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Inside Track: Second tour of duty offers new challenges
Jim Haveman, director of the Michigan Department of Community Health, finds himself back in familiar territory.
“This is my second tour of duty,” quipped Haveman.
It’s possible this tour will be more exciting than the first, which was under the Engler Administration. This time there’s an elephant in the room nobody can ignore: a health care system whose costs have spun out of control, even as 30 million Americans try to survive without insurance.
“There’s so many interesting things going on in health care today,” said Haveman, citing “the complexity of it,” along with “the tension in the system,” mergers among hospitals and, of course, the Patient Protection and Affordable Care Act. “I just love this type of work,” he said.
“We are a $15 billion enterprise. That’s our budget,” said Haveman. “Twenty percent of the people of the state get their health care through this department, through the health plans. We touch 40 percent of the children of the state through our Medicaid program. We fund the Community Mental Health programs, the public health offices …
“In Kent County alone, this department spends $859 million, through Medicaid and Community Mental Health, public health and the Michigan Office of Services to the Aging.”
The challenges include getting ready to implement the decisions Snyder will make on expansion of Medicaid, and how to implement the requirements of the Affordable Care Act, which includes insurance exchanges and new models of accountable care for organizations.
There are also strategies to be developed for combating chronic diseases that overload hospital systems with in-patients “because 75 percent of the Medicaid money goes to people with five or more chronic conditions,” said Haveman.
A big question facing Michigan is whether or not it will set up and operate its own insurance exchange as required by PPACA. State governments that ignore that part of the law will have an exchange set up and run for them by the federal government. Snyder supports a Michigan-run exchange using Priority Health HMO as a model in offering essential health insurance benefits, which must be available through all plans sold through an exchange.
The Michigan House, however, led by Republican opponents to “Obamacare,” does not support cooperation with the federal government on PPACA and refused to consider enabling legislation introduced last year by the Michigan Senate.
Last week, the House Health Policy Committee rejected a proposal to create a state-run online exchange where people can compare and buy health insurance plans. Snyder’s administration, as a “just in case,” had already applied for a federal grant as a first step toward a fallback position of teaming with the federal department.
“Now that the Secretary of Health and Human Services (the federal agency implementing the health insurance exchange requirement) has given the state up until Dec. 14 to decide what they’re going to do, I think there’s some breathing room here on how to handle it,” Haveman said.
“We would like to do a state exchange. Sure,” he said.
Haveman noted that with Snyder’s successful career in the technology industry, it makes sense for Michigan to have an online electronic insurance exchange, operating on a concept that has been compared to Travelocity, where consumers can find what they want when they want it, at the lowest available price.
Once it is clear how Congress will deal with the “fiscal cliff” issues during December, said Haveman, Snyder will be better informed for making a decision on the Medicaid expansion. “I’m sure the February budget announcement that the governor makes will have information on those plans,” he said.
“We have an unhealthy state, as you know. We’re working on this whole obesity issue, with the Four-by-Four plan. And infant mortality is a huge priority. When I talk about health and wellness, I also talk about safety. Citizens really want us to have a safe state, so that’s a high priority for us, as well,” he added.
In early October, MDCH learned of four medical facilities in Michigan that had received contaminated steroid injections from the East Coast company behind the national meningitis outbreak. So safety was the critical issue in mid-November, when MDCH granted emergency Certificates of Need for St. Joseph Mercy Health System. The St. Joseph Mercy hospital in Ann Arbor has been evaluating and treating more patients related to the fungal meningitis outbreak than any other. MDCH expedited the review of a CON required to allow the hospital to expand its operating room capacity, and granted an emergency CON to allow use of a mobile MRI service there.
Health care is now a key part of the Michigan economy, noted Haveman. “One of the most underrated things in this state is the importance of health care,” especially to the cities where health care, pharmaceuticals and medical device manufacturing have become a major part of the local economy.
“Health care is an $80 billion or $90 billion industry in Michigan,” said Haveman, and in many Michigan cities it is the largest employer and touches the widest array of vendors.
“We have got to take some pride in what we build here in Michigan. I really see us being more proactive in doing that,” said Haveman.
Building may be in his family’s genes. In 1933, his father, James K. Haveman, started an architectural firm in Grand Rapids and subsequently designed scores of Christian Reformed Church churches and schools throughout West Michigan.
Haveman Jr. went to local Christian schools and then to Calvin College, majoring in economics. There he met his wife-to-be, Barb, a Fremont girl. In his senior year, Barb urged him to take some sociology courses and that summer he worked at Camp Blodgett.
“I said, ‘Hey, this is kind of cool,’” recalls Haveman. The economics training later helped him in administration, but he veered away from it as a career and went to grad school at Michigan State, where he earned a Master’s in social work in 1968. His first career job was at Bethany Christian Services as a therapist working with children in foster care.
He became involved in community activities and met Bill Kooistra, a psychologist. In the late 1960s, drug and alcohol abuse was not treated as a behavioral and medical problem. Kooistra formed Project Rehab to help the increasing numbers of drug addicts who were living on the streets in Grand Rapids. In 1971, Kooistra asked Haveman to become its co-director. It was an experience Haveman says was “completely different” than all the other work he had done up to that time.
“I found that in my career, I went to work for agencies that were small, facing challenges, and was able to help build them up,” he said.
From Project Rehab, Haveman went to work for Kent County on the Community Mental Health Board, where he became familiar with the value of private nonprofit agencies such as Hope Network.
After helping build that program, Haveman rejoined Bethany Christian Services, where he was CEO until Gov. John Engler offered him his first job in state government. When the Engler administration wrapped up, Haveman said, “I got called by the White House. They said, ‘How would you like to become the acting Minister of Health in Iraq? And I said yes to that, too.”
Haveman worked in Iraq from 2003 to 2004, first as the acting Minister of Health and then as senior advisor to the U.S. ambassador. Following that, he started his own business as a consultant and served on many boards, all of which entailed “a lot of travel around the world.”
Haveman describes himself as a typical Dutch Christian Reformed person with Midwest values: “We believe in leaving this world a better place than we found it.”