MI Community Care (MiCC) provides "no wrong door" access to high quality health care and an array of supportive services for the region's most vulnerable populations. But equally important, the program takes a preventive approach by investing significant time and effort into improving the Livingston and Washtenaw County region's health, mental health, and social service systems. To accomplish this systems change work, the Center for Health and Research Transformation (CHRT) at the University of Michigan, provides administrative, fiduciary, research, and strategic support to the MiCC collective. CHRT ensures that MiCC partners receive the full complement of support they need to advance shared values and objectives.
In 2018, dozens of representatives from Washtenaw-area organizations that are deeply involved in the prevention and treatment of substance use disorders (SUD) participated in an SUD system transformation process hosted by MiCC. One of the main recommendations to emerge from this effort was the development of a single point of entry and universal screening tool for Washtenaw County. Today, as a direct result of this systems change process, residents can call a 24/7 hotline staffed by licensed mental health and substance use professionals at the county’s safety net provider.
With funding from MDHHS, CHRT staff worked with dozens of community partners, on behalf of MiCC, to improve Washtenaw County’s homeless system of care by focusing on homelessness diversion. Frontline workers and support staff at a range of local housing and supportive housing agencies recieved training in homelessness diversion. A 2021 pilot program showed that during the first three months of the program, 54 percent or participants were successfully diverted and none returned to shelter. Diverting from the shelter requires much less time than sheltering individuals. It also prevents the stress and trauma associated with episodes of homelessness.
In addition to being lead on some participant cases, CHWs provide support on others, offering a variety of services and expertise; including deep knowledge of local resources, language support, assistance with provider visits and benefits applications, among many others. Importantly, CHWs are trusted community members who meet people where they are, bringing much-needed services to places people feel most comfortable at.
Since its establishment in 2011, the Michigan Health Information Network (MiHIN) has worked to build connectivity and enable secure data sharing between healthcare providers throughout the state. The work of MiCC and its Learning Network supports MiHIN in the development of a framework for community-based data sharing by collectively developing shared tools and techniques to exchange participant information, developing the foundations for cross-sector data sharing through shared consent forms and processes, and examining data sources to support improved identification of disparities and increased access to services.
Huron Valley Ambulance (HVA) established a community paramedicine (CP) program to deliver the most appropriate resources in the right care setting for each patient. Initially, the program focused on addressing two specific problems: diverting non-emergent problems from emergency departments (EDs) and providing specialized services to skilled nursing facilities (SNFs) to prevent their patients from being readmitted to the hospital. CPs are trained at identifying social needs through their experiences. Integrating HVA CPs into the MiCC network gives CPs a direct connection to a larger health and social service network, and also allows involved organizations to tap into HVA CP’s unique vantage point to identify patients that fit MiCC referral criteria.