RHTP Initiatives

Michigan Hubs will serve as regional leaders in advancing care integration, chronic disease improvement and long-term health system sustainability. Hub partners will formalize and expand cross-sector partnerships to strengthen integrated care models, increase Community Health Worker (CHW) capacity, reduce chronic disease risk and improve hypertension and diabetes outcomes through targeted programming. These efforts will also help improve access and reduce strain on rural health care systems.

Funded partners:

Regional Hub Leads: The Regional Hub Lead serves as the backbone and accountable entity. They are responsible for convening partners, aligning strategy, managing funds, and overseeing performance, and will be accountable for achieving chronic disease outcomes across their respective region. Regional Hub Leads are not required to directly deliver all services and may meet expected outcomes through coordination, partnership, and subcontracting with organizations that have relevant experience/expertise.

Local Hub Leads: Local Hub Leads are responsible, on-the-ground implementation partners that lead or deliver specific chronic disease and/or social determinants of health (SDOH) activities within their communities. Local Leads include local health departments (LHDs) and Community-Based Organizations (CBOs) and are responsible for implementing evidence-based interventions, engaging community members, and contributing to Hub outcomes.

Hub Technical Assistance Partners: Hub Technical Assistance partners will help participating organizations put RHTP projects into action by providing hands-on guidance, connecting them with resources and experts, and creating opportunities to learn from one another. They will support work focused on coordinated care, community health workers, and chronic disease prevention and management, while helping organizations address challenges, share promising practices, and plan for long-term sustainability.

This project will focus on improving chronic disease outcomes in high-need counties by expanding access to diabetes and hypertension management resources, education and community-level support. Programming will be designed to enhance self-management skills, improve care coordination and reduce preventable complications among vulnerable residents.

Funded partners:

• Berrien County Health Department
• Health Department of Northwest Michigan
• Holland Physician Hospital Organization
• Marshfield Clinic Health System Hospitals, Inc.
• Memorial Healthcare
• Michigan Community Health Worker Alliance (MiCHWA)
• National Kidney Foundation of Michigan

Through the Healthy Homes Collaborative, Community Action Agencies (CAAs) will connect rural residents and families to health, housing, energy and social service resources that support long-term stability and improved chronic disease outcomes. Activities will include outreach, education, referrals, assistance accessing existing services and follow up in coordination with health care, housing, energy assistance and community partners.

Funded Partners:

• Alger-Marquette CAB
• Chippewa-Luce-Mackinac Community Action and Human Resources Authority
• Community Action Agency of South-Central Michigan
• Community Action of Allegan County
• Dickinson-Iron CSA
• Eight CAP, Inc.
• Five CAP, Inc.
• Gogebic-Ontonagon CAA
• Human Development Commission
• Menominee-Delta-Schoolcraft CA
• Mid-Michigan Community Action Agency
• Northeast Michigan Community Service Agency (CSA)
• Northwest Michigan Community Action Agency

Area Agencies on Aging will participate in cross-generational care coordination models that connect older adults with preventive health services, CHWs, health care providers and community support. The goal is to strengthen coordinated care and prevention for rural older adults.

Funded partners:

• Region 1B Area Agency on Aging (AAA) - AgeWays Nonprofit Senior Services
• Region 2 Area Agency on Aging (AAA) - WellWise Services Area Agency on Aging
• Region 3B Area Agency on Aging (AAA) - CareWell Services Southwest

Child and Adolescent Health Centers will integrate CHWs into school-based health teams to provide health education, screening, referrals, care coordination and follow-up for children and adolescents. Projects will strengthen access to preventive and behavioral health services through school and community partnerships.

Funded partners:

• Alcona Health Center
• Benzie-Leelanau District Health Department
• Corner Health Center
• District Health Department #10
• Harbor Beach Community School District School Wellness Program
• Health Department of Northwest Michigan
• Intercare Community Health Network
• LMAS Health Department
• Mid-Michigan Community Health Services
• MyMichigan Health Services
• Northwest Michigan Health Services
• Public Health Department of Delta-Menominee
• Rudyard Area School
• Scheurer Community Health Center
• Shiawassee Health Department
• Sterling Area Health Center
• Thunder Bay Community Health Service
• Upper Great Lakes Family Health Center

Federally Qualified Health Centers will implement integrated diabetes and hypertension care models that include providers, CHWs and other care team members. Activities may include patient education, self-monitoring, lifestyle support, technology-enabled care and coordinated follow-up. Centers will also strengthen CHW capacity through training, care team integration and development of sustainable workflows and billing practices.

Funded parters:

• Alcona Health Center
• Baldwin Family Health Care
• Cherry Health Heart of the City
• Covered Bridge Healthcare
• East Jordan Family Health Centers
• Family Medical Center of Michigan - Lenawee
• Grace Health
• Great Lakes Bay Health Centers
• Isabella Citizens for Health
• Lakeland Immediate Care Center, DBA Cassopolis Family Clinic Network
• Northwest Michigan Health Services
• Sterling Area Health Center
• Thunder Bay Community Health Service
• Traverse Health Clinic
• Upper Great Lakes Family Health Center

Family Resource Centers will connect children, adolescents and families to preventive care, behavioral health services, chronic disease education and social supports through outreach, screening, referrals and follow-up. They will also partner with health and community organizations to increase participation in evidence-based preventive and behavioral health programs.

Funded parters:

• Calhoun Intermediate School District
• Child Abuse and Neglect (CAN) Council Family Resource Center (FRC)
• Child and Family Charities
• Northeast Michigan Family Resource Center
• Tuscola Family Enrichment Center
• Voices for Children

Local health departments will support community-wide prevention initiatives, chronic disease programs, health education, data collection, referral coordination and cross-sector partnerships. They may serve as backbone organizations connecting health care, social services, schools, housing partners and CHWs.

Funded partners:

• Central Michigan University (LHD Mobile Unit)
• District Health Department #10 (Lake County - Mobile Health)

United Ways will coordinate cross-sector partnerships that connect rural residents and families to health, behavioral health, social services and other community resources. Projects will strengthen outreach, referral pathways, community navigation and follow-up.

Funded partners:

• United Way of Greater Central Michigan
• United Way of West Shore (Manistee and Mason counties)

Aimed to support training and professional development of key local health department professionals working in chronic disease prevention and management, this program will strengthen workforce capacity and increase the number of professionals equipped to address chronic disease in rural communities.

Funded partners:

• Benzie-Leelanau District Health Department
• Berrien County Health Department
• Branch-Hillsdale-St. Joseph Community Health Agency
• Central Michigan District Health Department
• District Health Department #2
• Health Department of Northwest Michigan
• Ingham County Health Department
• Livingston County Health Department
• Mid-Michigan District Health Department
• Sanilac County Health Department
• Van Buren/Cass District Health Department
• Western Upper Peninsula Health Department

Funding will support training and professional development of key professionals providing maternal health care (family physicians, EMTs, obstetricians, certified nurse midwives and additional health professionals), which will increase the number of providers able to engage in maternal health.

Funded partners:

• Central Michigan University
• Covenant Missions
• Ella E. M. Brown Charitable Circle dba Oaklawn Hospital
• Emergent Health Partners
• Michigan Primary Care Association
• Munson Healthcare
• Regents of the University of Michigan Health

Funding is utilized for efforts to recruit, train, and retain critical health care providers including establishing rural medical residency programs. These efforts will be targeted at increasing access to care and improving health outcomes for rural residents.

Funded partners:

• Alcona Citizens for Health, Inc.
• Cass County Community Mental Health Authority dba Woodlands Behavioral Healthcare Network
• Cherry Grove Fire and Rescue
• Community Mental Health for Central Michigan
• DLP Marquette General Hospital LLC
• Drummond Island Medical Center, Inc.
• Emergent Health Partners (Recruitment, Retention)
• Gogebic Community College
• Helen Newberry Joy Hospital
• Hospice of Michigan, Inc.
• Kalkaska Memorial Health Center
• Mackinac Straits Health System, Inc.
• Manistee-Benzie Community Mental Health
• McClaren Health Care Corporation
• MHP Salud
• Michigan Health Council
• Michigan Oral Health Coalition 
• Michigan Pharmacy Association
• Mobile Medical Response
• Montcalm Center for Behavioral Health
• Munson Healthcare
• North Central Michigan College
• NorthCare Network (Recruitment, Retention)
• Northern Pine Health Center, PC
• OSF Healthcare - Saint Francis Hospital

This program will provide a multipronged approach to supporting workforce capacity by supporting regional shared infrastructure to support LLMSW supervision in addition to providing stipends to licensed MSWs providing that supervision, incentivizing more licensed MSWs to provide that critical service.

Funded partners:

• Michigan Health and Hospital Association
• Mid-State Health Network
• NorthCare Network

This program will support training, professional development, and retention of community paramedics, which will strengthen the community paramedicine workforce and increase the number of providers equipped to deliver essential health services in rural and underserved communities. 

Funded Partners:

• Michigan Association of Ambulance Services
• Michigan Association of Emergency Medical Technicians
• Mobile Medical Response
• MyMichigan Health Foundation
• West Shore Community College

This program will assess the current CHW workforce, including workforce capacity, needs, and gaps, to inform strategies that strengthen recruitment, development and sustainability of community health workers in rural areas.

Funded partners:

• Michigan Community Health Worker Alliance (MiCHWA)

Intended to create a talent and recruitment pipeline that will transition high school students to health care professionals through a partnership with Area Health Education Centers (AHEC) and other relevant entities. Pipeline programs will be established to both move rural high school students into health care professions in their home communities as well as encourage non-rural students to become critically needed rural health care professionals.

Funded partners (Area Health Education Centers, AHECs):

• Mid-Central Regional Center
• Northern Lower Regional Center (MidMichigan Health Services)
• Southeast Regional Center
• Upper Peninsula Regional Center (Upper Great Lakes Family Health Center)
• Western Regional Center

Designed to bridge the mental health care provider gap in our rural communities, the program provides educational stipends to social work students. Through university partnerships, individuals with BSW degrees are provided stipends to enroll in one of the currently existing one-year advanced clinical MSW programs. 

Funded partners:

• Eastern Michigan University
• Michigan State University
• Oakland University
• Saginaw Valley State University
• Spring Arbor University
• Western Michigan University

To increase the pool of available mental health professionals, this program will provide scholarships to MSW students. At least two university partners will provide scholarship opportunities to MSW students who make a five-year commitment to serving in rural communities after graduation.

Funded partners:

• Northern Michigan University
• Regents of the University of Michigan (University-Led Award)
• Saginaw Valley State University
• Spring Arbor University

This project focuses on assessing the capacity of CIE Coordinating Entities and Network Partners to meet statewide standards, while initiating technical assistance, peer learning and ongoing alignment efforts. It includes conducting a statewide assessment to support system coherence and developing an evaluation plan to measure key performance indicators and project outcomes. Additionally, the project provides targeted technical assistance to emerging CIE Coordinating Entities in rural communities to strengthen statewide coordination.

This project establishes a standardized Rural Infrastructure Maturity Stratification Framework and conducts baseline assessments aligned with CIE Coordinating Entity Standards to guide technical assistance efforts. It delivers tailored support to strengthen governance, administrative capacity and cross-sector participation while addressing the unique coordination and service delivery challenges in rural communities. Additionally, the project implements a preliminary evaluation framework to track progress and optimizes performance for established entities to enhance their ability to serve rural regions effectively.

This project focuses on expanding rural health capacity by hiring Disease Intervention Specialists and a Project Coordinator, and providing comprehensive training on HIV, STI, and viral hepatitis linkage to care. It ensures coordinated outreach and education for Rural Health Emergency Departments while developing a standardized linkage-to-care protocol. Ultimately, the project strengthens the ability of rural emergency departments to quickly and effectively link individuals newly diagnosed with HIV, viral hepatitis or syphilis to appropriate care.

This project strengthens rural behavioral health access by selecting Community Mental Health Service Program (CMHSP) projects for RHTP funding under the Care Closer to Home and Interoperability pillars and providing ongoing support, guidance and monitoring through CMHA. It includes developing and implementing a performance measurement system to track baseline and ongoing telehealth utilization and other rural behavioral health access indicators. Additionally, the project delivers targeted technical assistance to funded sites to enhance implementation, coordination and service delivery.

This project will strengthen connections between the Saginaw and Bay County Community Information Exchange (CIE) Coordinating Entities (CEs) by improving interoperability and creating more consistent referral processes across systems and service areas. It will expand participation among health care and community-based organizations, improve closed-loop referrals and information sharing, and make it easier for health systems to connect with multiple CEs through a single integration. The project will also establish tools to measure performance, assess partner experience and sustainability, and guide continued growth of the CIE network.

The Michigan Center for Rural Health will launch and manage a statewide initiative to help Rural Health Clinics adopt improved data integration, innovative technologies and standardized evaluation tools, beginning with outreach, cohort selection and tailored technical assistance. Through structured subgrant processes and hands on support, participating clinics will implement upgrades ranging from Health Information Exchange (HIE) and Community Information Exchange (CIE) integration to workflow enhancing tools like optimized EHR systems, digital literacy resources and revenue cycle technologies. These efforts aim to strengthen clinical coordination, modernize digital infrastructure and ensure long‑term sustainability of health information technology across Michigan’s rural care network.

This project establishes a baseline understanding of rural provider readiness for health information exchange and builds strategic partnerships to guide coordinated outreach and technical assistance. It develops scalable participation models and onboarding frameworks for priority use cases—including oral health integration—alongside consistent progress reporting to MDHHS. Additionally, the project strengthens MiHIN’s core organizational and facility management capabilities to better support rural provider engagement, onboarding, participation tracking and statewide reporting for RHTP-related data exchange.

MPCA will undertake a statewide effort to modernize health center infrastructure by expanding interoperability, enhancing electronic health records and improving data exchange across participating health centers. It emphasizes the adoption of advanced technologies—including AI tools, remote patient monitoring, collaborative Electronic Health Record (EHR) systems and automated quality reporting—to strengthen clinical, operational and financial performance. Together, these initiatives aim to boost patient engagement, improve care coordination and ensure robust reporting and social‑needs data sharing to better serve rural populations.

MyMichigan Health Foundation will expand EMS coordination across 11 medical centers by hiring and onboarding new EMS Coordinators dedicated to improving alignment, communication and operational consistency across regions. Through comprehensive assessments and collaboration with partners like the MI Stroke Program, the organization will identify barriers, strengthen data flow and create targeted action plans to enhance system integration. These efforts aim to improve EMS functionality, streamline reporting and support more efficient, connected care for rural communities across the state.

National Jewish Health will engage rural healthcare partners across Michigan to strengthen tobacco cessation referral systems by conducting outreach, building partnerships and supporting implementation of standardized workflows to the Michigan Tobacco QuitLink. The organization will increase partner capacity through ongoing training, technical assistance, monitoring and reporting to improve referral volume, workflow efficiency and quitline enrollment. Additionally, they will develop enhanced tools, resources, and training programs—along with exploring incentives and convenings—to further support sustainable health systems change in rural communities.

This project builds a full technology, data, and care coordination system to identify and support rural patients with chronic kidney disease, diabetes, and COPD. It begins by setting up governance structures, partner agreements, and an AI model that can prioritize eligible patients, followed by creating enrollment workflows and getting state approval for all eligibility and screening criteria. The team then adapts the MindAIgle platform for chronic disease navigation, integrates it with regional information sharing systems, and trains Community Health Workers to use it for referrals, benefits, and stipend distribution. The project collects baseline clinical data, establishes a monitoring and evaluation framework, and launches a stipend pilot using GiveCard for more than 120 patients. By the end, the project tracks health outcomes, evaluates how stipends were used, and delivers a full sustainability and scale up plan for continuing the platform and cash support model beyond the Rural Health Transformation Program.

The Michigan Emergency Department Improvement Collaborative (MEDIC) will partner with rural emergency departments to expand and strengthen HIV, Hepatitis C, and syphilis screening by identifying rural emergency departments champions, assessing current practices, and initiating targeted outreach. The team will build expertise and collaboration through learning sessions, a rural‑focused HIV testing website, and ongoing engagement with public health partners, while also providing individualized technical assistance to support implementation. These efforts aim to equip rural emergency departments with tailored tools, updated workflows and sustained support to improve early detection, increase testing capacity and reduce gaps in infectious disease screening across Michigan’s rural communities.

This project pilots a comprehensive interoperability initiative with skilled nursing facilities in Marquette County to strengthen health information exchange, improve care coordination and reduce administrative burden across transitions of care. Through detailed baseline assessments, workflow redesign and implementation of bidirectional Admission, Discharge and Transfer (ADT) and Continuity of Care (CCD) data exchange, the pilot aims to improve functional outcome reporting, streamline transitions and enhance social needs referrals using UPHIE and community information exchange tools. Ultimately, the initiative is designed to boost staff satisfaction, improve resident and family experiences and generate policy and workflow recommendations that advance quality, efficiency and interoperability in rural SNF settings.

Upper Peninsula Health Care Solutions will build the region’s Community Information Exchange (CIE) infrastructure by strengthening organizational capacity, modernizing data‑sharing systems, and establishing the structures needed to serve as a long term coordinating entity. The organization will update strategic and administrative frameworks, enhance the Upper Peninsula Health Information System (UPHIE) technological and privacy capabilities, expand cross sector partnerships, and pilot new interoperable service lines such as closed loop referrals, Customer Relationship Management (CRM) tools, behavioral health registries, and research data systems. These efforts aim to create a sustainable, secure, community driven network that improves care coordination, supports social needs services, and strengthens health outcomes across the Upper Peninsula.

This project aims to expand access to care in the DHD#10 region by integrating and training highly skilled community health workers, strengthening digital literacy for residents and providers and advancing connected systems through technology-based solutions. It supports implementation of Community Health Improvement (CHIP) strategies by developing community spaces for social connection, piloting innovative mobility solutions to improve regional transit interoperability and enhancing a CIE between DHD#10 and its social care partners. Ultimately, the project leverages infrastructure and real-time information sharing to improve efficiencies, care coordination and overall health outcomes across communities.

This project strengthens Michigan’s 211 system by gathering comprehensive feedback from service providers across the state’s rural and tribal communities to improve collaboration and enhance the usefulness of the statewide Resource Directory. It includes modernizing interoperable technology to support accurate, up‑to‑date resource data and expanding MI211 and regional center capacity to conduct outreach and engagement. The project also establishes baseline data and develops plans for future activities informed by focus group findings and provider input to ensure continuous system improvement.

This project establishes implementation priorities and a comprehensive project plan to support rural local health departments participating in interoperability initiatives. It builds a coordinated statewide technical assistance infrastructure, assesses organizational readiness and delivers customized training to strengthen capacity. The project also enhances cross‑sector collaboration and improves coordinated referral systems between health care, public health and community-based organizations in rural communities.

Public Health, Delta & Menominee Counties will embed a new Community Health Worker program to strengthen connections between residents and essential health and social services, improving access to care across rural communities. The organization will map local providers, assess communication gaps, and collaborate with partners—including 211 systems and neighboring Marinette, Wisconsin—to build more interoperable, comprehensive resource networks. Ultimately, these efforts aim to establish a seamless “no wrong door” approach so community members can be efficiently linked to needed services regardless of where they first seek help.

This project strengthens the systems and partnerships that connect rural residents in Saginaw County to health care and community resources. It brings partners together to improve coordinated referral processes, strengthen Community Information Exchange (CIE) infrastructure, and help local organizations work more effectively across sectors. These efforts aim to improve access to services, reduce fragmentation, and support more coordinated, whole-person care.

Tuscola County Health Department will expand immunization access by hiring and onboarding a Travel Immunization Nurse and deploying weekly mobile vaccination clinics to reach underserved areas. The plan also adds a Community Health Worker to strengthen preventive health services, improve referral systems and deepen partnerships with local providers and community organizations. Together, these efforts aim to boost vaccination rates, enhance community health literacy and improve overall access to essential public health services across the county.

The University of Michigan Data Modernization Initiative (DMI) team will coordinate closely with MDHHS and rural partners to guide statewide data modernization efforts, ensuring aligned planning, clear data sharing agreements, and consistent project oversight. They will design and pilot new digital tools—including a unified rural health data portal, an open source analytics platform, and automated SAS to R/Python translation capabilities—to expand rural access to modern data infrastructure and support informed decision making. Additionally, the team will deliver comprehensive training, mentorship, and community building activities that build long term analytics capacity across rural health departments and strengthen Michigan’s public health workforce.

This project establishes a comprehensive governance framework to coordinate MDHHS, the Rural Interoperability Advisory Council, evaluation teams and technical assistance partners, while aligning performance measurement through a statewide Evaluation and Measurement Plan. It develops and validates rural interoperability priorities and implementation pathways that reflect varying levels of provider readiness and technical maturity, guiding technical assistance, MiHIN alignment, regional partnerships and future investment decisions. The project also assesses core capabilities needed for rural data exchange and supports development of a Rural Health Data Exchange Framework and scaling roadmap that integrates governance input, interoperability priorities, readiness findings and sustainability considerations into a cohesive statewide strategy.

This project will expand access to the Program of All-Inclusive Care for the Elderly (PACE) in rural Michigan, with a focus on bringing coordinated, community-based care closer to older adults in underserved areas. The project will explore new service areas and flexible care models, including satellite locations and mobile services, while strengthening telehealth, remote monitoring, transportation, pharmacy access, and connections with rural health care providers. Outreach and referral efforts will also help rural families, providers, and community partners better understand and connect eligible residents with PACE services.

Funded partners:

• PACE Central Michigan
• PACE Northeast Michigan (NEMI)

This project will help older adults in rural Michigan safely transition home after a medical facility discharge and remain independent in their communities. Through proactive discharge planning, individualized coaching, and post-discharge support, the Care Transition Coordination and Support (CTCS) program aims to improve access to care, reduce avoidable use of higher-acuity services, and lower 30-day hospital readmissions.

Funded partners:

• Region 10 Area Agency on Aging (AAA) - Area Agency on Aging of Northwest Michigan (AAANM)
• Region 11 Area Agency on Aging (AAA) -Upper Peninsula Commission for Area Progress (UPCAP)
• Region 3C Area Agency on Aging (AAA) - Branch-St. Joseph Agency on Aging Region (IIIC)
• Region 4 Area Agency on Aging (AAA) - Region IV Area Agency on Agency (RIVAAA)
• Region 7 Area Agency on Aging (AAA) - Region VII Area Agency on Aging
• Region 9 Area Agency on Aging (AAA) - Northeast Michigan Community Service Agency (NEMCSA)

Mobile Health Technical Assistance will help RHTP-funded mobile health programs build strong, sustainable services by providing hands-on guidance, shared learning opportunities, and practical tools for implementation. Technical assistance will support areas such as mobile unit outfitting and operations, community engagement, data collection and exchange, reporting, and individualized coaching, while also developing standardized resources and best practices that can be used across Michigan.

Funded partners:

• Central Michigan University
• Wayne State University

This project will expand direct care worker training and career pathways in rural Michigan by bringing hands-on training directly to communities through mobile, portable, and community-based training sites. The project will offer multiple levels of direct care worker training, specialty and skill-building courses, credentialing opportunities, and train-the-trainer programs, with activities across both the Upper and Lower Peninsulas. It will also promote direct care careers through community outreach and targeted recruitment to help grow and sustain the rural direct care workforce.

This project will strengthen emergency preparedness among rural nursing homes by building stronger connections with hospitals, EMS, emergency management, public health agencies, and Health Care Coalitions (HCCs). Through hands-on training, emergency operations plan reviews, ongoing collaboration, and evaluation, participating nursing homes will improve their ability to coordinate, communicate, and respond during emergencies. The project will also develop a sustainable regional preparedness model that can be expanded to other communities.

Grant Funding Opportunity (GFO) awardees have been selected, and project descriptions will be added soon. In the meantime, the organizations selected to receive funding are listed below.

Funded partners:

• Ambulatory Infusion Care - North, Inc.
• Aspire Rural Health System
• Bronson Health Foundation
• Cass County Medical Care Facility 
• Copper Shores Community Health Foundation
• District Health Department #10
• Feonix - Mobility Rising
• Insight Hospital and Medical – Coldwater
• Lakeshore Food Club
• Life EMS Ambulance
• Mecosta Osceola Transit Authority 
• Michigan Association of Ambulance Services
• Michigan Health Improvement Alliance, Inc.
• Northeast Michigan Community Services Agency
• Randy's House
• Region VII Area Agency on Aging
• Samaritan's Way Recovery Community Organization
• Sheridan Community Hospital Clinic
• Thunder Bay Community Health Service, Inc.
• UPCAP Services, Inc.

Funded partners:

• Central Michigan University - Rural Health Excellence Institute
• Community Mental Health Association of Michigan (CMHA)
• Developmental Disabilities Council (Wayne State)
• Michigan Primary Care Association (MPCA)
• Michigan State University (Intensive Outpatient Program)
• Northern Michigan University - Center for Rural Health
• Regents of the University of Michigan: Overdose Prevention Engagement Network (OPEN)

Expanding access to care by hiring community health workers and rural transport staff, purchasing an ADA-accessible van, and contracting telehealth behavioral health and traditional providers. This program will strengthen infrastructure through dedicated recruitment support and new IT equipment. Together, these efforts improve care quality, coordination, and accessibility for tribal members.

Establishing a Community Integrated Paramedicine model to deliver more coordinated, community-based care. Also improving transportation access by purchasing two community health transit vehicles. Together, these efforts strengthen rural care delivery and improve accessibility for tribal members.

Modernizing patient care by implementing a new EHR system that improves clinical management, documentation, and coordination. Includes comprehensive staff training, enhanced billing support, and a full RFP process to select the most appropriate vendor. Together, these investments strengthen efficiency and overall quality of care.

Strengthening community health by hiring a Population Health Nurse, expanding fresh produce production, and purchasing a wheelchair-accessible van to improve transportation for members with disabilities. Advancing long-term food sovereignty through strategic master planning to support a sustainable agricultural enterprise. Together, these efforts enhance access to care, nutrition, and mobility for tribal community members.

Expanding on-site care by launching a new specialty care clinic and increasing transportation access with additional transport vehicles. Bringing services directly to the community by hosting two mobile health unit events. Together, these efforts improve access, mobility, and specialty care for tribal members.

Strengthening behavioral health services by establishing a substance use disorder clinic and the infrastructure needed to support it. Workforce training further enhances provider capacity and ensures high‑quality, culturally responsive care. Together, these efforts expand access to essential SUD treatment for tribal members.

Expanding care options by hiring an MSW, Traditional Healer, and Mammography Technician, and by leasing a mammography machine for on-site screening services. Also enhances clinical efficiency and coordination through improvements to the Electronic Health Record system. Together, these efforts improve access, care quality, and culturally responsive services for tribal members.

Enhancing clinical interoperability by implementing a new EHR system and training 12 staff members to support its use. In addition, improving rural patient access to healthcare with the purchase of two transport vehicles. Together, these efforts strengthen care coordination, efficiency, and mobility for tribal members.

Expanding care access by hiring two Care Coordinator Nurses and three Community Health Workers, and by purchasing two patient transport vehicles. IT infrastructure upgrades improve clinic operations, while emergency preparedness kits support high‑need patients. Together, these investments strengthen care coordination, mobility, and community resilience for tribal members.

Establishing a satellite clinic will improve access by bringing services closer to where tribal members live and work. Behavioral health and patient support will be enhanced by integrating a Peer Support Specialist into the health clinic. IT infrastructure upgrades include a modernized data center with disaster recovery, which enhances system reliability and care coordination.

Enhancing care coordination and behavioral health support by hiring a Nurse Case Manager, Integrated Care Social Worker, Nurse SUD Coordinator, and Referral Specialist Lead. Together, these positions strengthen patient navigation, integrated care, and substance use disorder services.

Expanding care access by hiring a Traveling RN, Community Health Worker, and Medical Case Manager, and by purchasing two client transport vans. Furthering support for elders and underserved families through a new satellite office while strengthening nutrition and wellness by enhancing the food sovereignty program. Together, these efforts improve mobility, care coordination, and community health for tribal members.

Increasing access to care by launching a medical travel program and conducting a comprehensive seven county health and access survey. Strengthening workforce stability through a Workforce for Wellness Initiative focused on recruitment, retention, and professional development. Infrastructure and technology improvements further enhance clinic operations and service delivery for tribal members.