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: 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: 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

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