Q&A: Dave Schneider gives COVID and legal outlook for 2022 – status of the reform


Dave Schneider is the executive director of Health Management Associates based in the Lansing office. He is a seasoned administrative officer with over 30 years of experience improving specialty care.

Prior to HMA, Schneider was a behavioral medicine specialist with the Michigan Department of Health and Human Services (MDHHS), where he led metrics project development and coordinated programs to improve behavioral health in Michiganders.

In these Q&A, Schneider discusses the impact of the Omicron variant on health care in Michigan, the expansions to long-term care in 2022, and the future of legislation on integrated specialty plans.

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Patrick Jones: What do you think is the most important thing in health care in Michigan right now?

Dave Schneider: “Right now it’s obviously COVID and with the growth and numbers that we’ve seen. I saw a headline today [that cited] 13,000 new cases or so [similar] and 260 more deaths in the past five days in Michigan. So [we’re] try to get this under control [though], nevertheless our vaccination rates are not where we want them to be. “

PJ: What is Michigan planning with the new Omicron variant to increase vaccination rates and deal with this new variant? How does Michgian plan to combat this new strain?

DS: “We have seen a number of health systems start again reducing elective benefits, which is very unfortunate. We really see a lot of letters to the public from the medical directors, from the heads of these major health systems, asking for it [people] to get the vaccine. You’ve put a real public marketing effort into getting people to get vaccinated.

One of the problems we face in Michigan is much of what the governor did in 2020 to defeat the first wave and contain some of the spread. She can no longer do that [since] the legislature has taken steps to stop them and brought them to justice.[{While] We see from the administration, recommendations and guidelines, we see no limits to things. It really comes down to convincing people to get vaccinated. I know all Medicaid health plans are working aggressively to get all of their enrollments vaccinated. But I hear stories from events where a single-digit number of people show up. “

PJ: Can you tell me about what these Medicaid health plans are doing to get those enrolled vaccinated? Are they using incentives?

DS: “I don’t know the incentives firsthand. I know they are running phone campaigns. They call numbers that encourage them to get vaccinated. They also sponsor events. I know one was holding an event at the Detroit Pistons training facility that still drew very, very few people. There is so much misinformation and so much skepticism that we struggle to get people vaccinated. “

PJ: How has the focus on health equity changed not only in the legislature but also in health systems, hospitals and community organizations over the past year?

DS: “The way COVID has evolved from the beginning has exposed health inequality for a number of reasons, from employment issues to life situations to many other things. But the different approaches to treatment and different approaches to the vaccine at the beginning really got a lot of attention. It is now generally accepted that there are differences in access [to health care and insurance]. There is no longer so much arguing. So what do we do about it?

We see this across the country at Medicaid, where the state requires health plans to be aligned with health equity [including] Efforts to provide more transportation to allow better access. These differences aren’t just racial; they’re not just economic, but geographical, especially in a state like Michigan, which is home to many large rural areas. Most things have large rural areas and access in those areas can be very difficult. “

PJ: What is the need to expand community-based organizations for the elderly? What is the current problem there and what are the people of Michigan doing to solve it?

DS: “Michigan just got one Renouncing my choicewhich is a waiver for the disabled and the elderly, but mainly for the elderly [people]. However, there is insufficient access to HBCS and insufficient coverage for the aging population. The governor put money into the budget this year to expand the number of slots for the My Choice exception, but it still won’t get as far as we need it to.

The state had already developed a plan in 2018 to look at how to move to managed long-term service and support (LTSS). These included five global recommendations that the state was working on. Then COVID struck and everything was put on hold. In Michigan, unfortunately, your option under Medicaid is turning into a nursing home very quickly. Michigan has more beds than many states, and the skilled care facilities are very strong.

COVID has shown us at the national level that we need to find a better way to feed our aging population. I think we’ll see changes there. There is a lot of talk about the LTSS being a focus for the state next year. But I think by the time we make better progress on COVID, COVID is taking up too much of everyone’s time. Hopefully the state will start dealing with LTSS in 2022. “

PJ: Where are we standing? Integrated Plan Legislation (SIP)? Where do you see the discussion in the next session?

DS: “I think there is a lot of discussion and a lot of negotiation. I think we will probably see action in February, maybe March. I think there are some other bills that also require action. There is the invoice for pharmacy service management that is in-house. I think you will see some action first and then I think you will see action on the SIP bills. I think there’s a pretty good chance that, with some bipartisan support, it will emerge from the legislature successfully.

I think [passage] more likely than ever because dissatisfaction, resentment and dissatisfaction with the behavioral health system are widespread. Part of our misfortune is directed at the wrong people. [Also]what we see is too much on [emergency department (ED)] enter. We see inadequate access and we see inadequate crisis continuum. Is this ED boarding for Medicaid people or is it commercial insurance? It’s usually all of the above, but what you see is that there are problems. I think there is enough money in the American Rescue Pan Act (ARPA) and other funding – one-time funding – to address a lot of these things. I think what happens is that people want to see a change. They don’t necessarily know what it has to be, but if they see a proposal that promises to change that and improve price response and improve access, I think they will be supported. “

PJ: Do you think these plans will bring this change, the required access, and the cost reduction?

DS: “It depends on many variables. I think what is really important is how the state integrates care at the service delivery level. Just because funding is built in doesn’t mean care is. We have seen other states move to integrated service delivery after years of integrated funding. This requires creativity, the willingness to support a certain infrastructure, and a better exchange of data and information. Better models for care coordination are needed. It requires an understanding of different models of practice. Primary care offices have a very different business model than a behavioral health office. I think the key to solving many of these problems is taking the steps to create systemic integration at the service delivery level. When that happens, I think a lot of the problems will be resolved. “

This interview has been edited for clarity and length.


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