CHRTlines Blog

Recent Posts

03/11/2014 Obesity in Michigan: What Can We Do?

12/16/2013 To Improve Mental Health Care in Michigan: The Need for Unprecedented Commitment and Cooperation

12/02/2013 The Hunger for Debate: Communication and the Affordable Care Act


March 31, 2014

The Detroit News:

Sign-ups for health care coverage due

CHRT Director Marianne Udow-Phillips discusses the status of ACA enrollment numbers as the March 31 deadline approaches.

Read the article »

March 21, 2014


Beaumont, Botsford, Oakwood health systems intend to merge

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.

Watch the interview »

March 19, 2014

Detroit Free Press:

Those who don't get health insurance face penalties

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.

Read the article »

March 14, 2014

Interlochen Public Radio:

The Abortion Insurance Opt-Out Act takes effect tomorrow, what can we expect?

Cynthia Canty, host of Michigan Radio’s Stateside, speaks with CHRT Director Marianne Udow-Phillips about the Abortion Insurance Opt-Out Act.

Listen to the interview »

March 9, 2014

Detroit Free Press:

Questions and answers on health care reform: Deadlines, income limits and policy extensions

CHRT Health Policy Analyst Josh Fangmeier and Claire McAndrew, director of the private insurance program at Washington, D.C.-based Families USA, answer health care reform questions from Free Press readers.

Read the article »

The Center for Healthcare Research & Transformation (CHRT) illuminates best practices and opportunities for improving health policy and practice. Based at the University of Michigan, CHRT is a non-profit partnership between U-M and Blue Cross Blue Shield of Michigan designed to promote evidence-based care delivery, improve population health, and expand access to care.

April 9, 2014

Best Practices in Care Management for Senior Populations

CHRT Policy Paper

Publication details »

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’s CO-OP Plans: Analysis of 2014 Rates

CHRT Policy Paper

Publication details »

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

Premium Cost Changes Attributable to the Affordable Care Act

CHRT Issue Brief February 2014

Publication details »

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

Obesity in Michigan: Impact and Opportunity

CHRT Issue Brief January 2014

Publication details »

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

Medicaid and Medicare Disproportionate Share Hospital Programs

CHRT Policy Paper

Publication details »

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

Care Transitions: Best Practices and Evidence-based Programs

CHRT Policy Paper

Publication details »

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

Wellness Programs: Do They Work?

CHRT Policy Paper

Publication details »

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

Affordable Care Act Funding: An Analysis of Grant Programs under Health Care Reform — FY2010–FY2013

CHRT Issue Brief December 2013

Publication details »

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

Community Mental Health Services: Coverage and Delivery in Michigan

CHRT Policy Paper

Publication details »

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

Access to Mental Health Care in Michigan

Cover Michigan Survey December 2013

Publication details »

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

Payment Strategies: A Comparison of Episodic and Population-based Payment Reform

CHRT Policy Paper

Publication details »

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

Impact of Benefit Design on Cost, Use, and Health: Literature Review

CHRT Policy Paper

Publication details »

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

Emerging Health Insurance Products in an Era of Health Reform

CHRT Issue Brief November 2013

Publication details »

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.

September 25, 2013

Cover Michigan 2013

Employee Cost-Sharing for Health Insurance in Michigan

Publication details »

September 25, 2013 This brief reports on trends in health insurance premiums and cost-sharing among private-sector employers in Michigan and the United States from 2002 to 2012, and provides a focused look at high-deductible health plans by employer size. While employer cost-control efforts in the 1990s could be characterized as a shift toward managed care, the first decade of the 2000s may be better characterized as a shift of costs to employees. Small employers (those with fewer than 50 employees) widely adopted high-deductible health plans between 2009 and 2012, whereas larger employers (50 or more employees) relied more on increasing the employees’ share of premiums as the primary form of cost containment. Recent trends indicate, however, that large firms may also be moving toward high-deductible plans.

Private Health Insurance in Michigan, 2008 to 2011

Publication details »

September 25, 2013 More than 500,000 people in Michigan lost their private health insurance from 2008 to 2011. The primary reason for the decline in private insurance in Michigan and in the nation was the erosion of employer-sponsored insurance (ESI), the most common way that Americans get private coverage. From 1999 to 2011, the proportion of individuals covered by ESI decreased by approximately 15 percent nationwide. In Michigan during that time, the percentage of people with ESI fell by 20 percent, the second greatest reduction among all states, exceeded only by South Carolina. In spite of these declines, in 2011 the proportion of people covered by employer-sponsored plans in Michigan remained 4.5 percentage points higher than the national average, in part because a larger percentage of employers in Michigan have historically offered health insurance. This issue brief describes trends in private health insurance coverage in Michigan and the U.S., and focuses on coverage both by industry type and by income level.

Safety Net Providers and Uncompensated Hospital Care in Michigan

Publication details »

August 30, 2013 Michigan’s safety net providers were deeply influenced by the economic recession from December 2007 to June 2009, as the numbers of uninsured and publicly insured individuals grew statewide. As a result of the increase in both the uninsured and the Medicaid populations, free clinics and federally qualified health centers (FQHCs) saw increased demand for low- or no-cost services. In 2011, two years after the official end of the recession, 133,000 more people in Michigan were uninsured and 502,000 more were covered by Medicaid than in 2007. As a result of the growth in the uninsured population, many hospitals also experienced a sharp increase in uncompensated care costs. This brief describes the impact of the recession on safety net providers, changes in uncompensated hospital care by county, service demands and use of FQHC services, and the change in the supply of free clinics in Michigan from 2007 to 2011.

The ACA’s Coverage Expansion in Michigan: Demographic Characteristics and Coverage Projections

Publication details »

July 31, 2013 In January 2014, the Affordable Care Act (ACA) will begin to offer new health insurance coverage options to millions of Americans, many of whom are currently uninsured. There is still considerable uncertainty, however, about how the coverage expansion will play out. Several states continue to debate whether to expand eligibility for their Medicaid programs as the ACA intended. Health insurance exchanges that will offer coverage in the individual and small group markets are still being developed by the federal government and many states for the open enrollment launch in October 2013. Employers, who still provide coverage to the majority of Americans, are evaluating what, if any, changes to make in their health care offerings. All of these issues are reflected in activity in Michigan. To better understand the likely coverage effects of the ACA on Michigan’s insurance market, it is important to recognize the demographic characteristics of Michigan residents who will be most affected. This issue brief is intended to both describe the characteristics of these populations and project how the ACA will affect the overall picture of coverage in Michigan. Since there is still uncertainty about whether or not Michigan will move forward on an expansion of Medicaid, alternative projection scenarios are included.

Regional Variation of the ACA’s Coverage of the Uninsured in Michigan

Publication details »

July 31, 2013 In 2014, the Affordable Care Act (ACA) will expand health insurance coverage to many Michigan residents, especially those who currently lack coverage. The effects of the ACA will likely be uneven across the state, however, due to considerable regional variation in the proportion of uninsured adults. In addition, it is still unclear whether Michigan will expand Medicaid eligibility by 2014 as intended by the ACA. This issue brief examines the regional variation in the impact of the ACA on Michigan’s uninsured, particularly in view of whether Medicaid is expanded or not. To observe regional differences, we calculated uninsured rates for non-elderly adults (aged 19–64) across 33 county-based regions using data from the American Community Survey (ACS) from 2009 to 2011. In addition, we calculated Medicaid and exchange eligibility for each region under both scenarios (Medicaid expansion or no expansion).

The Uninsured in Michigan

Publication details »

July 31, 2013 Uninsured Americans face substantial barriers to receiving and paying for high quality health care services. The economic recession from 2007 to 2009 caused the uninsured rate to surge in Michigan and in the United States as a whole. Michigan’s uninsured population peaked at 1.2 million in 2009 (12.4 percent of the total state population); the national uninsured rate peaked a year later in 2010, with 47.2 million people uninsured (15.4 percent of the population). The uninsured rate declined from 2010 to 2011 both in Michigan and the United States overall. This recent reduction in the uninsured rate was driven largely by increased insurance coverage among young adults ages 18 to 25, many of whom acquired or retained coverage as a result of the Affordable Care Act (ACA). This issue brief describes trends in the rates of the uninsured in Michigan and the United States from 2008 to 2011, as well as uninsured rates by age, race/ethnicity and income in Michigan.

August 30, 2013

The Impact of ACA Taxes and Fees

CHRT Issue Brief August 2013

Publication details »

Under the Affordable Care Act (ACA) 25 million Americans are expected to obtain health care coverage by 2019. Many of those who are expected to get coverage under the ACA will either receive subsidies through health insurance exchanges to help make coverage more affordable or will be covered under an expanded Medicaid program. The federal government will fund the premium subsidies along with the majority of the cost of the Medicaid expansion. The Congressional Budget Office estimates that these coverage expansions will require $1.2 trillion in new federal spending over the period 2013–2022. The ACA offsets this new spending with reductions in other federal spending and revenues from new taxes and fees. Approximately half of the offset occurs through reductions in spending to providers of care or limitations to tax deductions/credits, with the remainder offset through new taxes and fees. This brief describes these new taxes and fees and their likely impact on consumers.

July 8, 2013

Satisfaction with Health Care Coverage

Cover Michigan Survey July 2013

Publication details »

This brief, the second from Cover Michigan Survey 2013 (fielded third quarter of 2012), describes how satisfied Michiganders reported being with their source of health coverage in 2012 and the experiences and factors that were associated with coverage satisfaction. Respondents with individually-purchased insurance were least satisfied with their coverage as well as least concerned about losing their coverage, while those with Medicaid were most satisfied and most concerned about losing coverage. Negative experiences with coverage played a large role in respondents’ reported satisfaction with their coverage.

June 3, 2013

The Affordable Care Act and Its Effects on Small Employers

CHRT Issue Brief May 2013

Publication details »

The Patient Protection and Affordable Care Act (ACA) is expected to increase access to affordable health insurance through a variety of provisions, many of which relate to employer-sponsored health coverage. A previous CHRT report details how the ACA impacts both midsize (100 to 1,000 employees) and large (more than 1,000 employees) firms, but certain provisions uniquely affect small firms (fewer than 100 employees), which represent 78% of private-sector firms in Michigan. In general, small firms will have to decide whether or not to offer health coverage, but this decision and its impact may not be so clear cut. Various incentives and penalties are built into the ACA to persuade more small businesses to offer coverage, but these levers are not applied uniformly across all small firms. Many of the provisions relevant to small firms depend on a number of variables, and small employers will have to first understand their own specific characteristics before understanding the impact of the ACA.