Projects

See below additional examples of our work with federal and state government, foundations and other health organizations.

Who should participate? All staff from nursing homes in Michigan can benefit from attending: Administrators, Nurses, CNAs, Therapists, Social Workers, Activities, Dietary, and Housekeeping; as well as residents and their families.

What is required? Participation with WellbeingTREE is free.

Completed Sessions

(See the supporting materials below)

Bereavement and Grief Session Topics and Recordings:

Session One: “There is Wisdom in the Building”
A discussion of strategies for staff and residents to support each other after a death. View a recording of session one
Session Two: “Caring for Yourself”
Recognizing signs of grief in yourself, teaching residents to recognize signs of grief in themselves, and applying strategies to respond to those signs. View a recording of session two
Session Three: “Caring for Others”
Assisting others when a death occurs. View a recording of session three
Session Four: “It’s Always Too Soon, Until It’s Too Late”
Communication is key to ensuring residents, families, and staff know their roles during these events. View a recording of session four
Session Five: “Memorials”
Memorials are for the living and a good way to honor staff and remember residents. View a recording of session five

Social Isolation and Loneliness Topics and Recordings:

Session One: “Loneliness and Companionship”
Exploring the connection between social isolation and loneliness with our physical and mental health, addressing ways that can alleviate another's social isolation with care processes. View a recording of session one
Session Two: “Transforming Systems & Processes to Promote Connectedness”
Exploring ways that systems, processes, and practices can promote loneliness and isolation and can prevent finding desired companionship for residents. View a recording of session two
Session Three: "Empowering Resident Voice and Choice"
Delving into what empowerment means in the nursing home for both residents and staff and encouraging the use of observation and assessment to help homes identify practices that build empowerment. Valuable resources are shared that participants can use to carry their learning forward. View a recording of session three
Session Four: "Tackling Loneliness & Promoting Social Connection Among Nursing Home Residents"
Taking a deep dive into the definition of loneliness, we ask the question "How can nursing home residents feel so lonely when they are surrounded by others?" Examining risk factors that may increase the likelihood of loneliness and discussing health outcomes associated with loneliness. View a recording of session four
Session Five: "Effective Approaches for Reducing Loneliness in Nursing Home Residents"
Discussing strategies to mitigate social isolation and loneliness in nursing home residents including navigating family estrangement as well as using different types of technology and laughter therapy. View a recording of session five

Altarum and the University of Michigan are teaming up to help primary care providers effectively manage pain in older adults.

When prescribing opioids to older adults, it is important to balance pain relief and quality of life with the risk of opioid dependency. The ROMPO (Reframing Optimal Management of Pain and Opioids in Older Adults) project goal is to respond to the unique challenges providers face when caring for older (age 60+) patients who use opioids through a comprehensive educational program.

Implementing ROMPO into your practice will help reduce your older adult patients’ use of opioids while addressing pain in a more effective and sustainable manner.

Benefits of Participating

Improve outcomes for older adult patients experiencing pain
Learn to measure and document your patients’ pain using the PEG as part of a comprehensive approach to improving functionality and well-being
Incorporate an ambulatory pain order set into patients’ charts for easy access to medication and referral orders, as well as clinical decision support
Learn shared decision-making strategies to help empower older adults to become active participants in their medical care
Access prescriber support and clinician resources
Work with a dedicated Practice Facilitator who will provide customized technical assistance for your practice

Plus:

Earn free Continuing Medical Education (CME) and Maintenance of Certification (MOC) credits – up to 20, depending on eligibility
Participating practices earn up to $1000 in incentive payments after submission of data at three time points.

Eligible Providers Must:

Specialize in Internal Medicine, Family Medicine, or Geriatrics, and care for patients aged 60 and over.

Designed to transform hospital-like institutions that approach elders as medical patients into communities, nursing home comprehensive culture change initiatives are the definition of radical change. Staff are trained and coached to not only provide medical and supportive services, but also on how to consistently prioritize resident choice and quality of life. Although over the last four decades significant work to develop approaches that foster a person-centered model of care have been designed, little has been done to measure the effectiveness or standardize different culture change protocols.

Altarum’s Delivery Systems Transformation team is committed to implementing, evaluating, and advocating for best practices that ensure quality of life in old age. To advance the work on person-centered care we developed the Systems Change Tracking Tool^SM (SCTT). A uniquely purpose-designed QI instrument that allows all members of the nursing home staff, from administrators through care aides and household staff to track their accomplishments and challenges implementing person-centered care over time. By completing and reflecting on the SCTT regularly, staff understand more clearly where they are moving the needle on person-centeredness and how they can make culture change a reality for their residents.

The need for more person-centeredness in the nursing home sector has become starkly clear during the COVID-19 pandemic. Nursing homes nationwide struggled not only to curb high rates of morbidity and mortality, but also with significant resident decline and premature death directly traceable to social isolation and loneliness. As residences where 1.3 million elders live their final years, those in public health are called to refine and amplify practices and protocols that can be used to enhance residents’ quality of life. With the further benefit of making the job of care aides more rewarding.

How the Systems Change Tracking Tool Works

As culture change training proceeds, the SCTT assesses changes that occur in the residential long-term care setting by measuring staff-led shifts in person-centered practices and protocols using 58 items. To ensure its cogency and usefulness, the SCTT underwent cognitive testing and an iterative review process by long-term care, culture change, and survey methodology experts. Importantly, the tool’s instructions acknowledge that not all changes discussed in the instrument will happen quickly—and some may not happen at all.

The SCTT features questions that are grouped into six domains, as established by the Holistic Approach to Transformational Change (HATCh) theoretical model.

The six HATCh domains^1,2are:

Care Practices Continuous improvement of clinical and non-clinical care (for example, consistent staffing among residents)
Workplace Practices Endeavors that affect residents through their impact on staff (for example, access to information about resident preferences)
Environment Creating a home environment that is comfortable and comforting to the residents that live there (promoting feelings of home and comfort)
Family/Community Resident activities to benefit personal and social interactions; opportunities to engage residents (for example, being able to listen to music of their choice or dine at a local restaurant)
Leadership Developing culture change among all staff levels, including offering skill-building trainings for direct care staff and inclusive decision making for care plans
Stakeholders Institutional and regulatory factors that influence culture change; working with stakeholders so these are in harmony with what residents need

Completed quarterly, the tool has four possible responses options: the home has a plan for implementation; the home has a plan that is partially implemented; the home has a plan that is fully implemented; or the home has no plan for implementation.

Working with Altarum to Measure Nursing Home Culture Change Using the Systems Change Tracking Tool

The SCTT tool is publicly available and free to use. We invite anyone who is interested in learning more about how we implemented the SCTT protocol in our own on-going comprehensive culture change initiatives to reach out. We would be pleased to discuss how other organizations might use the tool for their own purposes including for Quality Assurance and Performance Improvement (QAPI) projects. We believe this tool can be a valuable asset in advancing best practices in eldercare nationwide.

If you are interested in using the tool please contact us!

White-Chu, et al. (2009). Beyond the medical model: the culture change revolution in long-term care. Journal of the American Medical Directors Association, 10(6), 370–378. https://doi.org/10.1016/j.jamda.2009.04.004
Healthcentric Advisors. (2015). Holistic Approach to Transformational Change®. Retrieved from https://www.youtube.com/watch?v=DtRnzz4ztbk&feature=youtu.be

The rates of high blood pressure, heart attack, and stroke in Michigan are all higher than the U.S. median. Residents of rural Michigan are more likely to die prematurely from cardiovascular disease (CVD) than urban residents.*

Healthy Hearts for Michigan (HH4M) offers primary care practices a dedicated Practice Advisor and other resources they need to help patients with CVD:

Coaching to help enhance shared decision making and patient engagement
Guidance to help increase workflow efficiency and promote team-based care
Assistance to streamline provider-to-provider electronic referrals
Support to improve MIPS, HEDIS, and other reporting program scores

The HH4M Practice Advisor assists the practice with:

Leveraging existing EHR data to identify undiagnosed hypertension “Hiding in Plain Sight”
Implementing or improving upon a patient Self-Measured Blood Pressure program
Employing an “Ask-Advise-Connect” opt-out Tobacco Cessation program

Altarum, along with our partners Michigan Center for Rural Health and Upper Peninsula Health Care Solutions, is excited to announce the Healthy Hearts for Michigan program, a 12-month research study in partnership with Northwestern University. We aim to assess the capacity of Michigan’s primary care practices to adopt and sustain quality improvement strategies for treatment of hypertension and smoking, the leading risk factors of CVD.

Who is eligible? Michigan-based primary care providers.

What is required? Support staff, with provider guidance, will work with a dedicated Practice Advisor to assess current workflows, establish screening and treatment protocols, and collect quarterly study data.

HH4M is funded by the Agency for Healthcare Research and Quality (AHRQ).
Study Number: STU00213920.
Principal Investigators: Anya Day, MPH and Theresa Walunas, PhD

*MDHHS 2019 BRFS Annual Reports

Covid-19 has overextended many providers. At the same time, the heightened stress, loneliness, and anxiety faced by their patients exacerbates the ongoing opioid crisis. Addressing both challenges requires new tools and workflows.

To help, Altarum is offering free virtual cross training and ongoing technical assistance to equip providers with the skills to screen and refer their clients. This training will be scheduled at your convenience and will use fun, interactive activities, teach-backs, and role-playing to build on the knowledge and experience of participants, and enhance collaboration between the two organizations.

Because only about 50% of women and men with substance use disorders report using contraception and the number of pregnant women with opioid use disorder more than quadrupled in the past few years, our goal is to increase substance use disorder screenings and referrals in family planning clinics and increase family planning screening and referrals within substance use disorder services.

Participation Benefits

Financial compensation for sites. Participating sites will receive a stipend of $3,000.
Professional development. Participants will better understand the relationship between family planning and substance use disorder services and will engage more effectively with clients. Program participants will have the opportunity to earn up to 25 continuing medical education credits.¹
Ongoing technical assistance. Up to six months of individualized technical assistance, as well as opportunities for continued communication and collaboration between family planning and behavioral healthcare sites.
Compelling data to leverage for future opportunities. Participants will receive economic analysis results, including costs saved through achieving improved client outcomes and avoiding costly societal impacts of SUDs, unplanned pregnancies, and STIs.
Community engagement and service integration. Participants will be trained with other service providers in their community to foster relationships and better integrate services.

Participation Requirements

The program is available to any Title X funded family planning provider and any behavioral health provider that provides services or treatment for substance use disorder nationwide. Program expectations include:

Staff attendance at 6–8 hours of virtual training.
Provide data for all pre- and post-training evaluation measures. Altarum will provide technical assistance as needed to help participating organizations gather and submit data.
Participating clinical sites should be able to commit 3–7 staff members (depending on practice size) to attend the training, representing as many of the following roles as possible:
- Health Care/Direct Service Providers
- Medical Program/Agency Director
- Administrative/Front Desk Staff
- Medical Assistant
- Clinical Director
- Case Manager
- Recovery Support Services

How to Get Started

If you have any questions, please reach out to Jessica McDuff, Project Manager, at linkstudy@altarum.org.

¹Altarum is accredited by the Michigan State Medical Society to provide continuing medical education for physicians.

The Altarum designates this PI CME activity for a maximum of 20 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

An extraordinary number of youth are struggling with depression. What can you do to help? Join our new program, funded by the Michigan Health Endowment Fund, which provides rural practices in Michigan free telehealth technology, training, and clinical resources to help expand depression treatment. Watch our video to learn more!

If you are a rural provider in Michigan who treats adolescents, you are eligible to participate in the Responding to Adolescent Depression through Integration and Telemedicine (RAD-IT) program. It is designed to expand access to screening, treatment, and specialty referrals among the growing numbers of youth struggling with depression in rural areas. Without the ability to access care via telehealth, many rural adolescents will go untreated.

Benefits to Medical Practices

Participating in this program will not only help you expand your practice to more patients who need care—it will also prepare you for a post-Covid world where telehealth will be increasingly common. Our program offers the following benefits:

HIPAA-Compliant Telehealth equipment that is yours to keep. Practices may use the equipment and software provided (and/or their own equipment) to conduct telehealth visits with any of their patients. The DX80 equipment is yours to keep upon program completion. The WebEx platform is valid for 3 years. Together, the package is valued at ~$5,000.
Virtual training which eligible clinicians can participate in to receive 20-50 Continuing Medical Education (CME) and Maintenance of Certification (MOC) credits. Training includes three virtual trainings, four short case-based podcasts, and two Plan-Do-Study-Act (PDSA) cycles. Learn more about our CME and MOC program.
An interactive Learning Management System with a curated toolbox of resources for clinicians, teens, and their parents. Resources include up-to-date information on subjects such as depression, bullying, substance use, self-harm, suicidality, and telehealth.
A dedicated facilitator assigned to each practice, who will help you: implement effective screening and treatment practices, use telehealth as a BH resource, collect and submit program data, develop and/or improve workflow and billing procedures, and implement follow-up and patient monitoring protocols.
Access to the Remote Care for Kids (RCK) Network, a telehealth network of over 100 licensed behavioral health providers who specialize in treating adolescents with depression. These clinicians are committed to the RAD-IT program and may be used for clinician-to-clinician consults, or as a treatment resource for your patients.
Tailored behavioral health referral guides that present up-to-date information on behavioral health clinicians near your practice. The guides use intuitive icons, so you can easily identify treatment modalities, insurance accepted, languages spoken, and more.

How to Get Started

Contact Haley McCrary, RAD-IT Project Manager at 734-545-6308, RAD-IT@altarum.org

PACE, the Program of All-Inclusive Care for the Elderly, is an innovative program that provides high-quality, person and family-centered long-term services and supports (LTSS) to older adults, most of whom are lower-income and eligible for both Medicare and Medicaid (known as "dual-eligibles").

The PACE model is especially important today as we work to find solutions that enable more older adults to remain in their homes while receiving quality and affordable LTSS.

But there are barriers to expanding PACE to a larger share of aging low- and middle-income Americans. One of them is the cost of prescription drug coverage.

Dually-eligible beneficiaries, who make up the majority of PACE participants, have all of their Part D costs covered. But due to conflicting provisions in the original PACE statute and the 2003 law that established the Part D program, Medicare-only participants are forced to pay exorbitantly high premiums for their drug coverage.

To address this, Altarum has devised a set of policy solutions and advocacy tools that the documents on this page contain. They can be used by anyone to advocate on behalf of their PACE program or community. They include the following:

PACE and Part D Issue Brief This is a primer of how middle-class Medicare beneficiaries are effectively barred from choosing PACE due to exorbitantly high Part D costs, and the legislation and CMS waivers that can address it. This also includes infographics that illustrate both processes.

Huron Valley PACE Combined BIPA 903 and Part D Waiver Request and Letters of Support This document features the waiver request from Altarum and Huron Valley PACE to CMS to address high Part D costs. While this wavier was declined, there is still potential for this waiver to be granted in the future. We also include our rebuttal letter to CMS.

For those who would like to submit their own waiver to CMS, we include in this batch of documents letters of support for the waiver from the acting director of the Michigan Department of Health and Human Services and Representative Debbie Dingell.

Letter from CMS Granting VA PACE Waiver In 2011, CMS granted some PACE organizations a conditional waiver that permits any participant in the PACE program who is eligible for VA drug coverage to choose to receive their prescription drug coverage through the VA and avoid paying the Medicare Part D premium. This letter is helpful background information to understand the potential for such a waiver to be granted on a wider scale.

NPA PACE Part D Choice Issue Brief and Part D Pricing Study This succinct brief from the National PACE Association (NPA) summarizes a promising bipartisan legislative approach to solving the PACE Part D dilemma that has been introduced in the House of Representatives. Pages 3 and 4 highlight the enormous cost differential between prescription drug costs faced by Medicare-only PACE participants, who are forced to buy their prescription drug coverage through a PACE Part D plan with no federal cost subsidies, as compared to the costs of all other Part D plans available in the marketplace.

Altarum Medicare Part D for PACE Participants Without Medicaid This slide set, used to present to legislative and executive branch staff in early 2022, accompanies the Milliman financial impact study discussion slides, providing background on administrative and legislative possible solutions.

Milliman Medicare PACE Part D for PACE Participants Without Medicaid This slide set, used to present to legislative and executive branch staff in early 2022, accompanies the Altarum financial impact study discussion slides, providing actuarial analysis of the cost outcomes for key stakeholders, should all non-dual PACE participants switch to a Part D PDP: Beneficiaries, CMS, Rx Plans and Part D plan sponsors.

Leadership Council on Aging Organizations (LCAO) PACE Part D slides This slide set was prepared for presentation in the fall of 2021 to the 70 beneficiary advocacy organizations comprising the LCAO, and outlines a framework for these organizations to understand and help accelerate momentum for a solution to the PACE Part D dilemma.

Does Your PACE Program Need Assistance Navigating this Process? Contact Us.

We encourage anyone who is interested in expanding PACE to leverage these materials to advance this important policy reform. If you would like to use our consulting services to help your PACE program navigate this process, please contact Altarum Delivery System Transformation Senior Director Krissy Azeem.

Altarum is evaluating a culture change initiative in six nursing homes in Michigan. The project aims to improve quality of life for residents of the nursing homes by improving the skills of staff and operational practices and protocols of the participating homes. The project is funded by the Michigan Department of Health and Human Services with Civil Monetary Penalty funds.

[format] => full_html ) ) ) [field_approach] => Array ( [und] => Array ( [0] => Array ( [value] =>

Altarum is assessing the impact and sustainability of comprehensive culture change training and education in a variety of nursing homes by monitoring selected clinical quality measures; analyzing quality-of-life reports from residents, family members and staff; tracking shifts in operations (such as more dining flexibility); and assessing the economic impact.

The Eden Alternative®, a global non-profit organization dedicated to creating quality of life for elders and their care partners, is providing education and coaching to the nursing homes. The training is designed to empower nursing home administrators and all other staff to understand how daily practices and protocols can be shifted from rigid, institutional patterns of service delivery to care that is more individually tailored to the individual needs and preferences of elderly residents.

[format] => full_html ) ) ) [field_results] => Array ( [und] => Array ( [0] => Array ( [value] =>

The project is in its second year, and we expect to have preliminary findings to share later this year. Our hope is to use learnings from Michigan to inform and replicate similar comprehensive culture change initiatives in other states.

Projects

TOPICS

WellbeingTREE Learning and Action Network (LAN)

Reframing Optimal Management of Pain and Opioids in Older Adults (ROMPO)

The Systems Change Tracking Tool

Are You a Primary Care Provider in Michigan?

Are You a Family Planning or Substance Use Disorder Service Provider?

Are You a Rural Provider in Michigan?

Policy Reforms Needed to Expand the Program of All-Inclusive Care for the Elderly (PACE)

Improving Quality of Life for Nursing Home Residents Through a Culture Change Initiative

Completed Sessions

Benefits of Participating

How the Systems Change Tracking Tool Works

Working with Altarum to Measure Nursing Home Culture Change Using the Systems Change Tracking Tool

Participation Benefits

Participation Requirements

How to Get Started

Benefits to Medical Practices

How to Get Started

Does Your PACE Program Need Assistance Navigating this Process? Contact Us.