Nav: Home

Primary care providers say Michigan's Medicaid expansion helped patients' health and work

June 13, 2018

ANN ARBOR, MI - Extending medical insurance to low-income Michigan residents meant they had better access to health care, earlier detection of serious illnesses, better care for existing health problems and improved ability to work, attend school and live independently, according to a newly published survey of primary care providers.

Published in the Journal of General Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation, the results come from 2,104 primary care doctors, nurse practitioners and physician assistants who care for 12 or more people insured by the Healthy Michigan Plan, Michigan's expansion of the Medicaid insurance program to low-income adults.

IHPI's researchers conducted the survey as part of a contract with the Michigan Department of Health and Human Services to conduct the formal evaluation of the Healthy Michigan Plan required by the federal waiver that allowed Michigan to customize its Medicaid expansion.

The researchers note that the waiver allowed Michigan to require that new Medicaid expansion participants see a primary care provider within months of enrolling, and work with that provider to assess their health risks. The new findings suggest this could provide a model for other states currently considering expanding Medicaid, or working to expand it under recent policy decisions.

"While Michigan's Medicaid expansion has been looked at as an example of financial incentives for healthy behavior, I think the primary care part of it is an underappreciated strength," says Susan Goold, M.D., M.A., M.H.S.A., the professor of internal medicine who led the study. "Primary care practitioners said that people gained access to care they didn't have before, including preventive services, and care for chronic conditions and other problems that they might otherwise have ended up in the emergency department for."

One year after Medicaid expansion took effect in Michigan, the survey of primary care providers about their previously uninsured patients found:
  • 74 percent said that Healthy Michigan Plan coverage had a positive impact on patients who have chronic diseases such as diabetes, asthma, heart disease and arthritis

  • 71 percent said the coverage had led to earlier detection of serious illnesses in patients who had not previously been diagnosed; earlier detection can improve outcomes and reduce overall costs of care

  • 69 percent said that patients stuck to their medication better because of their new insurance coverage; adherence to prescribed medicines can improve health outcomes

  • 56.5 percent said their patients had improved their health-related behaviors. The Healthy Michigan Plan offers incentives such as gift cards and discounts to encourage participants to stop smoking, exercise more and engage in other healthy behaviors.

  • 57 percent said coverage positively affected their patients' emotional well-being

  • 46 percent said coverage improved their patients' ability to work or attend school

  • 41 percent said patients' ability to live independently improved because of their coverage

In addition to its impact on patients, the survey showed that the Healthy Michigan Plan had a major impact on primary care providers' own practices. For example:
  • 56.2 percent reported an increase in patients who were seeing a doctor or other health care provider for the first time in years

  • 57 percent had hired additional office staff, and 53 percent had hired additional clinicians

  • Nearly 56 percent said they had consulted with a professional who specializes in connecting high-need and underserved people to care and social services, either a case manager, a care coordinator or a community health worker

  • 52.3 percent said they'd seen an increase in their number of new patients

  • Nearly 51 percent said that patients they'd seen before who had lacked insurance or paid directly for their care had gained insurance

  • 15 percent said their primary care site had begun offering mental health services

  • Just under 16 percent said that their existing patients had experienced a decrease in their ability to get a same-day or next-day appointment because of the increase in patients covered by the Healthy Michigan Plan

Before designing the survey and sending it to all primary care providers who cared for 12 or more Healthy Michigan Plan participants in 2014, the researchers conducted in-depth interviews with a sample of primary care providers from around the state. Their paper contains anonymous quotes from some of those who gave interviews.

More than 77 percent of the providers who returned the survey were either family practice physicians or general internal medicine physicians, and 17 percent were nurse practitioners or physician assistants, who can provide a full range of primary care services when working with a supervising physician under Michigan law. Rural and Upper Peninsula providers were over-represented in the survey respondents, though three-quarters practiced in an urban setting and 31 percent were in the Detroit metropolitan region.

"According to primary care providers, it's working - it's getting patients in the door so providers can talk to them about what they need to do to stay or get healthy," says Goold, who also has a faculty appointment in the U-M School of Public Health. "I do think that other states can learn from our example."
-end-
More about IHPI's evaluation of the Healthy Michigan Plan: http://michmed.org/Medicaid

Reference: J Gen Intern Med, DOI: 10.1007/s11606-018-4487-6

Michigan Medicine - University of Michigan

Related Public Health Articles:

Public health guidelines aim to lower health risks of cannabis use
Canada's Lower-Risk Cannabis Use Guidelines, released today with the endorsement of key medical and public health organizations, provide 10 science-based recommendations to enable cannabis users to reduce their health risks.
Study clusters health behavior groups to broaden public health interventions
A new study led by a University of Kansas researcher has used national health statistics and identified how to cluster seven health behavior groups based on smoking status, alcohol use, physical activity, physician visits and flu vaccination are associated with mortality.
Public health experts celebrate 30 years of CDC's prevention research solutions for communities with health disparities
It has been 30 years since CDC created the Prevention Research Centers (PRC) Program, currently a network of 26 academic institutions across the US dedicated to moving new discoveries into the communities that need them.
Public health experts support federally mandated smoke-free public housing
In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities, three public health experts applaud the efforts of the US Department of Housing and Urban Development to protect nonsmoking residents from the harmful effects of tobacco exposure.
The Lancet Public Health: UK soft drinks industry levy estimated to have significant health benefits, especially among children
The UK soft drinks industry levy, due to be introduced in April 2018, is estimated to have significant health benefits, especially among children, according to the first study to estimate its health impact, published in The Lancet Public Health.
Social sciences & health innovations: Making health public
The international conference 'Social Sciences & Health Innovations: Making Health Public' is the third event organized as a collaborative endeavor between Maastricht University, the Netherlands, and Tomsk State University, the Russian Federation, with participation from Siberian State Medical University (the Russian Federation).
Columbia Mailman School Awards Public Health Prize to NYC Health Commissioner Dr. Mary T.
Dr. Mary T. Bassett, Commissioner of the New York City Department of Health and Mental Hygiene, was awarded the Frank A.
Poor health literacy a public health issue
America's poor record on health literacy is a public health issue, but one that can be fixed -- not by logging onto the internet but by increased interaction with your fellow human beings, a Michigan State University researcher argues.
Despite health law's bow to prevention, US public health funding is dropping: AJPH study
Although the language of the Affordable Care Act emphasizes disease prevention -- for example, mandating insurance coverage of clinical preventive services such as mammograms -- funding for public health programs to prevent disease have actually been declining in recent years.
'Chemsex' needs to become a public health priority
Chemsex -- sex under the influence of illegal drugs -- needs to become a public health priority, argue experts in The BMJ this week.

Related Public Health Reading:

Introduction to Public Health
by Mary-Jane Schneider (Author)

Introduction to Public Health, Fifth Edition offers a thorough, accessible overview of the expanding field of public health for students new to its concepts and actors. Written in engaging, nontechnical language, this best-selling text explains in clear terms the multi-disciplinary strategies and methods used for measuring, assessing, and promoting public health.
Packed with illustrative real-world examples, this updated edition provides students with informative discussions of the current technical issues and practical obstacles facing public health practitioners and policymakers alike.... View Details


The Health Gap: The Challenge of an Unequal World
by Michael Marmot (Author)

In this groundbreaking book, Michael Marmot, president of the World Medical Association, reveals social injustice to be the greatest threat to global health

In Baltimore’s inner-city neighborhood of Upton/Druid Heights, a man’s life expectancy is sixty-three; not far away, in the Greater Roland Park/Poplar neighborhood, life expectancy is eighty-three. The same twenty-year avoidable disparity exists in the Calton and Lenzie neighborhoods of Glasgow, and in other cities around the world.

In Sierra Leone, one in 21 fifteen-year-old women will die in her fertile years... View Details


Public Health: A Very Short Introduction (Very Short Introductions)
by Virginia Berridge (Author)

Public health is a term much used in the media, by health professionals, and by activists. At the national or the local level there are ministries or departments of public health, whilst international agencies such as the World Health Organization promote public health policies, and regional organizations such as the European Union have public health funding and policies. But what do we mean when we speak about "public health?"

In this Very Short Introduction Virginia Berridge explores the areas which fall under the remit of public health, and explains how the individual... View Details


The Public Health Crisis Survival Guide: Leadership and Management in Trying Times
by Joshua M. Sharfstein (Author)

Firefighters are taught to battle flames. Police learn to respond quickly to 911 calls.

So why are so few health officials prepared for public health crises?

The Public Health Crisis Survival Guide is here to help. Whether it's an infectious disease outbreak, a scathing news report, or a sudden budget calamity, this book gives public health readers an honest and practical overview of what to do when things go wrong -- not just to survive, but to lead and thrive in the most difficult circumstances.

With examples drawn from history, recent headlines, and the... View Details


A History of Public Health
by George Rosen (Author), Elizabeth Fee (Introduction), Pascal James Imperato (Introduction)

Since publication in 1958, George Rosen’s classic book has been regarded as the essential international history of public health. Describing the development of public health in classical Greece, imperial Rome, England, Europe, the United States, and elsewhere, Rosen illuminates the lives and contributions of the field’s great figures. He considers such community health problems as infectious disease, water supply and sewage disposal, maternal and child health, nutrition, and occupational disease and injury. And he assesses the public health landscape of health education, public health... View Details


Public Health: What It Is and How It Works
by Bernard J. Turnock (Author)

Using a straightforward systems approach, Public Health: What It Is and How It Works explores the inner workings of the complex, modern U.S. public health system--what it is, what it does, how it works, and why it is important.

The book covers the origins and development of the modern public health system; the relationship of public health to the overall health system; how the system is organized at the federal, state, and local levels; its core functions and how well these are currently being addressed; evidence-based practice and an approach to program planning and evaluation for... View Details


Public Health 101: Healthy People―Healthy Populations
by Richard Riegelman (Author), Brenda Kirkwood (Author)

From clean drinking water, to seat belts, to immunizations, the impact of public health on every individual is undeniable. For undergraduates, an understanding of the foundations of public health is an essential step toward becoming an educated citizen.

Public Health 101: Healthy People--Healthy Populations provides a big-picture, population perspective on the determinants of health and disease and the tools available to protect and promote health. It examines the full range of options for intervention including use of the healthcare system, the public health system, and society-wide... View Details


Public Health Nursing: Population-Centered Health Care in the Community, 9e
by Marcia Stanhope RN DSN FAAN (Author), Jeanette Lancaster RN PhD FAAN (Author)

Prepare for a successful career as a community/public health nurse! Public Health Nursing: Population-Centered Health Care in the Community, 9th Edition provides up-to-date information on issues that impact public health nursing, such as infectious diseases, natural and man-made disasters, and health care policies affecting individuals, families, and communities. Real-life scenarios show examples of health promotion and public health interventions. New to this edition is an emphasis on QSEN skills and an explanation of the influence of the Affordable Care Act on public... View Details


Introduction To Public Health
by Mary-Jane Schneider (Author)

Introduction to Public Health, Fourth Edition offers a thorough, accessible overview of the expanding field of public health for students new to its concepts and actors. Written in engaging, nontechnical language, this best-selling text explains in clear terms the multi-disciplinary strategies and methods used for measuring, assessing, and promoting public health. Packed with illustrative real-world examples, this updated edition provides students with informative discussions of the current technical issues and practical obstacles facing public health practitioners and policymakers alike.... View Details


Community/Public Health Nursing: Promoting the Health of Populations, 6e
by Mary A. Nies PhD RN FAAN FAAHB (Author), Melanie McEwen PhD RN (Author)

Covering the nurse’s role in promoting community health, Community/Public Health Nursing, 6th Edition provides a unique ‘upstream’ preventive focus and a strong social justice approach in a concise, easy-to-read text. It shows how you, as a nurse, can take an active role in social action and health policy – especially in caring for diverse and vulnerable population groups. Written by community health nursing experts Mary A. Nies and Melanie McEwen, this book offers clinical examples and photo novellas showing how concepts apply to the real world, and describes the issues and... View Details

Best Science Podcasts 2018

We have hand picked the best science podcasts for 2018. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

The Person You Become
Over the course of our lives, we shed parts of our old selves, embrace new ones, and redefine who we are. This hour, TED speakers explore ideas about the experiences that shape the person we become. Guests include aerobatics pilot and public speaker Janine Shepherd, writers Roxane Gay and Taiye Selasi, activist Jackson Bird, and fashion executive Kaustav Dey.
Now Playing: Science for the People

#479 Garden of Marvels (Rebroadcast)
This week we're learning about botany and the colorful science of gardening. Author Ruth Kassinger joins us to discuss her book "A Garden of Marvels: How We Discovered that Flowers Have Sex, Leaves Eat Air, and Other Secrets of the Way Plants Work." And we'll speak to NASA researcher Gioia Massa about her work to solve the technical challenges of gardening in space.