February 24, 2014
Detroit Free Press:
CHRT Director Marianne Udow-Phillips discusses her experience signing up her goddaughter for health coverage on the first day of open enrollment on the marketplace with the Detroit Free Press.
October 8, 2013
Cynthia Canty, host of Michigan Radio’s Stateside, speaks with CHRT Director Marianne Udow-Phillips about the Michigan Health Insurance Exchange one week after its official opening on Oct. 1.
October 6, 2013
Detroit Free Press:
CHRT Health Policy Analyst Josh Fangmeier and Paul Duguay, deputy director of the Lansing-based Michigan Association of Health Plans, answer health reform questions from Detroit Free Press readers.
October 6, 2013
WDIV Channel 4:
CHRT Director Marianne Udow-Phillips joins Frank McGeorge, an emergency room physician at Henry Ford Health System, and Lance Gable, a professor of Public Health Law at Wayne State University, to discuss the Affordable Care Act.
October 1, 2013
Fox 2 News:
The Associated Press cites CHRT'sprojection for the number of enrollees on Michigan's health insurance exchange in 2014 in an article picked up by various media outlets, including Fox 2 News, the San Francisco Chronicle and Kansas City Star.
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.
August 30, 2013
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
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 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.
March 18, 2013
Understanding the impact of health care coverage (or the lack of it) on health care access is crucial to improving the picture of health care in Michigan. The Center for Healthcare Research & Transformation (CHRT), in partnership with the Institute for Public Policy and Social Research at Michigan State University, has surveyed Michigan residents three times (in 2009, 2010, and 2012) on key issues relating to health care coverage, access to care, and health status. The latest survey, Cover Michigan Survey 2013, was fielded in the third quarter of 2012. This report compares data from 2010 and 2012 and focuses on one aspect of that survey: the relationship between coverage status and access to care. Future reports will cover other aspects of health care in Michigan.