By: Nick Deleeuw for the Michigan State Medical Society
The physician-patient relationship is among society’s most important, but rarely in practice does health care remain so intimate. A myriad of external interests necessitates additional layers of input that influence the downstream delivery of health care. Physicians, clinicians, and medical schools determine best practices. Researchers develop new medicines and treatments, while pharmaceutical companies, payers and others determine what they will cost and who will pay for them. State and federal governments have their say, too, passing laws and enacting policies – in the service of their constituents – that regulate the way medicine is practiced, what is or is not considered health care, and how services are regulated and reimbursed, among other things.
Here in Michigan, three state departments have particular and important connections to the practice of medicine. Last November’s elections swept to power a new governor who selected new directors to lead each department, and a new legislature tasked with approving her selections.
The Michigan Department of Health and Human Services (MDHHS), the Department of Licensing and Regulatory Affairs (LARA), and the state Department of Insurance and Financial Services (DIFS) each in different and important ways impact the way physicians practice medicine and the way patients obtain the health care they need.
From implementing and overseeing Medicaid and the Healthy Michigan Plan, to professional licensing, the never-ending battle over automobile no-fault insurance reform, and the fight against opioid addiction, each department and each new director has an important role to play in the way Michigan physicians treat patients.
THE PROCESS
A new governor’s oath of office on the steps of the state Capitol represents only the first step in the state’s regular and formal transition of political power. Once the inauguration is over, the real work of political transformation process begins.
Among a new governor’s first moves in office, is the shepherding of new directors into their roles leading the state’s various departments. It’s hardly a turnkey process.
Selecting the individuals who will oversee operations for some of the state’s biggest staffs and most important missions begins even before the Governor is sworn in. The governor and her transition team meet with stakeholders, speak with the outgoing administration, and even interview departmental staff. Decisions are made, individuals are asked to serve, and announcements are delivered to the legislature and the media.
Following the first of the year come formal appointments, and the state Senate performs an oversight role called “advice and consent.” The state Constitution grants the Senate the power to reject by a majority vote certain individuals within 60 days of their appointment.[1]
The new Senate Majority Leader Mike Shirkey formed a 5-member Advice and Consent committee, chaired by Senator Peter Lucido, a Macomb County Republican, and tasked it with researching, interviewing, and vetting the governor’s nominees.
Among the individuals brought before the committee – and permitted to assume their leadership roles without objection – were new Michigan Department of Health and Human Services Director Robert Gordon, Department of Insurance and Financial Services Director Anita Fox, and Department of Licensing and Regulatory Affairs Director Orlene Hawks.
Today, each leads a major state department playing a critical role in the health care process.
Michigan Department of Health and Human Services
Perhaps no department intersects more frequently with the state’s patient and physician communities than MDHHS. The department works to provide opportunities, services, and programs that promote a healthy, safe, and stable environment for state residents by developing measurable health, safety, and self-sufficiency outcomes to reduce and prevent risks, foster healthy habits, and improve lives.
That’s a big list, and an even bigger responsibility.
MDHHS operates four adult psychiatric hospitals and another for residents under 18. It oversees Medicaid plans for the state of Michigan. It’s also responsible for enacting the Healthy Michigan Plan.
Robert Gordon became the MDHHS Director on January 14, and oversees health care programs, Children’s Protective Services, food assistance and many other statewide health initiatives. An attorney who once clerked for U.S. Supreme Court Justice Ruth Bader Ginsberg, Gordon is a veteran of the U.S. Department of Education and the U.S. Office of Management and Budget under President Barack Obama. He was once described as the quarterback for the President’s evidence-based policymaking initiatives, connecting program funding with quality service delivery.
For Gordon, helping connect patients with health care providers is a family business.
“I grew up around public health watching my father help those in need find the right path in order to be successful,” said Gordon. “He was a psychiatrist at Bellevue in New York, but he also worked with a non-profit organization that helped homeless individuals with mental health and substance abuse issues transition into housing.”
He took the lessons his father taught him and has developed a remarkable personal record of public service. Improving health care access has been a consistent focus.
“During my years working for the Obama Administration, I helped drive legislation that created the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program,” said Gordon. “The program works to improve the health of at-risk children through evidence-based home visiting programs, and it’s one of the successes I am most proud of from that time.”
Now at MDHHS, Gordon says his first goal is improving health for all Michiganders. He’s quick to point to the importance and success of the Healthy Michigan Plan, with roughly 670,000 enrollees across the state.
According to the Department, through last September the plan covered at least one primary care visit for a million different enrollees – 10.5 million primary care visits in total. It’s funded 370,000 mammograms, 2.4 million dental visits, 935,000 preventative care appointments, 100,000 colon cancer screenings, and 37,000 obstetric visits or deliveries, antepartum, or postpartum care.
That’s good news for patients, and the department insists it’s good news for providers, too. MDHHS estimates, for instance, that hospitals have experienced a reduction in uncompensated care of approximately $2.8 billion since the program’s inception.
While Healthy Michigan, Medicaid, and similar programs focus on patients’ access to care, the department also offers and coordinates programs and initiatives to better fill the provider pipeline.
“We work with Michigan physicians in a strong health care ecosystem—mature Managed Care Organizations with significant expertise, high-quality and dedicated providers, from hospitals to community mental health organizations, and outstanding universities across the state,” said Gordon.
Among MDHHS’ partnerships with providers are the Michigan State Loan Repayment Program, and a new initiative in the pipeline called MiDOCS.
“Designed to improve health care services in underserved communities, the Michigan State Loan Repayment Program assists employers in the recruitment and retention of medical, dental and mental health primary care providers who continue to demonstrate their commitment to building long-term primary care practices in underserved communities designated as Health Professional Shortage Areas,” said Gordon.
Program participants can receive up to $50,000 tax-free to pay off their educational debt, in exchange for a two-year commitment to practice where patients have the least access. Since 1991, more than 1,000 providers have participated in the program.
MiDOCS sets even more aggressive goals. The program is a partnership between MDHHS and four Michigan medical schools with a target of developing 500 additional physicians by 2029 to work in underserved areas. The program will add select Graduate Medical Education residency slots in targeted communities, and offer up to $75,000 in loan repayment to each participant in exchange for a two-year post-residency practice commitment.
Together, with the rest of its responsibilities, MDHHS is firmly entrenched as state government’s central player in health care. Gordon is determined to see the department meet its goals with creative partnerships, and two eyes fixed on results.
“Since becoming director, I have visited several locations including county offices, a hospital and our labs, and I found that every office has passionate and dedicated staff who want to serve the state as effectively as they can,” said Gordon. “I feel one of my most critical jobs is to help clear obstacles.
“To do so, we need to fix systems that are not working; cut waste and spend smarter, treating taxpayers’ money like it is our own; and we need to use evidence in our decisions and make that evidence public.”
Michigan Department of Insurance and Financial Services
The Michigan Department of Insurance and Financial Services (DIFS) also plays a critical role in the state’s health care system. DIFS is the state agency tasked with overseeing 26 HMOs, 139 domestic and 1,447 foreign insurance companies, and more.[2]
With a departmental vision to “foster a regulatory environment that protects consumers,” among other goals, DIFS has its work cut out for it – in particular as it tackles insurer practices that still too often stand between patients and the care their physicians know they need.
Guiding the ship and its 350 employees since mid-January is Anita Fox. Fox is an attorney by trade, with three decades of legal experience, and a reputation as an authority in insurance coverage. In fact, she’s even taught insurance law at Michigan State University.
“I (see) the DIFS Director position as a unique opportunity and challenge to take what I have learned in the private sector and apply it to public service,” said Fox. “DIFS’ focus is on consumer protection through its mission to ensure that the insurance and financial services industries are safe, sound, and entitled to public confidence, while providing a business climate that promotes economic growth.
“DIFS protects the public in numerous ways, including investigating and shutting down fraudulent enterprises, those who issue false insurance certificates and those who abuse the medical reimbursement system.”
Under Fox’s leadership, the department is aggressively investigating and combatting fraud in the insurance and financial services sectors in partnership with the Attorney General’s office and law enforcement. DIFS is also focused on consumer protection through enhanced financial education and outreach.
While her department’s role includes oversight of private insurers, Fox’s position also comes with responsibilities in current debates surrounding potential auto insurance reform.
Fox says her initial goal is to learn all she can from the professionals within the department, industry groups, legislators, industry, and consumers to help identify and prioritize initiatives, which will include her role in evaluating options for reducing auto insurance premiums in Michigan.
Debate continues to rage at the state Capitol over proposals to reform Michigan’s Auto No-Fault Insurance Law, a national best practice that ensures motorists involved in a catastrophic automobile accident have access to the health care they need to put their lives and families back together again.
Fox and DIFS are key players as the Whitmer administration considers options and crafts policies, making the department’s relationships with Michigan physicians as important as any.
Michigan Department of Licensing and Regulatory Affairs
The state’s Department of Licensing and Regulatory Affairs was established to ensure state regulations safeguard Michigan residents through a simple, fair, efficient and transparent regulatory structure.
Director Orlene Hawks says LARA’s partnership with the physician community is essential to those efforts.
“We rely on physicians to sit on our respective medical boards to provide leadership, expertise, and oversight for disciplinary actions against licensed health professionals,” said Hawks. “Our partnerships with professional associations like MSMS is crucial to improving our services, processes, and overall licensing framework in Michigan. We take a collaborative approach to professional licensing in Michigan meaning we listen and respond to the immediate needs and concerns of our physician community as it relates to their license.”
Hawks has wide experience leading complex organizations within state government, serving under both Republicans and Democrats. Prior to joining LARA, she led the state’s Operation Excellence project dealing with MDHHS’s child protective services investigations, and spent five years as the director of the Office of Children’s Ombudsman. She also managed the Quality and Program Services section in the (Department of Community Health, and the Child, Adolescent and Family Health Services) section in MDHHS.
Now she’s tackling LARA, and she’s set aggressive goals to eliminate regulatory redundancies while improving licensure transparency, and modernize every single one of the department’s licensing and regulatory IT systems.
“Every resident in Michigan has – in some manner – interacted with LARA during their lifetime,” said Hawks. “Our licensees include individual professionals and facilities that require oversight in order to ensure the health and safety of Michigan residents. From childcare centers to hospitals; residential builders to physicians; LARA’s oversight extends to almost all aspects of life in Michigan.”
Among its roles is oversight of the Michigan Automated Prescriptions System (MAPS), and work implementing state policy in the battle against opioid addiction and use.
“Michigan is currently combating a national public health crisis,” said Hawks. “The opioid crisis has infiltrated countless Michigan communities and harmed numerous families and individuals across our state. LARA plays a significant role to combat this crisis on a statewide scale and provide appropriate services to individuals suffering from substance use disorder.”
The department recently updated Substance Use Disorders Service Program rules, as well. Hawks says the new rules improve patient care in substance use disorder facilities in Michigan, eliminate unnecessary, burdensome and outdated rules to improve requirements to ensure they operate in a safe, efficient, and cost-effective manner.
“We have seen the number of opioid and controlled substance prescriptions steadily decline in Michigan,” Hawks said. “We hope to continue this trend in the coming years by leveraging our statewide partnerships and continuing our prevention efforts.”
Those partnerships are what make the most important and effective work done by LARA, MDHHS, and DIFS possible.