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 Mission Blue 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 births 1 Each birth cost Medicaid $11,000, which translates to $286 million in costs for Michigan 1 If Michigan can reduce the number of unintended pregnancies by just 10%, > $27 million in Medicaid expenditures would be saved annually 1 Every $1 spent on family planning services saves an estimated $3 in medical costs. 2 1.Michigan Department of Community Health 2.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 1. Plan First MA waiver for contraceptive coverage 2. Talk Early & Talk Often Helps parents of young children discuss sex 3. Contraceptive Equity Includes birth control in script coverage 4. 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. Interagency Work Group Members 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

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: oTo reduce health care costs and improve quality of care delivered to Michigan residents oTo 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 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 Medical Directors’ Committee Measurement Workgroup Implementation 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 Development Process (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.govwww.guideline.gov For more information on MQIC go to www.mqic.org www.mqic.org

20. Provider Task Force Composition oPhysicians- OB/GYN, Family Practice, Internal Medicine oNurses/nurse practitioners/nurse midwife oCommunity-based/Medicaid and Title X providers oMDCH, MDHS, local public health oHealth plans and health systems (medical directors, quality management, IT, provider education) oUniversities/medical schools oSchool-based health care oPsychology/social workers oThose working with cultural minorities and underserved

21. CDC Recommendations oIndividual responsibility across the lifespan oConsumer awareness oPreventive visits oInterventions for identified risks oInterconception care oPre-pregnancy checkup oHealth insurance coverage for women with low incomes oPublic health programs and strategies oResearch oMonitoring improvements “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

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

24. oMeasurable Objectives needed oEvaluation Plan developed at the beginning oContinued Data Analysis required Lessons Learned