In Pursuit of Health Equity

2021 IMPACT Report


In Pursuit of Health Equity

Friends —

In the second year of the pandemic, vaccines became widely available, but more died of COVID. American Indians, African Americans, and seniors experienced the highest rates of morbidity, demonstrating the fragile health of these historically marginalized populations, as well as longstanding health disparities driven by social influencers of health. Behavioral health concerns skyrocketed. As did job losses, substance use concerns, and other social, behavioral, and economic problems. 

That knowledge, and the grief we’ve experienced losing loved ones to the virus, has redoubled our commitment to public health. 

CHRT’s 2021 work–managed by our dedicated, mission-driven, growing team–addressed all of these issues through research and evidence-based recommendations for policymakers and decision leaders. 

Of particular note, in 2021 CHRT:
  • Produced a series of briefs to inform policymakers and practitioners about how to support caregivers, physicians, and communities throughout the pandemic;
  • Began a major Promotion of Health Equity initiative with partners across the state; 
  • Completed a three-year national initiative focused on building equitable and thriving communities through integrated care;
  • Significantly advanced its focus on caregivers, who have faced tremendous stressors and setbacks during the pandemic;
  • Launched a demonstration project to provide home-based health and social care to seniors and people with disabilities;
  • Helped non-profit clients build a path toward long-term financial sustainability while advancing strategic objectives;
  • Began to systematically apply an equity lens across each project in our growing portfolio; and more.

In the pages that follow, you’ll find highlights from the year, sharing these and other initiatives. 

It feels right to document this work–to recognize all of the positive accomplishments you, and our team members, have fueled in the midst of a very challenging year. 

We remain grateful to each of you–our staff, our clients, our funders, our partners–and we look forward to continuing to work with you to advance the health of our community, our state, and our nation next year, and in the years to come. 

Terrisca Des Jardins
Executive Director
Center for Health and Research Transformation (CHRT)

Tony Denton
Chair, CHRT Board of Directors
Senior Vice President and Chief Operating Officer,
University of Michigan Health – Michigan Medicine

Terrisca Des JardinsTony Denton
Michelle Duprey
“Starfish Family Services partnered with CHRT to create and facilitate an evaluation plan for a very important grant. CHRT worked tirelessly and collaboratively with my team, and the result was a well rounded evaluation of our Pediatric Integrated Health Care model, a well written and informative paper that showed the effectiveness of the model, and an integration impact calculator that others can utilize when considering Pediatric Integrated Health Care. The evaluation accomplished the goals of the grant and created something that can help the Integration landscape for years to come.

— Michelle Duprey
national subject matter expert in pediatric integrated health care

Strategic Goals

All CHRT projects revolve around three strategic goals

2021 GOAL #1

Be, and be known as, a source for evidence-based, non-partisan information on health policy issues and trends. 

Physician burnout.

CHRT fielded a survey to gather Michigan primary care provider perspectives on burnout before and during the COVID-19 pandemic. More than 2,000 physicians responded, and the prevalence of self-reported symptoms of burnout had increased from 31 percent in 2018 to 40 percent in 2021. Further, more than a quarter agreed or somewhat agreed that COVID-19 made them feel burned out and consider leaving medicine. 

CHRT’s Michigan Physician Survey explores the perspectives of primary care providers. Michigan physicians are asked to describe their patient and practice characteristics, their services, and more.READ MORE

COVID vaccination.

Between March 19 and April 1, 2021, CHRT fielded a supplement to its regular Cover Michigan Survey to better understand who wasn’t getting vaccinated against COVID-19 and why. Those less likely to have received at least one dose of the vaccine had lower incomes, no health insurance, or no medical home. Eighty-six percent of those who did not intend to get vaccinated reported that they were worried about vaccine-related side effects. 

CHRT’s Cover Michigan Survey was developed in 2009 to explore health status, health insurance coverage, and health care access trends for populations across the state of Michigan. READ MORE

Unpaid caregivers.

CHRT scanned the current state of caregiver support programs across Michigan and the U.S. and produced three briefs about the needs of unpaid caregivers. The first brief reviewed six state and federal policy options to support unpaid caregivers, the second analyzed how COVID-19 had impacted caregivers, and the third analyzed the current state and evidence-base of programs supporting Michigan’s 1.7 million caregivers.

CHRT’s work on unpaid caregiving was funded by the Michigan Health Endowment Fund and the National Institute on Disability, Independent Living, and Rehabilitation Research. READ MORE

Annual wellness visits.

CHRT researched annual wellness visit use among persons with physical disabilities from 2008 to 2016–before, during, and after the rollout of the Affordable Care Act (ACA). Researchers considered insurance type, race, sex, and disability type to determine how persons with disabilities used AWVs. While AWV use increased after the passage of the ACA, persons with disabilities were 15 percent less likely to use AWVs than the general population.

CHRT’s paper on annual wellness visits for persons with physical disabilities was supported by the National Rehabilitation Research and Training Center and published in the Annals of Family Medicine. READ MORE

Health policy fellowship.

Since 2012, 122 health service researchers, policymakers, and nonprofit leaders have completed CHRT’s four-month Health Policy Fellowship program. In the midst of the COVID-19 pandemic–to secure the safety of fellows, staff, and the community–CHRT put its traditional fellowship on hold but organized a series of remote learning sessions for fellowship alumni who were interested in refreshing their skills and building their networks.

CHRT’s Health Policy Fellowship brings together policymakers, researchers, and nonprofit fellows to learn about health policy and the research process.
It’s about making a difference. In 2021, we had a large focus on unpaid caregivers. We looked at both stressors and burdens for unpaid caregivers as well as at local, state, and federal policies that support caregivers. Identifying innovative policy solutions is important to us and the clients we work with.”

–Robyn Rontal
policy analytics directoR

2021 GOAL #2

Help community-based health collaborations improve population health and magnify their impact. 

Collective action.

CHRT provided backbone support to a coalition of 200 volunteers from 100 community agencies dedicated to improving health, health care, and health equity across Washtenaw County. In 2021, CHRT helped these volunteers launch new projects to address health disparities, facilitated volunteer work groups to advance their objectives and impact, informed more equitable and just policies in the community, and more.

The Washtenaw Health Initiative focuses on improving health, health equity, and health care for low-income, uninsured, under-insured, and underrepresented populations across Washtenaw County.READ MORE

Care coordination.

CHRT launched a complex care management program staffed by two-dozen care managers and community health workers at medical, behavioral, and social service agencies. We enhanced data collection, facilitated quality improvement and care coordination meetings, managed community-based referrals, developed new partnerships, and distributed funding to partners to address some of the most pressing effects of the COVID-19 pandemic. 

MI Community Care is an initiative designed to improve the health and well-being of residents with complex needs, enhance capacity at participating organizations, and reform the regional care system.READ MORE

Learning community.

CHRT facilitates a learning community for a dozen regional and statewide organizations working to advance health equity in Genesee, Jackson, Kent, Livingston, and Washtenaw Counties. In 2021, the organizations developed a shared mission and vision for the network, identified key equity metrics across all regions, established an evaluation plan, reviewed technology platforms, and developed best practices for data collection. 

The Health Equity Learning Network works to develop an equitable system of integrated medical, behavioral, and social services that empower communities to achieve optimal health for everyone. READ MORE

Homelessness diversion.

CHRT brought together housing and homelessness partners to identify areas of need and develop activities to improve the homeless response systems in Livingston and Washtenaw Counties. CHRT then assessed housing needs in both counties and provided backbone support, proposal writing, and data support for a pilot program that trained frontline workers and support staff in implementing a homelessness diversion model.

Improving the homeless response system is a collaboration between several different shelters, housing and supportive housing providers, homelessness prevention agencies in Washtenaw County.  READ MORE

Vital seniors.

CHRT led preliminary work to develop a community-integrated health network to address the social needs of seniors in southeast Michigan. This involved providing backbone support to a group of local partners and, through a collective impact model, helping them identify shared values and objectives. The network designed and implemented a Home Nutrition+ pilot to serve vulnerable adults in Washtenaw County. 

The Vital Seniors Initiative, managed by the Ann Arbor Area Community Foundation (AAACF) and funded by the Glacier Hills Legacy Fund, addresses key challenges faced by seniors and their caregivers.
“Collective impact theory states that no single policy, government department, organization, or program can solve the complex social problems we face as a society. CHRT offers critical services to support collective action. Our backbone support is not just about administration, it‘s about identifying what partners need, and helping them achieve their vision.”

— Sharon Kim
associate director of policy

2021 GOAL #3

Build the evidence base for local and state programs that can be replicated and scaled to improve health and social welfare.

Workforce shortages.

For the Behavioral Health Workforce Resource Center, CHRT researched the impact of public health emergencies on behavioral health care providers and clients, the potential benefit of employing community health workers to connect patients with integrated physical and behavioral health services, and the types of behavioral health providers that integrate services into the primary care setting in rural and urban areas across Michigan.

Behavioral health workforce research was funded by the U.S. Health Resources and Services Administration and the U.S. Substance Abuse and Mental Health Services AdministrationREAD MORE

Long-term services.

CHRT informed the state of Michigan's long-term services and supports (LTSS) strategic plan. Staff reviewed best practices on key LTSS options and equity initiatives, conducted an environmental scan of federal opportunities, and provided examples of how states have structured their LTSS programs. CHRT also conducted a series of internal and external key informant interviews, and completed a literature review, to inform recommendations.

LTSS encompass a variety of health, health-related, and social services that assist individuals with functional limitations related to physical, cognitive, or mental conditions or disabilities.READ MORE

Integration framework.

CHRT identified a framework to facilitate the integration of historically siloed health, behavioral health, and human service systems. The EVOLVE integration framework–which describes essential work in Environment, Values, Opportunity, Leadership, Validation, and Engagement–highlights the key factors to consider when developing a well-functioning, sustainable, and integrated health and human services system.

The EVOLVE project was funded by The Kresge Foundation. The research was published in the American Public Human Services Association's Policy and Practice Magazine.READ MORE

Pediatric integration.

CHRT evaluated the effectiveness of two pediatric integration initiatives in Wayne County to determine whether integration improved patient outcomes and the quality of pediatric care. The evaluation found that both patients and physicians benefited from easy access to a trained behavioral health consultant. CHRT developed a financial impact calculator to help pediatric practices determine the cost and benefits of employing behavioral health consultants.

CHRT's research on the impact of pediatric integration on people, providers, and health systems was conducted in collaboration with Starfish Family Services and the UM School of Public Health. READ MORE

Social needs.

CHRT is providing fiscal and strategic support to five regional initiatives working to integrate health, behavioral health, and social services to address social needs, improve health outcomes, and reduce disparities for Michigan residents. To identify health disparities, the initiatives collaborated with other partners to develop a statewide infrastructure for collecting, analyzing, and reporting on the social needs of regional participants.

Michigan's Promotion of Health Equity initiative is funded by the U.S. Centers for Medicare & Medicaid Services and the Michigan Department of Health and Human Services.
“CHRT works with all sizes or organizations and programs in very real world settings. Often our partners are creating and implementing a program at the same time we’re evaluating it because in community-based settings there’s not always the luxury of time. We're very involved with stakeholders and funders to make sure that we're working collaboratively to meet their needs.” 

–Melissa Riba
director of research and evaluation

2021 Publications

December 20, 2021

A look back at the journey of the Vital Seniors Initiative—and where it’s heading next

Deana Smith, Matt Hill, Allison Fritsch, Erin Horne

November 23, 2021

Here’s the current state of programs supporting Michigan’s 1.7 million caregivers

Patrick Kelly, Marissa Rurka, Cristin Cole, Erica Matti, Melissa Riba

November 2, 2021

Integrating behavioral health consultants at pediatric clinics benefits children, but can practices afford it?

Michelle Duprey, Jung Nichols, Sarah Boyce, Shaine Reinke, Patrick Kelly, Melissa Riba, David Hutton

September 24, 2021

Annual wellness visit use among persons with disabilities in the Annals of Family Medicine

Tanima Basu, Neil Kamdar, Patrick Brady, Cristin M. Cole, Jaque King, Robyn Rontal and Diane M. Harper

July 2021

Innovative payment and care delivery models: ACOs in the USA, Handbook of Integrated Care, 2nd edition, Springer

Terrisca Des Jardins

June 17, 2021

EVOLVE, CHRT’s integration framework, in APHSA Policy and Practice Magazine

Samantha Iovan, Kathryne O’Grady, Marianne Udow-Phillips

June 14, 2021

Predictive model-driven hotspotting to decrease ED visits: an RCT, Journal of General Internal Medicine

Jeremy Lapedis, Ayşe G Büyüktür, Karin Teske

March 21, 2021

The hidden cost of unpaid caregiving: The case for supporting unpaid caregivers across the state of Michigan

Matt Hill, Jenny Nulty, Deana Smith, Erin Spanier, Karin Teske

“As I step down from the CHRT board following many years of service, I reflect on the very crucial role that CHRT played in Michigan’s Medicaid expansion. Across the state, many questioned whether Michigan’s physicians had the ability to provide services to the hundreds of thousands of residents who would be newly covered by Medicaid. CHRT found that Michigan’s physicians did have that capacity. The research was influential in the governor and legislature’s decision to expand Medicaid as part of the Affordable Care Act.”

— John Z. Ayanian
Director, university of Michigan Institute for Healthcare Policy and Innovation

2021 News

Media Mentions

Puzzle with people

January 6, 2021

Trump rule forces Michigan hospitals to reveal secret prices

Detroit Free Press

by JC Reindl

February 18, 2021

Nursing home COVID-19 infection rates down, hampered by other challenges

WWMT West Michigan

by Mike Krafcik

February 21, 2021

State of confusion: Michigan's mental health system

Crain's Detroit

by Chad Livengood

February 25, 2021

House Oversight Committee hearing on COVID-19 nursing home policy

13 on Your Side

by Emma Nicolas

March 2, 2021

Republicans seize on nursing-home deaths to weaken Democrats


by David Welch and Gabrielle Coppola

March 10, 2021

Michigan Gov. Whitmer stands by COVID nursing home policy

Click on Detroit

by Rod Meloni

March 12, 2021

What we know about the impact of Whitmer's nursing home policies

Detroit Free Press

by Clara Hendrickson and Kristen Jordan Shamus

March 12, 2021

What we know about the impact of Whitmer's nursing home policies


by Clara Hendrickson and Kristen Jordan Shamus

March 15, 2021

Nessel declines to investigate Whitmer's nursing home policies

Deadline Detroit

by Allan Lengel and Violet Ikonomova

March 15, 2021

Michigan AG Dana Nessel won't investigate

Detroit Free Press

by Dave Boucher and Clara Hendrickson

March 15, 2021

Michigan Republicans pushing for probe of nursing home orders

The Sault News

by David Eggert

March 15, 2021

Attorney General Nessel won't investigate Whitmer policies

Detroit News

by Craig Mauger

April 10, 2021

Michigan is overwhelmed by another COVID-19 surge. Is Wisconsin next?

Milwaukee Journal Sentinel

by Rory Linnane, Daphne Chen and Tim Bannon

June 3, 2021

Hertel: Michigan not undercounting nursing home deaths

Detroit Free Press

by Dave Boucher

July 7, 2021

Michigan Auditor General to study long-term care facility deaths

Detroit Free Press

by Christina Hall and Clara Hendrickson

July 12, 2021

EVOLVE framework provides model for integrating health and human services

The Kresge Foundation

by Kate McLaughlin

August 27, 2021

Costs rising for Michigan COVID care with return of deductibles, copays

Bridge Michigan

by Robin Erb and Makayla Coffee

August 28, 2021

COVID-19 copay, deductible returns may encourage vaccination

Beckers Hospital Review

by Nick Moran

September 3, 2021

Opinion: Insurers are driving up the price of staying unvaccinated

The Detroit News

by Melissa Riba

December 8, 2021

Washtenaw County marks ten years of improving health care


by Jaishree Drepaul-Bruder


Puzzle with people

January 1, 2021

Presentation to IDEAL RRTC on broadband internet access and implications for the health of people with disabilities

Robyn Rontal

January 1, 2021

Presentation to members of the Inter-University Consortium for Political and Social Research on Policy solutions to support family caregivers

Robyn Rontal and Cristin Cole

January 1, 2021

Presentation to the Kresge Foundation's Health and Human Services Integration Grantees integration and frameworks for success

Samantha Iovan and Marianne Udow-Phillips

March 1, 2021

Presentation to the Washtenaw Health Plan Board of Directors on the newly funded Promotion of Health Equity Initiative

Terrisca Des Jardins

May 1, 2021

Presentation to the UAW International Health and Safety Conference on integrating peer recovery support programs into the workplace

Matthew Hill

May 1, 2021

Presentation to the 2021 Michigan State of Reform Health Policy Conference on new approaches to long-term services and supports

Jaque King

May 1, 2021

Presentation to the Institute for Healthcare Policy and Innovation on current and past health policy collaborations

Terrisca Des Jardins, Melissa Riba, Nancy Baum and Robyn Rontal

May 1, 2021

Presentation to the University of Michigan Department of Learning Health Sciences about current and past collaborations

Terrisca Des Jardins

August 1, 2021

Presentation to the Alliance to Advance Patient-Centered Cancer Care on ways to use communications to inform policy and practice

Erin Spanier

October 1, 2021

Presentation to the Michigan Health Endowment Fund and Center for Health Care Strategies on Michigan's caregiver support programs

Melissa Riba and Patrick Kelly

October 1, 2021

Presentation to the Institute for Healthcare Improvement LAN on creating meaningful experiences for patients and community

Terrisca Des Jardins

“CHRT’s Promotion of Health Equity project really cuts across all three of our strategic goals. It’s recognizing formally that social issues impact people's health, and that it's no longer adequate to work within the traditional health care system alone if we want to improve health and advance equity.” 

— Nancy Baum, PhD
director of health policy, CHRT

2021 Financial Position

Audited statement
of financial position

December 31, 2021

CHRT Assets tableCHRT Liabilities Table

Sources of

12 months ended December 31, 2021 (audited)
Expenditures w pass through


Pie Chart
“As co-director of Blue Cross Blue Shield of Michigan’s new Collaborative Quality Initiative–designed to promote health equity by addressing patients’ social needs and enhancing data systems to make equity part of quality improvement–I work with CHRT on Michigan’s five-county Promotion of Health Equity initiative. CHRT has deep roots in the community, and connections to equity leaders across the state.” 

— Renu Tipirneni, MD
co-director, Michigan Social Health Innovations to Eliminate Disparities (M-SHIELD) CQI


Board of Directors

Tony Denton, Chair
Senior Vice-President and Chief Operating Officer, University of Michigan Health – Michigan Medicine

Lynda Rossi, Vice Chair
Executive Vice President, Strategy, Government, and Public Affairs, BCBSM

John Z. Ayanian
Director, University of Michigan Institute for Healthcare Policy and Innovation

Rob Casalou, Board Treasurer
Regional President and CEO
Saint Joseph Mercy Health System

Toshiki Masaki
President, Detroit Chapter,
Japanese American Citizens League

Amy McKenzie
Senior Vice President and Chief Medical Officer, BCBSM

Fran Parker
Retired, Executive Director
UAW Retiree Benefit Trust

Todd Van Tol
Senior Vice President
Health Plan Business, BCBSM

Brent Williams
Medical Director, University of Michigan Complex Care Management Program

Terrisca Des Jardins (Ex-Officio)
Executive Director, Center for Health and Research Transformation

“In my 30-plus-year career at the Ford Motor Company, I held many roles—from engineering, public policy, and government relations to data analytics. Outside of that role, I served on Michigan’s Asian and Pacific American Affairs Commission and Health Care Information Technology Commission. I joined the CHRT board because I believe the organization is poised to make tremendous contributions to advance health equity in our state and nation.” 

— Toshiki Masaki
past chair, Michigan Asian and Pacific American Affairs Commission


Jeffery Barrera
FPHLP Intern

Ryan Bartholomew
Senior Health Policy Analyst

Nancy Baum, PhD
Health Policy Director

Gudrun Bossman
Senior Financial Analyst

Ayse G. Büyüktür, PhD
Program Manager

Cristin Cole
Healthcare Analyst

Kirsten Cormier
Administrative Associate

Vinusha Devarakonda
Website Usability Intern

Terrisca Des Jardins
Executive Director

Allison Fritsch

Emma Golub
Healthcare Analyst

Wendy Hawkins
Health Policy Project Manager

Matthew Hill
WHI Project Manager

Erin Horne
CE Program Manager

Samantha Iovan
Health Policy Sr. Project Mgr

Elizabeth Jahn
Business and Finance Director

Patrick Kelly
Senior Healthcare Analyst

Sharon Kim
Associate Director

Jaque King
Policy Analytics Sr. Project Mgr

Joe Koss
Business and Finance Analyst

Amy Martinez
FPHL Intern

Erica Matti
Senior Health Policy Analyst

Madeline Mehall

Augustina Nguyen
FPHL Intern

Angela Palek
Senior Financial Specialist

Gregory Powers
Sr. Communications Strategist

Melissa Riba
Research & Evaluation Director

Robyn Rontal
Director of Policy Analytics

Marissa Rurka
R&E Project Manager

Andrew Smentkowski
Business Development Director

Deana Smith
Community Initiatives Sr. Project Manager

Kimberly Snodgrass
Health Communications

Erin Spanier
Communications Director

Karin Teske
R&E Senior Project Manager

John Tsirigotis
Healthcare Analyst

Ivana Tullet
Compliance Staff Specialist

Seaira Wainaina
Communications Intern 

Eljonna Williams

Helen Xu

Funders and Clients

ABIM Foundation
Administration for Community Living
Ann Arbor Area Community Foundation
Blue Cross Blue Shield of Michigan
City of Ann Arbor
City of Detroit
Detroit Wayne Integrated Health Network
Henry Ford Health System
Huron Gastro
Huron Valley Ambulance
Institute for Healthcare Improvement
Kresge Foundation

Michigan Health Endowment Fund
Michigan Medicine
Michigan Multipayer Initiatives
Michigan Public Health Institute
MSMS Foundation
Saint Joseph Mercy Health System
Shelter Association of Washtenaw County
State of Michigan
Thome Foundation
United Auto Workers
University of Michigan
Washtenaw County

Phyllis Meadows
“The Kresge Foundation’s Health team partnered with CHRT to conduct a study to describe and understand models for integrating health and human services. The goal of the study was to define opportunities for developing systems that could improve outcomes for children and families in communities. These findings enabled the Kresge Foundation to more effectively invest in multiple sites across the country seeking to strengthen their approach to service delivery”

— Phyllis Meadows, PhD, MSN, RN
Senior Fellow – Health, The Kresge Foundation