Health Care Trends: Access

Includes survey information about Michigan consumers and providers’ experience with access and coverage, health status and experiences with the health care system. Benchmarks and trend data is provided.


Commercial ACO Products: Market Leaders and Trends

In 2006, Elliott Fisher of Dartmouth coined the term “accountable care.” Accountable care arrangements are based on three principles:1,2 Accountability for Quality: A group of providers is clinically and financially responsible for the entire continuum …


Michigan Health Insurance Marketplace: Overview and Operations

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 reside …

  1. 1 The Dartmouth Institute for Health Policy and Clinical Practice. 2012. Accountable Care Organizations. (accessed 8/5/14).
  2. E. Shigekawa and M. Udow-Phillips. November 2013. Emerging Health Insurance Products in an Era of Health Reform. (Ann Arbor, MI: CHRT).
  3. J. Damore and W. Champion. January 19, 2014. The Great ACO Debate: 2014 Edition. The Health Care Blog. (accessed 8/5/14).
  4. E. Shigekawa and M. Udow-Phillips. November 2013. Emerging Health Insurance Products in an Era of Health Reform. (Ann Arbor, MI: CHRT).
  5. D. Muhlestein. January 29, 2014. Accountable Care Growth In 2014: A Look Ahead. Health Affairs Blog. (accessed 8/5/14).
  6. Ibid.
  7. Ibid.
  8. M. Petersen, P. Gardner, T. Tu, and D. Muhlestein. Growth and Dispersion of Accountable Care Organizations: June 2014 Update. (N.p.: Leavitt Partners, June 2014).
  9. CHRT Analysis of press releases, news articles, and Oliver Wyman research (P. Barlow, S. Wolin, S. Shah, and N. Shah. October 2013. Turning An ACO Into An Insurance Product.
  10. J. Grossman, et al. September 2013. Arranged Marriages: The Evolution of ACO Partnerships in California. California Health Care Almanac. (accessed 8/5/14).
  11. Aurora Accountable. Care Network 2014. Aurora Health Care. (accessed 8/5/14).
  12. R. Kirchen. April 26, 2013. Aurora ACO already has 40 employers. Milwaukee Business Journal. (accessed 8/5/14).
  13. The McKinsey Center for U.S. Health System Reform defined a narrow network as a network that includes participation of between 31 and 70 percent of all hospitals in the rating area.
  14. McKinsey Center for U.S. Health System Reform. 2014. Hospital networks: Updated national review of configurations on the exchanges. (accessed 6/16/14).
  15. M. Brodie, J. Firth, L. Hamel. February 2014. Kaiser Health Tracking Poll: February 2014. Kaiser Family Foundation. (accessed 5/30/2014)
  16. Ibid.
  17. S. Corlette, J. Volk, R. Berenson, and J. Feder. 2014. Narrow Provider Networks in New Health Plans: Balancing Affordability with Access to Quality Care. The Center on Health Insurance Reforms, Georgetown Health Policy Institute and the Urban Institute. (accessed 5/30/14).
  18. S. Corlette, K. Lucia, and S. Ahn. 2014. Implementation of the Affordable Care Act: Cross-Cutting Issues Six-State Case Study on Network Adequacy. The Urban Institute. (accessed 9/24/2014).
  19. S. McCarty and M. Farris. 2013. ACA Implications for State Network Adequacy Standards. State Health Reform Assistance Network, Robert Wood Johnson Foundation. (accessed 6/25/14).
  20. M. Evans. March 12, 2014. Reform Update: Narrow networks bring equal parts controversy and savings. Modern Healthcare. (accessed 6/16/14).
  21. M. Evans. March 12, 2014. Reform Update: Narrow networks bring equal parts controversy and savings.
  22. A. Higgins, G. Veselovskiy, and L. McKown, Provider Performance Measures In Private And Public Programs: Achieving Meaningful Alignment With Flexibility To Innovate. Health Affairs 32(8): 1453–1461. (accessed 8/5/14).
  23. Z. Song, et al. 2012. The ‘Alternative Quality Contract,’ Based on a Global Budget, Lowered Medical Spending, and Improved Quality. Health Affairs 31(8): 1885–1894.
  24. J. Grossman, et al. September 2013. Arranged Marriages.
  25. Shaller Consulting Group. March 2013. Forces Driving Implementation of the CAHPS Clinical & Group Survey. Aligning Forces for Quality, Robert Wood Johnson Foundation. (accessed 8/5/14).
  26. J. Miller. February 1, 2014. Data Will Drive ACOs in the Real World. Managed Healthcare Executive. (accessed 8/4/14).
  27. J. Anderson. September 2012. Aetna, Aurora Launch ACO Plan Featuring Premium Guarantee. AISHealth 3(9), reprinted from ACO Business News. (accessed 8/5/14).
  28. C. Williams. November 19, 2013. ACOs as private label insurance products. Western Pension Benefits Council. (accessed 8/5/14).
  29. J. Grossman, et al. September 2013. Arranged Marriages.
  30. U.S. Department of Health and Human Services. May 2014. Profile of Affordable Care Act Coverage Expansion Enrollment in Medicaid/CHIP and the Health Insurance Marketplace, 10-1-2013 to 3-31-2014: Michigan. (accessed 7/1/14).
  31. Fangmeier, Joshua; Udow-Phillips, Marianne. July 2013. The ACA’s Coverage Expansion in Michigan: Demographic Characteristics and Coverage Projections. Cover Michigan 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI. (accessed 7/1/14).
  32. Tavenner, Marilyn; Mould, Don. September 2013. Projected Monthly Enrollment Targets for Health Insurance Marketplaces in 2014 – Information. U.S. Department of Health and Human Services. (accessed 7/1/14).
  33. Blumberg, Linda; Holahan, John; Kenney, Genevieve; Buettgens, Matthew; Anderson, Nathaniel; Recht, Hannah; and Zuckerman, Stephen. May 2014. Measuring Marketplace Enrollment Relative to Enrollment Projections: Update. Urban Institute. (accessed 7/1/14).
  34. Consumers who tried to enroll in a plan during the open enrollment period, but did not finish by March 31, had until April 15 to complete the process. Those who submitted a paper application by April 7 were allowed to pick a plan through April 30.
  35. Fangmeier, Joshua; Udow-Phillips, Marianne. February 2014. Premium Cost Changes Attributable to the Affordable Care Act. Center for Healthcare Research & Transformation. Ann Arbor, MI.
  36. For each AV level, an insurer’s responsibility for covered services will vary among enrolled individuals but should, on average, match the AV level across a standard population enrolled in the plan.
  37. Catastrophic plans typically do not cover any benefits until the plan’s deductible is met, other than at least three primary care visits per year (generally with copay) and preventive services. The ACA requires coverage of certain preventive services with no cost sharing, including preventive services given an A or B rating by the United States Preventive Services Task Force.
  38. Individuals who received a notification from an insurer that their policy was not renewed are also eligible for a hardship exemption and may purchase catastrophic coverage. Centers for Medicare and Medicaid Services. December 2013. Options Available for Consumers with Cancelled Policies. (accessed 7/1/14).
  39. U.S. Department of Health and Human Services. May 2014.
  40. For example, unauthorized immigrants and incarcerated residents are ineligible to purchase coverage on the marketplace, regardless of income level or current coverage.
  41. Some Medicaid eligibility categories, such as certain “medically needy ” programs and 1115 demonstration waivers, offer a narrow set of benefits and do not qualify as minimum essential coverage. According to proposed federal rules, eligibility for these programs would not preclude eligibility for ACA financial assistance. Rosenbaum, Sara. February 2014. When Does Medicaid Coverage Amount to Minimum Essential Coverage Under the Affordable Care Act? An Update on the Treasury/IRS Rules Defining Minimum Essential Coverage. Health Reform GPS. (accessed 7/1/14).
  42. Under the ACA, ESI is considered affordable for an employee and his or her dependents if the employee’s annual premium for self-only coverage is less than 9.5 percent of annual household income. ESI meets adequacy standards (minimum actuarial value) if the plan has an actuarial value of at least 60 percent.
  43. Advanced credits must be reconciled when the household files taxes for that year. If household income is lower than projected, the applicant will receive the additional tax credit in the form of a tax refund. If income is greater than projected, the excess tax credits must be repaid to the federal government within certain limits.
  44. MAGI is a household’s Adjusted Gross Income (AGI), plus certain deductions. The ACA defines a household as a taxpayer plus a spouse and any dependents, including children or other family members, who meet certain requirements.
  45. Fangmeier, Joshua. August 2014. Effects of the ACA on Insurance Affordability for the Uninsured in Michigan. Center for Healthcare Research & Transformation. Ann Arbor, MI.
  46. Ibid.
  47. Insurers have some flexibility with the specifics of their benefit designs as long as they meet the actuarial values of each CSR level.
  48. Pace, Matt. October 2013. Applications Increased 31% during ACA’s 2nd Week. Millward Brown Digital. (accessed 7/1/14).
  49. CHRT calculation of HHS target enrollment compared to actual enrollments through November 2013.
  50. Specifically, the marketplace asks questions to confirm that applicants are not incarcerated and are legal U.S. residents.
  51. Centers for Medicare and Medicaid Services. Frequently Asked Questions on Health Insurance Marketplaces and Income Verification. August 2013. (accessed 7/1/14).
  52. Department of Health and Human Services, Office of the Inspector General. June 2014. Marketplace Faced Early Challenges Resolving Inconsistencies with Application Data. (accessed 7/1/14).
  53. Goldstein, Amy; Eilperin, Juliet. December 2013. Health-care enrollment on Web plagued by bugs. Washington Post. (accessed 7/1/14).
  54. Cohn, Jonathan. December 2013. Exclusive: The Obamacare Error Rate Has Fallen Dramatically. The New Republic. (accessed 7/1/14).
  55. Ornstein, Charles. April 2014. Medicaid Programs Drowning in Backlog. Pro Publica. (accessed 7/1/14).
  56. Applicants that select a plan between the 1st and the 15th of the month can have effective coverage on the first day of the following month. Applicants who select a plan after the 15th generally have to wait until the first day of the second following month to begin using their new plan.
  57. Werner, Erica. May 2014. Health insurers: Payment rates above 80 percent. Associated Press. (accessed 6/2/14).
  58. Centers for Medicare and Medicaid Services. April 2014. Interim Payment Process Payment Timeline for May through September 2014. (accessed 7/1/14).
  59. Avalere Health. May 2014. Exchange Enrollment Outpaces Expectations in 22 States. (accessed 7/1/14).