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How healthy is Calhoun County?

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Karria Watkins works out at the Battle Creek Family YMCA on Wednesday, Jan. 6, 2021 in Battle Creek, Mich.
Karria Watkins works out at the Battle Creek Family YMCA on Wednesday, Jan. 6, 2021 in Battle Creek, Mich.

By the numbers, Calhoun County is not the picture of health.

Calhoun County has consistently ranked in the bottom quartile for overall health outcomes in Michigan for at least the last decade, according to county health rankings by the Robert Woods Foundation’s Conduent Healthy Communities Institute.

Although health assessments represent a snapshot of the community and health officials are cautious about year-over-year comparisons, the 2020 rankings for Calhoun County show the community is struggling on several fronts.

Out of 83 Michigan counties, Calhoun County ranked No. 73 for overall health outcomes, which takes into consideration length and quality of life. The county ranked No. 62 in health factors, which takes into account health behaviors, clinical care, social and economic issues and the physical environment.

County health care leaders completed a health needs assessment in the fall of 2019 aimed at identifying the underlying causes of poor health in Calhoun County. The study found that social factors  — such as income, education and race — and access to care, had the largest negative impact on people’s health.

The confluence of the pandemic, economic uncertainty and a national reckoning on race highlighted health challenges in Calhoun County.

Although the need to improve community health is not new, the events of the last year have made the need for better community health more urgent in Calhoun County, with the community’s overall poor health exacerbating the impact of the pandemic.

“Obviously, we know there is a lot of work that needs to be done to help Calhoun County residents connect with a healthier lifestyle,” said Jill Hinde, CEO of the Battle Creek YMCA. “That encompasses exercise, obesity, nutrition, mental health. There’s a lot of pieces that go into a healthy community.”

Learning to live healthy

Calhoun County is ranked No. 75 in human behaviors, which are the actions people take that impact their health such as eating a balanced diet, exercise, and increasing risks for disease such as smoking, excessive alcohol intake, and risky sexual behavior

The county’s low ranking for human behaviors points to an education problem, says Damon Brown, co-founder of RISE Corp., a nonprofit that serves vulnerable populations in Battle Creek.

“We want to educate people financially, emotionally, spiritually, and physically,” Brown said. “People not even knowing how to cook healthy, knowing what to cook, how to cook it, we want to offer those classes, exercising, doing financial literacy classes… The theme at RISE for this year is health. Our plan this year is to try to tackle that and partner with different organizations to address these different health disparities, especially when it comes to African Americans, people of color and low-income families.”

RISE Corp. will resume its healthy food, personal hygiene and household distribution program Jan. 15 at Washington United Methodist Church. The project, funded by the United Way of Greater Battle Creek and Kalamazoo, began as a response to the COVID-19 pandemic to support families in need, primarily in the city’s Washington Heights and Post/Franklin neighborhoods in Ward 2.

“No one organization can do it itself,” Brown said. “I feel now, it’s about economics more than anything. Yes, race does play a big role. A lot of things we have to get right and work on historically. But we’re seeing more than just African Americans and people of color, but people of all walks of life coming through these lines. This is a human thing and it’s human rights for people to have access to good health, mental health, physical health, spiritual health.”

Inequity is an underlying health concern

Social determinants of health — which include transportation, food access, education, cultural competency and discrimination — were identified as the top priority in the county’s health assessment because of the way they impact all other areas of health.

Inequity was identified as an underlying problem.

“It’s all interconnected,” said Kyra Wallace, president and CEO of the Southwest Michigan Urban League and a member of the Population Health Alliance, a community partnership to improve health and well-being in Calhoun County.

The health assessment found that in almost every indicator and category, Black community members are more negatively affected in social determinants of health including median household income and bachelor’s degree attainment. Black residents were also disproportionately affected by cancer, teen obesity, infant mortality rate and premature death, the assessment found.

The coronavirus also had a disproportionate impact on minority communities in Calhoun County, especially in the early days of the pandemic.

In May, about 22% of coronavirus patients in Calhoun County were Black, according to data from the Calhoun County Public Health Department. Only 11% of the county’s population is Black, according to U.S. Census Data. Similarly, Asian Americans in Calhoun County were being infected at a disproportionate rate, accounting for 16% of infections and just 3% of the population.

As the pandemic stretches on, county health data shows that infection rates by race are comparable to the county’s demographics. As of Jan. 8, 11.2% of the total confirmed cases in Calhoun County were among Black residents and 2.7% were among Asian Americans.

Still, the pandemic brought new awareness to the health inequities that existed already.

“It’s getting people’s attention because in some form or fashion, the pandemic has affected everyone,” Wallace said. “If it’s not in your own household, it’s in your ministry. It’s in your children’s education. It’s your favorite restaurant that you like to frequent. It’s stay-at-home orders. It’s having to wear a mask.”

In response to the pandemic and the findings of the county health assessment, Population Health Alliance declared racism a public health crisis last fall.

“The fight against systemic racism and change isn’t a new one. It’s one that’s been deep-rooted and prevalent for years and is just now starting to garner attention and support,” Public Health Alliance member Harry Bonner said at the time. “Political backing from the highest office within our state is creating a much-needed chain reaction, but more can still be done.”

Now, Population Health Alliance is working to promote and support organizations participating in equity audits and unconscious bias training. The group also is seeking resources and opportunities to provide greater partnership and support for communities of color.

“Conversations are being heard, and that’s what we have to start with,” said Wallace.

Access to care is a challenge

 

According to the county health rankings, Calhoun County is No. 16 in the state in clinical care.

Bronson Healthcare Group is among the largest employers in Battle Creek, with Bronson Battle Creek hospital to go with five primary care locations in Calhoun County. Oaklawn Medical Group is among the largest employers in Marshall through Oaklawn Hospital. Albion has been without its own hospital since Trillium Hospital closed in 2002.

Albion Health Services, a nonprofit corporation, purchased Trillium (formerly Albion Community Hospital) from the city in 1993. The hospital was losing between $1.5 and $2 million per year before closing, with hospital board members pointing to smaller Medicare and Medicaid payments and the fact that only 40% of Albion residents used the hospital as reasons for its decline.

In response to the hospital closure in 2002, the Albion Health Care Alliance was created through a partnership with Bronson (then Battle Creek Health System), Oaklawn, Albion College, the Battle Creek Community Foundation and the W.K. Kellogg Foundation. The alliance owns the Cram Medical Center at 115 Market Place, which houses Oaklawn Hospital Audiology, Whole Family Direct Care, the Grace Health Dental Clinic and Summit Pointe-Albion. Oaklawn additionally opened its express care clinic at 302 N. Monroe St. in Albion in 2018.

“While there continues to be unmet needs in Calhoun County, the spirit of providers in Calhoun County is about finding solutions and working together to do it,” said Rod Auton, administrator for Albion Health Care Alliance. “These collaboratives are really coming together to solve problems.”

Access to primary care providers is still a concern in Calhoun County, according to the community needs assessment, which identified areas in Albion and Battle Creek as health professional shortage areas.

Throughout the pandemic, the county health department and community partners have been intentional about providing free COVID-19 testing events in underserved areas.

Behavioral Health

Behavioral health was a concern in Calhoun County prior to the coronavirus outbreak.

The health needs assessment found a shortage of behavioral health providers, a lack of local access and long wait times for appointments.

The pandemic exacerbated behavioral health problems in the community, said Elishae Johnson, a licensed professional counselor certified in advanced alcohol and drug counseling who practices in Battle Creek.

“COVID-19 challenged all of what we thought we knew or were familiar with in our day to day lives,” she said. “The mental health impact has been huge”

Disparities in access to care also became more apparent, Johnson said, as people who were laid off from their jobs faced different stressors.

“It highlighted the importance of our mental health,” she said. “How can we make this more available to people who have these needs?”

The intersection of racial inequity and political unrest amid the health crisis also highlighted the importance of mental health, especially among Black community members.

“They’re not existing in a vacuum,” Johnson said. “I think people are struggling with the emotional capacity to deal with all of this at the same time.”

As the need for behavioral health shot up, providers made changes to make services more accessible.

Summit Pointe turned to telehealth to connect people to the care they needed, said CEO Jeannie Goodrich. The mental health care provider also created more digital resources and partnered with local school districts to send a newsletter to families.

Johnson said many insurance companies have also made it easier to get coverage for mental health.

The turmoil of the last year has removed some of the stigmas around mental health,  Johnson said, which is essential in moving the community toward a better future.

‘Meet people where they are at’

In response to the pandemic, the Battle Creek YMCA expanded its offerings in Albion and Marshall as part of an effort to “meet people where they are at,” said Hinde.

Battle Creek YMCA began offering activities in Albion this summer when the city had to cancel its programs. The YMCA provided outdoor fitness classes, summer camps and the state-subsidized Great Start Readiness Program for preschoolers. Albion College is partnering with the Battle Creek YMCA and the city to provide space for programming at the renovated Washington Gardener High School building. There are also plans to use Holland Park, Victory Park and McIntosh Park for programming.

“One of the lessons in the past year during COVID was a lot of what the Y can do to help impact people’s lives can exist inside these walls, but outside these walls as well,” Hinde said. “I think we all became much more aware of health. Many of us became more aware of health and mortality in 2020 than perhaps we were previously. Health has become a priority. Wellness, exercise, access to care, all of those things go into the broader picture of a healthier community.”

A new foundation

Despite all the challenges, health leaders see a reason to hope for a healthier future.

“The foundation was in some ways built anew in 2020,” Hinde said. “To me that’s the silver lining of COVID if there is one. It allowed us to see things in a different lens. It allows for innovation and for people to come together and do things differently.  I think we’re stronger than we knew and some amazing things were accomplished in 2020 and I’m excited to see where it goes.”

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Vermont Health Connect had 10 data breaches last winter

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Vermont Health Connect had 10 data breaches last winter
Vermont Health Connect has set up a special enrollment period in response to the coronavirus outbreak. VHC photo

In mid-December, a Vermont Health Connect user was logging in when the names of two strangers popped up in the newly created account.

The individual, who was trying to sign up for health insurance, deleted the information that had suddenly appeared.

“It was super unsettling to think that someone is filing in my account with my information,” the person, whose name is redacted in records, wrote in a complaint to the Department of Vermont Health Access. “Just seems like the whole thing needs a big overhaul.”

It was one of 10 instances between November and February when Vermont Health Connect users reported logging to find someone else’s information on their account.

The data breaches included names of other applicants and, in some cases, their children’s names, birth dates, citizenship information, annual income, health care plans, and once, the last four digits of a Social Security number, according to nearly 900 pages of public records obtained by VTDigger. On Dec. 22, the department’s staff shut down the site to try to diagnose the problem.

While officials say the glitches have been resolved, it’s the most recent mishap for a system that has historically been plagued by security and technical issues. The breaches could be even more widespread: Administrators of Vermont Health Connect can’t tell if other, similar breaches went unreported.

“We don’t know what we don’t know,” said Jon Rajewski, a managing director at the cybersecurity response company Stroz Friedberg. Regardless of whether there are legal ramifications for the incidents, they should be taken “very seriously,” he said.

“If my data was being stored on a website that was personal, — maybe it contains names or my Social Security number, like my status of insurance… — I would expect that website to secure it and keep it safe,” he said.

“I wouldn’t want someone else to access my personal information.”

Andrea De La Bruere, executive director of the Agency of Human Services, called the data breaches “unfortunate.” But she downplayed the severity of the issues. Between November and December, 75,000 people visited the Vermont Health Connect website for a total of 330,000 page views, she said. The 10 incidents? “It’s a very uncommon thing to have happen,” she said.

De La Bruere said the issue was fixed on Feb. 17, and users had reported no similar problems since. The information that was shared was not protected health information, she added, and the breaches didn’t violate the Health Insurance Portability and Accountability Act, or HIPAA.

“No matter what the law says technically, whether it’s HIPAA-related or just one’s personal information, it’s really concerning,” said Health Care Advocate Mike Fisher.

The timing of the issue is less than ideal, he added. Thousands of Vermonters will be logging into Vermont Health Connect in the coming weeks to take advantage of discounts granted by the American Rescue Plan. “It’s super important that people can access the system, and that it’s safe and secure,” Fisher said.

A ‘major issue

The issues first arose on Nov, 12, when at least two Vermonters logged in and found information about another user, according to records obtained by VTDigger.

Department of Vermont Health Access workers flagged it as a “major issue” for their boss, Kristine Fortier, a business application support specialist for the department.

Similar incidents also occurred on Nov. 17 and 18, and later on multiple days in December.

Department of Vermont Health Access staff members appeared alarmed at the issues, and IT staff escalated the tickets to “URGENT.”

“YIKES,” wrote a staff member Brittney Richardson. While the people affected were notified, the data breaches were never made public.

State workers pressed OptumInsights, a national health care tech company that hosts and manages Vermont Health Connect, for answers. The state has contracted with the company since 2014. It has paid about $11 million a year for the past four years for maintenance and operations, with more added in “discretionary funds.”

Optum appeared unable to figure out the glitch. “It is hard to find root cause of issue,” wrote Yogi Singh, service delivery manager for Optum on Dec. 10. Optum representatives referred comments on the issues to the state.

By Dec. 14, Grant Steffens, IT manager for the department, raised the alarm. “I’m concerned on the growing number of these reports,” he wrote in an email to Optum.

The company halted the creation of new accounts on Dec, 14, and shut down the site entirely on Dec, 22 to install a temporary fix. “It’s a very complex interplay of many many pieces of software on the back end,” said Darin Prail, agency director of digital services. The complexity made it challenging to identify the problem, and to fix it without introducing any new issues, he said.

In spite of the fixes, a caller reported a similar incident on Jan. 13.

On Feb. 8, a mother logged in to find that she could see her daughter’s information. When she logged into her daughter’s account, the insurance information had been replaced by her own.

“Very weird,” the mother wrote in an emailed complaint.

Optum completed a permanent fix on Feb. 17, according to Prail. Vermont Health Connect has not had a problem since, he said.

Prail said the state had reported the issues to the Centers for Medicaid and Medicare Services as required, and had undergone a regular audit in February that had no findings. The state “persistently pressured Optum to determine the root cause and correct the issue expeditiously but at the same time, cautiously, so as to not introduce additional issues/problems,” he wrote in an email to VTDigger.

“We take reported issues like this very seriously,” he said.

A history of glitches

The state’s health exchange has been replete with problems, including significant security issues and privacy violations, since it was built in 2012 at a cost of $200 million.

The state fired its first contractor, CGI Technology Systems, in 2014. A subcontractor, Exeter, went out of business in 2015. Optum took over for CGI, and continued to provide maintenance and tech support for the system.

Don Turner
Don Turner, right, then the House minority leader, speaks in 2016 about the need to fix the state’s glitch-ridden Vermont Health Connect website. With him are Phil Scott, left, then the lieutenant governor, and Sen. Joe Benning. Photo by Erin Mansfield/VTDigger

In 2018, when Vermont Health Connect was less than 6 years old, a report dubbed the exchange outdated and “obsolete.”

Officials reported similar privacy breaches in 2013, when Vermonters saw other people’s information.

An auditor’s report in 2016 found a slew of cybersecurity flaws, and officials raised concerns again during a  2018 email breach.

It wasn’t the first time that Vermont Health Connect users had been able to view other people’s personal information. Three times since October 2019, individuals had logged in to see another individual’s insurance documents. Prail attributed those incidents to human error, not to system glitch; a staff member uploaded documents to the wrong site, he said.

In spite of the issues, Prail said he and other state officials have been happy with Optum. After years of technical challenges with Vermont Health Connect, “Optum has really picked up the ball and improved it and been running it pretty well,” he said.

Glitches are inevitable, he added, and Optum has addressed them quickly. “They took a really difficult-to-manage site and made it work pretty well,” he said. “Optum is generally quite responsive to any issues we have.”

“I find any privacy breach to be concerning,” said Scott Carbee, chief information security officer for the state. He noted that the state uses “hundreds of software systems.” “While the scope of the breaches can be mitigated, true prevention is a difficult task,” he wrote in an email to VTDigger.

Optum spokesperson Gwen Moore Holliday referred comments to the state, but said the company was “honored” to work with Vermont Health Connect “to support the health care needs of Vermont residents.”

Prail said the Agency of Human Services had no plans to halt its contract with the company. “I don’t have a complaint about Optum,” he said. “They took a really difficult-to-manage site and made it work pretty well.”

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Filed under:

Health Care

Tags: data breaches, Optum, Vermont Health Connect

Katie Jickling

About Katie

Katie Jickling covers health care for VTDigger. She previously reported on Burlington city politics for Seven Days. She has freelanced and interned for half a dozen news organizations, including Vermont Public Radio, the Valley News, Northern Woodlands, Eating Well magazine and the Herald of Randolph. She is a graduate of Hamilton College and a native of Brookfield.