Northern Michigan Health Consortium

The Northern Michigan Health Consortium (nmhc) provides organizational support for the Northern Michigan community Health innovation region (chir), a 31-county region. This is done through community connections, a clinical community linkages (ccl) network, and mi-thrive community Health needs assessment and improvement initiative. The chir focuses on removing barriers to social determinates of Health, like access to Health care, affordable housing, healthy food, and transportation options, working at individual, sector, and system levels in pursuit of its mission to improve population Health, increase Health equity, and reduce unnecessary medical costs through partnerships and system change. The chir's certified clinical community linkages (ccl) network provides one-on-one navigation assistance in 31 counties through six hubs, each operated by a different local Health department through a contract with nmhc. In fy24, the chir received 6,400 referrals, an increase of about 50% over the previous year. The top five reasons for referral to navigation services were housing, food security, utilities, medical care cost/health insurance, and behavioral/mental Health. The chir leads community Health needs assessment (chna) every three years to quantify issues in the community by collecting primary and secondary data, including ccl client data, on behalf of local Health departments, hospitals, and other community partners. Using the best practice chna framework, a diverse mi-thrive design team created and implemented plans for compiling 100 secondary indicators by county and collecting primary data through surveys and community wide meetings.

As part of our partnership with healthy kids delta dental we provided outreach to 500 families. This outreach included personal calls to inform them of their child's dental benefits, assisting with finding a provider and scheduling appointments if requested. We also addressed any barriers they may have to attend these appointments including transportation benefit information. We work with several dental clinics who will not allow some clients to schedule again because of frequent no-shows. They will allow those families to reschedule once they have connected with our program to increase the likelihood that they will attend the next scheduled appointments. Through a partnership with the munson physician organization, Northern care partners, we were able to provide community Health worker (chw) assistance to address social determinants of Health (sdoh) needs for over 300 referred clients who had no other payment source. These patients are screened for sdoh needs at the physician office and referred to the community connections chw program if needs were identified and the patient consented. These chw's provide navigation assistance utilizing an evidence based, primarily home visiting model. We were able to successfully assist with things like food insecurity, transportation, housing, medical homes and specialty referrals, as well as Health insurance. Addressing these needs helps meet our community vision of healthy people in equitable communities, which includes a universally accessible comprehensive chw navigation system.