This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

Using a framework established by a national foundation, four major players in Washtenaw County's health sector are collaborating to rethink the way they invest in their community.

Those players – the 5 Healthy Towns Foundation (5HF), Michigan Medicine, St. Joseph Mercy Chelsea Hospital, and Washtenaw County Community Mental Health – have formed one of only four ReThink Health regional collaborations in the nation. A Rippel Foundation initiative, ReThink Health works with leaders of community organizations and health systems to guide transformative change and produce better health and well-being for all.

Amy Heydlauff is CEO of 5HF, which serves Chelsea, Dexter, Grass Lake, Manchester, and Stockbridge, all rural communities west of Ann Arbor. She first heard about ReThink Health at a conference and was so intrigued that she reached out to the Rippel Foundation and recruited the other three Ann Arbor-area organizations to form a collaborative. Collaborative members are working to cooperatively leverage their combined skills, talents, networks, and financial resources to achieve optimal physical and mental health in 5HF's service area.

"Most people think that our health has to do with doctors and hospitals, but that only accounts for 15-20% of what impacts it," Heydlauff says. "The rest is determined by where we live, how we live, our genes, and all the social determinants of health."

Heydlauff saw ReThink Health as an ideal way to address the remaining 80-85% of what was preventing residents in the region 5HF serves from achieving optimal health. With guidance from ReThink Health program associates, the four collaborators have discussed how to create policies, programs, and practices that will transform the system and promote health and well-being. They have considered the region's urgent needs, like emergency care, food assistance, and income support. They have explored issues that impact health, like a living wage, education, and humane housing. They have especially focused on how to strengthen residents' sense of belonging to community and how that will support their mental health. However, the work has just begun.

"It's a long-term project and really hard work. It takes a lot of the organizations' capacity and certain kinds of leaders. It takes a lot of bravery," says Katherine Wright, ReThink Health senior program associate. "I am really proud of the work we've done with 5 Healthy Towns this year."

Negotiating a well-being portfolio

The collaborative's work began when the four organizations met throughout 2020 to do what ReThink Health calls "negotiating a well-being portfolio."

"The goal is to work with regions and core partners, people who have decision-making power over resources in their region," Wright says. "In every place we go, a regional portfolio of investments exists. Every organization we work with has a lot of buying power and influence, and has a budget that comes from somewhere and goes somewhere. Our goal ... [is that] everybody should be thriving in all cases. To get there, you have to do a lot of work. A lot of people are not thriving right now, especially in our current crisis."

As the process begins, Wright leads the participating organizations in uncovering their systems, acknowledging the way they exist, and looking at where they spend their money.

"Is it in urgent services that are needed now? Or vital things everyone needs at all times? We help them see where their investment sits now and think about how they can shift those investments towards their goal," Wright says.

5HF funds programs that help residents to eat better, move more, avoid unhealthy substances, and connect with others in healthy ways. The ReThink Health collaboration's initial goal is to address that last point — to increase people's connection to community in order to reduce the loneliness and social isolation that has been proven to negatively impact mental health.

"Our agenda is definitely prevention," Heydlauff says. "While hospitals care about prevention, that's a holistic, altruistic value. That's not how they get paid. They get paid to take care of people who get sick, … whereas the foundation operates in the prevention space."

While 5HF has had a good relationship with St. Joseph Mercy Chelsea Hospital in the past, the collaboration will transform that relationship into an interdependent partnership that enables both to do their jobs better.

"Our relationship is deeper now in a way that allows us to say, 'This is a really big need. What can you do to help us and vice versa?'" Heydlauff says. "Instead of going to them with our decision made, we are making decisions together."

Amy Heydlauff.

Heydlauff offers diabetes as an example. If the health care systems took care of diabetes education as well as diagnosis and treatment, then 5 Healthy Towns could move funds spent on diabetes education to other community programs. In turn, the health care systems could connect patients to those programs, which address social determinants of health including social isolation, access to fitness opportunities, housing, employment, and education.

"We're on the frontier of thinking this way," Wright says. "We're asking them to engage a different framework, examine budgets, and meet with internal teams to talk about how to think about things differently. … What is it like for a person to move through their system? How complex and how difficult is it? And what are the easy ways to fill the gaps in that person's story?"

Building new connections

The ReThink Health initiative has helped build new connections with potential for long-lasting impacts on community health. For example, 5HF had never worked with Washtenaw County Community Mental Health before. Heydlauff believes the new partnership between the two organizations will help her staff better connect community members to mental health services while enabling the agency to reach more people in Washtenaw County's rural communities. Adding St. Joseph Mercy Chelsea Hospital and Michigan Medicine family practices to the mix extends that reach even further.

"We all know that we exist but we don't understand each other's strengths and weaknesses and what we can leverage with each other very well," says Dr. Anne Kittendorf, assistant professor of family medicine and family practice physician at Michigan Medicine. "If we can start to figure out how to utilize each other's programs better and overcome some of those communication challenges between organizations, I think that that will serve our area well."

Anne Kittendorf.

Michigan Medicine family practices in Dexter and Chelsea have collaborated with 5HF since its founding in 2009. For example, they already refer patients to 5HF's Next Steps fitness program.

"We have seen fantastic results in the numbers of people referred and how fitness has become an important part of patients' lives," Kittendorf says. "It makes a big difference for physicians to not just give fitness 10 seconds of lip service during an appointment, but to actually feel strongly enough about patients engaging in exercise that they not only recommend and talk about it, but help to facilitate connection to a program that will actually assist patients of all levels on their fitness journey."

According to Kittendorf, joining the ReThink Health collaboration was a logical step forward.

"Our department has always been very forward-thinking to how we could provide medical care in a different way that's more holistic. Part of that comes from our training in thinking about family units as well as understanding some of the social factors that can impact physical health and mental health," she says. "We've seen organizations so strongly siloed and payment models that have not supported some of the more holistic work that we felt that we could do within communities."

As the relationship between the collaborative members evolves, Kittendorf believes they will be able to overcome barriers and provide better care for people in each community.

"The timing is right. We have been evolving within our practices to provide a strong population health focus and increasing the strength of our integrated approach to how we intersect with community," Kittendorf says. "It dovetails very nicely to what we believe, and can move the needle for mental health in the community and how we can provide and evolve the services we offer in those ways."

Heydlauff says the organizations are working together on challenges that none of them can fix alone.

"The project has been long and hard — and it hasn't been what I expected," she says. "I thought we were going to pick a project and work on it together but, in fact, what we are doing is learning how to work together differently. ReThink Health has forced us to spend more time understanding each other."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media, communications manager for Our Kitchen Table, and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

All photos by Doug Coombe.