HIPAA violations on behalf of state residents. SAGs contemplating filing a civil action for HIPAA violations are encouraged but not required to contact the regional office of the Office of Civil Rights to discuss potential actions. SAGs are also required to notify and serve Health and Human Services with a copy of the complaint they intend on filing at least 48 hours prior to filing an action, unless notice is not feasible. While Health and Human Services is required to investigate any [Read More]

By VICTORIA KNIGHT
Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields.

A record-high number of primary care positions was offered in the 2019 National Resident Matching Program — known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record.

“I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.

The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family [Read More]

The state wants to end an agreement with the local public entity responsible for administering mental health services in West Michigan and instead go directly through a private health provider, sparking concern of the “privatization overnight” of mental health care.

The Michigan Department of Health and Human Services announced June 28 it plans to end its contract with Lakeshore Regional Entity, the pre-paid inpatient plan (PIHP) covering the region containing Allegan, Ottawa, Kent, Muskegon, Oceana, Mason and Lake counties.

In mental health service delivery, the state contracts with regional, locally controlled public entities known as PIHPs to administer behavioral health care services. The PIHPs in turn contract with the local community mental health agencies to deliver those services.

In this instance, DHHS wants to contract directly with Beacon Health Options—a private provider LRE already works with—and essentially make it the PIHP for the western Michigan region until the state can establish a new PIHP.

But this would mark the first time DHHS would depart from the usual mental health service delivery model and go directly through a private provider. DHHS spokesperson Lynn Sutfin said the state intends to strike a deal in such a way to make Beacon like a PIHP for the region under federal regulations.

But Robert Sheehan, [Read More]

By EWA MATUSZEWSKI
Collaboration is a favorite topic of mine, but one offshoot of collaboration I haven’t touched on much is learning collaboratives. A learning collaborative takes collaboration into a more formal, but still relaxed, learning environment, bringing together practice teams to share ideas and find solutions to existing challenges.

Some may recall the Mackinac Learning Collaborative (MLC), which was launched in Detroit in 2009-2010 with the goal of transforming primary care physicians’ offices into patient-centric practices. While our Patient Care Organization championed and led the effort, its success was due to the commitment of primary care practices and family residency training programs throughout SE Michigan who not only participated but did their homework between sessions and established collegial relationships with other MLC participants. The fact that many of these relationships are still thriving today remains among one of the most satisfying outcomes of the MLC.

The MLC was further buoyed by its guest speakers—thought leaders contributing big picture trends and insights on state and national initiatives. They weren’t paid speakers—and some sought out the MLC because they wanted to be part of an audience of 100-plus physicians, behavioral health specialists, nurses, medical assistants, office administrators and healthcare executives that were changing healthcare in the trenches.

I hope at [Read More]