Michigan Healthy Community Initiative Progress Report

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Background

The Executive Vice Presidents’ Working Group on Health (EVPWGH) was formed quickly and in direct response to President Coleman’s April 2004 address to the Regents.  The group reviewed the existing situation, undertook a gap analysis, and solicited project proposals.  An important goal of the EVPWGH was to identify proposals that improve U-M community health that could be implemented relatively quickly.  Three proposals were selected based on identified gaps and ability to implement:  Leadership and Engagement, Walking and other Exercise, and Ergonomics.  The longer-term projects were referred to the larger group. 

In the meantime, Dr. Kenneth Warner agreed to chair the Michigan Healthy Community Initiative Task Force, and a diverse group of faculty and staff leaders were appointed to serve as members of the Task Force.  With Ken Warner’s recent appointment as Dean of the School of Public Health, Dr. Robert Kelch, Executive Vice President for Medical Affairs, assumed the role of Chair of the MHCI.  In addition to the formal charge, the MHCI assumed responsibility for weighing the benefits of longer-term projects that were referred from the EVPWH:  Depression in the Workplace and Value-Based Benefits. 

Specific Components of the Charge

Develop models of how to enhance healthy living and health care delivery that effectively use the University’s financial and human resources toward the goal of benefiting the University community.

In April 2004, President Coleman asked the EVPWGH to plan programs that would support her initiative to improve the health of the University of Michigan community.[1]  Under the leadership of Zelda Geyer-Sylvia, EVPWGH completed the first phase of its work in April 2005 with a plan to implement three programs:

1. Leadership and Engagement:  mid-level managers to top leadership to set examples of and encourage healthy behavior, provide an atmosphere conducive to healthy behavior, recognize warnings of  unhealthy conditions, and know how to intervene to get employees, students and faculty to the right place for intervention.
2. Walking and other Exercise (renamed Physical Activity for Life):  ensuring safe bike and pedestrian walkways, encourage stair use, have contests and competition for healthy behavior changes (consistent with State and national initiatives); other physical activities will be added to broaden this initiative, provide choices, and ensure that everyone can participate.
3. Ergonomics: provide appropriate equipment and space for employees to work safely and effectively; will decrease work related injury and improve employee productivity.

Under the leadership of Laurita Thomas, the Working Group is implementing these programs.   LaVaughn Palma-Davis, who was appointed to spearhead the effort (during which time she will be on loan from the Health System), is leading a university-wide Implementation Team. She has received resources and approval from the EVPWGH for an Integrated Project Plan.

Promote and support healthy living in a multi-cultural context for University of Michigan students, staff, faculty, retirees, and dependents. This may involve, for example, utilizing on- and off-campus educational services, incentives in health care benefits, and rewards for meeting behavioral health targets.

While the EVPWGH focused on programs that could be implemented quickly, two more extensive proposals were referred for further review to the Task Force: 

1. Program to promote education, early identification, and treatment of depression and reintegration of patients into the classroom and workplace: Drs. Carli, Greden, and Winfield provided baseline information on the breadth and scope of depression in the workplace and the community, and some of the challenges being faced to address and treat depressive illness.  This includes multiple places where University staff, faculty and students can seek treatment; while Dr. Metzl provided information on Cultural stereotypes in depression: an analysis of media messages as well as chart review
2. An approach to benefit design that would include incentives to foster greater compliance with prescription drug regimens: targeting specific interventions to reduce or eliminate co-pays (e.g., drug treatment of hypercholesterolemia or diabetes).

Human Resources staff, with MCARE representation, is developing a current profile of U-M demographics and disease, and are forecasting what the most prevalent and costly diseases and conditions will be in the future (e.g., 2010 and 2015) given the changing demographics and morbidity of the University community.  This forecast vision is a collaborative effort between Human Resources and M-CARE staff. 

The Task Force met monthly from January through July 2005 and will resume its monthly meetings in September.  The goal of the first meeting was to get a snapshot of costs, lost workdays, risk factors among employees, trends, and opportunities for prevention.   Initial MHCI agendas followed up on the EVPWGH work and suggestions raised by MHCI Task Force members.  

Topics discussed in depth by the Task Force include:

• Employee Health and Well-Being at UMHS (L. Palma-Davis and P. Sheagren)
• Thoughts on How to Better Prioritize Health Care Interventions and Coverage (R. Hayward)
• EVPWGH Concept Papers: Leadership & Engagement (L. Thomas); Walking & Exercise (Z. Geyer-Sylvia); Ergonomics (M. Knepp)
• Mental Health Part I: Depression and Bipolar Disease: What Are They? Depression Center: What Is It? (J. Greden); and Impact of Depression on Employees, Families, Retirees and the Employer (T. Carli)
• Mental Health Part II: Cultural Stereotypes of Depression: Results of  a Media Analysis and Chart Review (J. Metzl); and  Student Health and Well-Being on the Ann Arbor Campus: Prevention, Intervention, and Opportunities for the Future (R. Winfield)
• Mental Health Part III: Where Do Our Employees Turn For Mental Health Services? Best Practices in Employer- Sponsored  Mental Health Services (T. Carli)

Benefits-based Co-payments:

• Overview of U-M Prescription Drug Plan, Keith Bruhnsen and Dawn Parsons
• The Benefit-based Copay: Using Outcomes Research to Get Prescription Drugs to People Who Need Them, A. Mark Fendrick
• Suboptimal Statin Adherence and Discontinuation in Primary and secondary Prevention Populations:  Should We Target Patients with the Most to Gain? James Stevenson
• Medicare First Dollar Coverage of ACE-Inhibitors for Beneficiaries with Diabetes Saves Money and Lives, Allison Rosen
• Benefit-based Copay for ACE Inhibitors and Angiotensin Receptor Blockers for UM Employees with Diabetes, Allison Rosen 

In addition to presentations at Task Force meetings, several other activities are under way:

• Outstanding outside organizations have been identified and invited to present to MHCI.  The first will be from Fairview Health System, a Koop Award winner.
• We will continue to invite internal University of Michigan experts to address MHCI Task Force and to provide a forum for members of our community who wish to present their ideas.
• We are working closely with L. Rudgers to plan and implement an extensive communication strategy to publicize the activities of the EVPWGH and MHCI, engage our community in dialogue and discussion, and foster development of and participation in key programs.
• A web site for intra-task force communication was developed and will be expanded as part of the communication strategy.  The web site includes links to relevant areas including state and federal initiatives and reports.  Relevant articles as well as all Task Force presentations are available on the site.

Looking Ahead:  Fall 2005

• Subcommittees to develop more in depth proposals on Depression in the Workplace, Value-Based Benefits, and Student Involvement are being charged and will bring recommendations forward this Fall.
• We envision development of our preliminary recommendations by December 2005.  The preliminary recommendations will include design, evaluation plan, and a research and dissemination plan.
• A Task Force budget will need to be developed.