July 18, 2014
The Detroit News:
CHRT Health Policy Analyst Josh Fangmeier breaks down how an economist’s grim predictions for significant premium increases and plateaued (or even increased) uninsured populations under the Affordable Care Act does not match current data—both nationally and in Michigan.
March 31, 2014
The Detroit News:
CHRT Director Marianne Udow-Phillips discusses the status of ACA enrollment numbers as the March 31 deadline approaches.
March 21, 2014
Rod Meloni, WDIV reporter, speaks with CHRT Director Marianne Udow-Phillips on how a newly announced alliance among Beaumont, Botsford and Oakwood health systems will affect patients.
March 19, 2014
Detroit Free Press:
As open enrollment on the insurance marketplace winds down, the Detroit Free Press discusses penalties facing some of those who remain uninsured, citing CHRT figures on penalty costs.
March 14, 2014
Interlochen Public Radio:
Cynthia Canty, host of Michigan Radio’s Stateside, speaks with CHRT Director Marianne Udow-Phillips about the Abortion Insurance Opt-Out Act.
November 12, 2014
ACOs are networks of clinicians and hospitals who share medical and financial responsibility for the full continuum of patient care. The Affordable Care Act formalized the term by establishing the Medicare Accountable Care Organization (ACO) program and launching several other ACO models. More than 18 percent of hospitals across the country are estimated to be participating in some form of an ACO, with more expected by the end of 2014. Simultaneously, many private sector health plans have launched an ACO network that they offer as a distinct insurance product option to individuals and employer groups. These products are based on contractual agreements with selected providers who are chosen based on financial and quality measures. Often, they are offered through Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) structures to encourage members to receive care from network providers. This paper describes activity concerning commercial insurance products based on ACO networks.
October 29, 2014
Chronic conditions affect millions of Americans and have a major impact on U.S. health care spending each year. Chronic diseases account for seven out of every ten deaths in the United States annually, and it is estimated that more than 75 percent of all health care costs are associated with chronic diseases. Approximately 45 percent of Americans nationwide are affected by at least one chronic condition and 60 percent of adults in Michigan suffer from a chronic condition. Currently, over 95 percent of Michigan adults report at least one behavior that may increase their risk for chronic conditions. This issue brief summarizes health care spending in Michigan for five common chronic conditions for Blue Cross and Blue Shield of Michigan (BCBSM) members.
October 14, 2014
Autism spectrum disorder (ASD) comprises a group of developmental disabilities that cause impairment in social interactions, communication skills, and behaviors that can have long-term health and social functioning costs for individuals with ASD and their families. In 2014, the Centers for Disease Control and Prevention (CDC) reported that approximately one in 68 children in the United States were diagnosed with autism spectrum disorder. Researchers estimate that it costs between $1.4 and $2.4 million to support an individual with ASD over a lifetime for direct costs such as medical care or special education, and indirect costs such as lost employment. In 2012 and 2013, Michigan passed legislation affecting the coverage of diagnosis and treatment of autism in state-regulated health plans. This issue brief provides an overview of ASD, various treatment approaches, federal and state coverage requirements, and the opportunities and challenges created by Michigan’s legislation.
September 19, 2014
Beginning in January 2014, the Affordable Care Act (ACA) introduced a series of health insurance reforms, particularly for consumers purchasing coverage through the individual market or covered through employment at a small firm. One of the most prominent of these reforms is the requirement that all health plan products in certain market segments must cover an established set of essential health benefits (EHBs). EHBs create a minimum standard for insurance coverage; however, because many health plan products often lacked benefits for certain services, implementation was lengthy, involving federal regulators, state agencies, private insurers, and consumers. This brief discusses how EHBs were defined and implemented, what plans must cover them, and how this has changed the insurance market. An analysis of the implementation process in Michigan is also provided.
August 25, 2014
On March 31, 2014, the Affordable Care Act’s (ACA) Individual Marketplace officially closed for most people until open enrollment begins for 2015 health plans on November 15, 2014. By the end of the first open enrollment period, 272,539 Michigan residents had signed up for a plan through the marketplace. Assuming that many of these residents complete the enrollment process, Michigan marketplace enrollment exceeded 2014 projections from CHRT, the Department of Health and Human Services (HHS), and the Urban Institute. This issue brief summarizes the plans that have been offered on the individual marketplace, explains the financial assistance available through the marketplace, describes the operational challenges faced by the marketplace, and recaps Michigan’s enrollment during the 2014 open enrollment period.
August 25, 2014
2014 marked the beginning of new health insurance affordability programs made available through the Patient Protection and Affordable Care Act (ACA), including tax credits to lower premium costs, assistance to reduce out-of-pocket expenses, and an optional state expansion of Medicaid eligibility. This analysis examines the effects of the ACA’s premium tax credits and cost-sharing reductions on Michigan’s uninsured population. While these two programs do provide financial benefits to many of Michigan’s uninsured, the extent of these benefits will vary due to the socioeconomic diversity of the uninsured population.
June 23, 2014
This paper provides a brief overview of key findings in the Institute of Medicine (IOM) 2011 report, Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, and its recommendations on how to address the gaps in pain prevention, care, education and research. It also examines how public and commercial insurers approach pain management, and summarizes the pain-related provisions in the 2010 Patient Protection and Affordable Care Act (ACA).
June 2, 2014
Hospitalizations pose substantial human and economic burdens for patients, families and the U.S. health care system as a whole. Hospital care is typically the largest category of health spending, and both acute and chronic conditions drive hospital utilization. This issue brief describes trends in hospitalization rates by diagnosis and by charges for admissions, from 2007 to 2011 in Michigan and the United States. It updates a 2010 issue brief with the most recent available data. The most significant finding in this analysis is that hospitalizations for septicemia rose sharply in both Michigan and in the United States from 2007 to 2011. Septicemia rose above all heart disease diagnoses, which are among the most common reasons for hospitalization. In contrast with septicemia, the discharge rate for many heart conditions declined during this time. Additional findings are consistent with trends reported in the previous issue brief, including an increase in procedures related to chronic pain and mobility.
May 22, 2014
While there has been considerable media coverage about the insurance impacts of the Affordable Care Act (ACA), there has been less discussion of the law’s changes to provider reimbursement policy, reforms to the delivery system, and investments in programs to improve the quality of care and constrain long-run growth in health care expenditures. This paper focuses on ACA cost containment policies that target the delivery of health care at the provider level, and aim to reduce system-wide health care costs—for the federal and state governments, individuals, and employers—through delivery system reforms. A companion paper, An In-depth Look at Six Cost Containment Programs in the Affordable Care Act, provides a more detailed description of six specific policies or initiatives created by the ACA that are designed to affect system-wide growth in health care costs.
May 22, 2014
This paper describes six cost containment policies or initiatives included in the Affordable Care Act (ACA) that target how health care is delivered and the growth of health care costs. A summary of the implementation occurring in Michigan is also provided. The policies or initiatives explored in depth here are: Accountable Care Organizations, Hospital-Acquired Conditions, Value-Based Purchasing, Hospital Readmission Reductions Program, Center for Medicare and Medicaid Innovation, and Program Integrity.
April 9, 2014
Care Management is a service designed to help patients and their caregivers manage medical conditions more effectively, in order to improve health and reduce the need for hospitalizations and emergency department visits. Care managers are generally nurses or social workers who work closely with patients and caregivers to assess health risks and needs, collaboratively develop care plans, and coach patients in self-care. Care managers strive to ensure close communication between patients and physicians, and among all providers involved in patients’ care. Health care providers increasingly offer care management, driven in part by reimbursement changes under the Affordable Care Act that sparked provider interest. Health plans are encouraging this trend through reimbursement policies and are moving away from offering care management directly or through vendor-supplied services. This analysis focuses on the question: do care management programs work for senior populations and, if so, what characteristics are shared by the most effective programs?
March 17, 2014
The Affordable Care Act (ACA) expands access to health insurance by providing premium tax credits for private coverage on the ACA’s health insurance marketplaces and expanding eligibility for Medicaid (in states that accept this option). The ACA also supports the launch of new health insurers, known as Consumer Operated and Oriented Plans (CO-OPs). For 2014, 22 CO-OPs are offering qualified health plans (QHPs) on the ACA’s marketplaces. Premium rates for these plans vary considerably across states, and some CO-OPs are much more competitive in their local markets than others. In some states, CO-OPs are offering the lowest rates for bronze and/or silver level plans. While in other states, CO-OP premiums are nearly twice as high as the cheapest competitor. To compare the competitiveness of CO-OP rates to local plans, CHRT analyzed data on 2014 ACA marketplace rates in each CO-OP state.
February 21, 2014
The Affordable Care Act (ACA) expands health insurance coverage to millions of uninsured Americans and introduces several reforms to the health insurance market, particularly for people who purchase coverage on their own or receive it through employment at a small business. Combined with other ACA provisions, these reforms mean that some people in the individual and small group insurance markets looking for coverage on the new health insurance marketplaces will experience significant increases in the premiums they pay for coverage and others will experience significant reductions. This issue brief describes the ACA provisions most likely to affect premium costs in the individual and small group markets. In addition to premium cost changes, this brief comments on out-of-pocket health care spending because personal health care spending includes both premiums and out-of-pocket costs.
January 27, 2014
For over a decade, Michigan has had one of the highest rates of obesity in the nation. Although obesity was just recently recognized as a disease by the American Medical Association, clinicians have long understood that obesity is associated with major health risks and is a driver of health care costs. But do all individuals categorized as obese face the same health issues? This study of privately insured individuals in Michigan makes clear that those who are categorized as severely obese face much greater health challenges and place higher demands on the health care system than those in other weight categories.
January 22, 2014
Congress created the Disproportionate Share Hospital (DSH) program in the early 1980s to help hospitals offset the costs of providing care to low-income individuals. Medicaid and Medicare each have a distinct DSH program, with a unique structure and financing mechanism. In addition to giving a brief overview of the Medicaid and Medicare DSH programs, this document will discuss the role of the state and federal governments in running the Medicaid DSH program; explain how the Michigan Medicaid DSH program is financed and structured; and examine the changes to the Medicaid and Medicare DSH programs under the Patient Protection and Affordable Care Act (ACA).
January 15, 2014
Poorly coordinated care transitions from the hospital to other care settings cost an estimated $12 billion to $44 billion per year. Poor transitions also often result in poor health outcomes. The most common adverse effects associated with poor transitions are injuries due to medication errors, complications from procedures, infections, and falls. Providers are focused on improving transitions, due in part to reimbursement changes under the Affordable Care Act. New payment models, including bundled payments and shared savings programs for Accountable Care Organizations, also create incentives to coordinate transitions and provide care in less intensive settings. Improving care transitions for complex patients moving from hospitals to skilled nursing facilities, to their own home, or to another setting can result in significant savings while improving patient safety. This paper summarizes best practices in care transitions and describes successful programs that reduced readmissions and overall costs. The paper also includes an annotated bibliography detailing the research on care transitions and describes the care transitions programs offered by the University of Michigan Health System and Blue Cross Blue Shield of Michigan.
January 7, 2014
Most Americans obtain health insurance coverage through their employer. As a result, it is in the interest of employers to promote a healthy, productive workforce as well as to moderate health care spending. Recently, many employers that provide health insurance coverage have turned to wellness programs to try to achieve both goals. The Patient Protection and Affordable Care Act (ACA) also includes several provisions to further encourage small and large employers to offer such programs. While it is clear that workplace wellness programs are becoming more prevalent, it is less clear whether they are actually achieving their goals of improving health and/or reducing benefit costs. This report describes common elements of wellness programs and reviews the research findings to date on their effectiveness.
December 19, 2013
The ACA is designed to reduce the number of uninsured Americans by expanding eligibility for Medicaid and offering tax credits for the purchase of private insurance. In addition, the ACA makes investments to expand access to care, implement broad private insurance reforms, and enhance the public health infrastructure. Many of these reforms and investments are paid for through direct spending included in the law. This issue brief updates an earlier CHRT brief and focuses on ACA grants that were awarded from when the law was signed (March 23, 2010) until the end of fiscal year 2013 (September 30, 2013). This brief examines grant programs funded by the ACA, how funds have been distributed to states and local organizations, and the effects of budget sequestration on future ACA funding. This brief also includes an analysis of ACA funding in Michigan during fiscal years 2012 and 2013.
December 9, 2013
Mental health care delivery in the state has changed forms many times since the early 1960s. At the federal level, President Kennedy signed the Community Mental Health Act (CMHA) in October 1963. The CMHA provided federal funding for the establishment of community mental health centers and started the trend toward deinstitutionalizing mental health patients. In 1965, the state of Michigan operated 41 psychiatric hospitals and centers for persons with developmental disabilities, serving approximately 29,000 residents. As of February 2013, only five psychiatric hospitals and centers were operating in Michigan. Michigan’s publicly funded mental health system has its origins in 1963's Public Act 54, which permitted counties to form Community Mental Health (CMH) boards to support and treat people with severe mental illness, developmental disabilities and substance abuse disorders outside of psychiatric hospitals and institutions. In 1974, Michigan’s P.A. 54 was replaced with Michigan P.A. 258, the Mental Health Code, which is the basis for Michigan’s publicly funded mental health system today, allowing the creation of CMH agencies in single counties and CMH organizations in two or more counties. Many subsequent changes created additional types of entities such as Substance Abuse Coordinating Agencies (CAs) and Prepaid Inpatient Health Plans (PIHPs—Medicaid behavioral health managed care organizations). Additional changes will take effect in 2014. This paper details the past, present, and future of community mental health care services in Michigan.
December 3, 2013
One in five Michiganders report having been diagnosed with depression at some point in their lives. Mental health disorders cause more disability among Americans than any other illness group. Using data from the Cover Michigan Survey and the Michigan Primary Care Physician Survey, both fielded in calendar year 2012, this brief explores issues related to prevalence of mental health disease, specifically depression and anxiety, and the capacity of the Michigan health care system to serve people with these conditions. Overall, it is clear that there is high need for mental health services in Michigan and the capacity to serve those in need is not adequate to the task.
November 27, 2013
Policymakers nationwide are currently discussing how to improve the way that health care providers are paid for the services they deliver, with a focus on pilot programs and demonstrations in the Affordable Care Act (ACA), such as bundled payments, accountable care organizations (ACOs) and value-based purchasing. Bundled payments focus on all the procedures involved in a single medical episode rather than considering these items individually, while ACOs and value-based purchasing emphasize provider performance at the population level. This paper examines these two broad types of payment strategies, including their research foundations, how they have been implemented in the past, and their operational strengths and challenges. Due to the variation of health care delivery systems, not all payment strategies are appropriate for every medical condition.
November 27, 2013
Many employers use cost-sharing in their health insurance benefit designs as a means to reduce costs and, for some designs, encourage improved enrollee health behaviors. This paper summarizes the literature on the impact that three commonly used benefit designs have on cost, use of services, and health status. Overall, the research concludes that increased cost-sharing can significantly reduce costs for employers—often at the expense of increasing out-of-pocket costs for enrollees—but has not shown an adverse effect on health for the average enrollee. However, across-the-board cost-sharing reduces the use of both highly effective and less effective treatments and has been shown to adversely affect those who are sicker and have lower incomes. A full summary of the literature and definitions of the various benefit approaches is included.
November 11, 2013
At least in part in response to the health coverage changes of the Affordable Care Act (ACA), many health plans are making significant changes to products that they plan to offer in the employer and individual market. While insurers were already moving away from paying for volume and toward paying for value prior to health reform, the ACA has been a catalyst for greater development of an array of health plan products. Individuals and small businesses may now purchase coverage on the individual insurance exchange and on the Small Business Health Options Program (SHOP) exchange, respectively. The majority of plans offered in Michigan on both the individual and SHOP exchanges are limited or narrow network plans. This brief focuses on three growing categories of health plan products and provider arrangements in the commercial market.