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.

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#MiACA symposium moves beyond the numbers

Numbers have become a prominent part of the Affordable Care Act vocabulary and used often to explain how the law is changing the ways health care is purchased, accessed and delivered. Just recently, media reported that more than 600,000 Michiganders ha …

News Article

Center for Healthcare Research & Transformation Survey Shows Dramatic Improvement in Health Insurance Coverage and Access since 2012

A survey brief released today by the Center for Healthcare Research & Transformation (CHRT) shows that in 2014, fewer Michiganders reported being uninsured and struggling to pay medical costs or delaying needed medical care, and more residents had …

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After two years, hard to call ACA anything but a success

Editor’s Note: This column was published in Bridge Magazine. It is hard to believe that as the Affordable Care Act turns five on March 23, it continues to be as controversial as it was on day one. The U.S. House of Representatives has taken 56 votes to …

News Article

Survey reveals 87 percent of Michigan primary care doctors have capacity to take new patients; 64 percent taking new Medicaid patients

A 2014 Center for Healthcare Research & Transformation (CHRT) survey of Michigan primary care doctors shows that the great majority – close to 9 out of 10 physicians – have capacity to accept more patients, quieting concerns about meeting increased …

Publication

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 …

News Article

Ways States Can (Try to) Tame Health Premiums

In this report on ways states can (try) minimizing premium spikes, Governing talks with CHRT Director Marianne Udow-Phillips about what’s happening in Michigan.

Publication

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 …

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To Improve Mental Health Care in Michigan: The Need for Unprecedented Commitment and Cooperation

Editor’s Note: This column appeared in Bridge Magazine. Soon, many hundreds of thousands of Michigan citizens will be obtaining mental health coverage through the Affordable Care Act—coverage that many have never had before. Our Center wanted to unders …

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New Products on the Health Insurance Exchange: What is Old Becomes New

When I was at Blue Cross Blue Shield of Michigan, we used to say that you couldn’t sell any products without having all key providers included in them. But, that was at a time when health benefits were considered “fringe benefits,” unions were powerful …

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The Importance of Federally Qualified Health Centers and the ACA

Editor’s Note: This column appeared in Bridge Magazine. About six months after the Affordable Care Act (ACA) was passed in 2010, our Center hosted a symposium in Ann Arbor on the future of the health care safety net. Sara Rosenbaum, an expert on both t …

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The Medicaid Expansion in Michigan Needs to Get Done Now

Editor’s Note: This column previously appeared in Bridge Magazine. On February 6, 2013, Governor Snyder announced his support for expanding Medicaid as envisioned in the Affordable Care Act. In his announcement, he talked about how the expansion would …

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The Disconnect Between Health and Mental Health

Editor’s Note: This column previously appeared in Bridge Magazine. Recent reports about a Medicaid experiment in Oregon reveal a major disconnect we have in the health care world: we make a historic —and unwarranted— distinction between “physical healt …

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A Medicaid Expansion for Michigan: The Facts Speak for Themselves

The Supreme Court’s June 2012 decision on the constitutionality of the Affordable Care Act made the Medicaid expansion—a cornerstone of the coverage expansion included in the law—an option rather than a requirement for states. To help Michigan policy m …

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Welcome to 2013!

When the Affordable Care Act passed in March of 2010, 2014 (the year when the most fundamental coverage changes resulting from the ACA occur) seemed a long way off. Well, 2014 doesn’t feel so far away now, does it? In fact, for those who are most immed …

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Poverty and Health: A Connection We Can’t Ignore

In a New York Times op-ed last December, Elizabeth Bradley and Lauren Taylor wrote about the study of global health spending published they published in the journal BMJ Quality and Safety. Their analysis broadened the concept of international health ca …

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The Affordable Care Act and the Courts

Much has been written this past week about the Virginia federal court decision about the constitutionality of the Affordable Care Act. While many have described the decision as politically motivated and delved into the politics of the various judges wh …

  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. http://www.wpbcseattle.org/Resources/Presentations/2013-11-19%20Presentation%20-%20John%20Stockton.pdf (accessed 8/5/14).
  29. J. Grossman, et al. September 2013. Arranged Marriages.
  30. Anthem Blue Cross. N.d. UCLA Joins Anthem Blue Cross ACO Network; Individuals Who Buy Insurance on Exchange May Be Able to Access UCLA’s ACO. Anthem Blue Cross press release. https://www.anthem.com/ca/health-insurance/about-us/pressreleasedetails/CA/2013/1473/ucla-joins-anthem-blue-cross-aco-network-individuals-who-buy-insurance-on-exchange-may-be-able-to-access-ucla-s-aco (accessed 8/5/14).
  31. Sansum Clinic Joins Anthem Blue Cross ACO Program, Signs on to Serve Anthem Members Purchasing through Covered CA. February 18, 2014. Market Watch. http://www.marketwatch.com/story/sansum-clinic-joins-anthem-blue-cross-aco-program-signs-on-to-serve-anthem-members-purchasing-through-covered-ca-2014-02-18 (accessed 8/5/14).
  32. Anthem Blue Cross. January 2014. Institutional Network Update. http://www.anthem.com/ca/provider/f5/s3/t3/pw_e211138.pdf (accessed 8/5/14).
  33. Introducing Anthem Blue Cross Vivity. Anthem Blue Cross. http://www.vivityhealth.com/ (accessed 9/24/2014).
  34. B. Herman. New Anthem network makes business case for HMO-ACO hybrid. Modern Healthcare. http://www.modernhealthcare.com/article/20140917/NEWS/309179964 (accessed 9/17/2014).
  35. J. Grossman, et al. September 2013. Arranged Marriages.
  36. G. Melnick and L. Green. April 2014. Four Years Into A Commercial ACO For CalPERS: Substantial Savings And Lessons Learned. Health Affairs Blog. http://healthaffairs.org/blog/2014/04/17/four-years-into-a-commercial-aco-for-calpers-substantial-savings-and-lessons-learned/ (accessed 8/5/14).
  37. Ibid.
  38. P. Markovich. 2012. A Global Budget Pilot Project Among Provider Partners And Blue Shield Of California Led To Savings In First Two Years. Health Affairs 31(9): 1969–1976.
  39. G. Melnick and L. Green. April 2014. Four Years Into A Commercial ACO For CalPERS.
  40. R. Mandel. N.d. An Alternative Quality Contract. Blue Cross Blue Shield of Massachusetts. http://www.genesys.org/GRMCWeb.nsf/HW_28.pdf (accessed 8/5/14).
  41. M. E. Chernew, R. E. Mechanic, B. E. Landon, and D. G. Safran. 2011. Private-Payer Innovation In Massachusetts: The ‘Alternative Quality Contract’. Health Affairs, 30(1), 51–61. http://content.healthaffairs.org/content/30/1/51.full?sid=3ee4066a-14ec-4bb4-a664-ae34c1936c95 (accessed 8/5/14).
  42. Z. Song et al. 2012. The ‘Alternative Quality Contract.’
  43. Blue Cross Blue Shield of Massachusetts. February 19, 2014. Blue Cross Blue Shield of Massachusetts President and CEO Andrew Dreyfus Outlines Ways to Address the Rising Cost of Health Care. https://www.bluecrossma.com/visitor/newsroom/press-releases/2014/2014-02-19.html (accessed 8/5/14).
  44. Ibid.
  45. Ibid.
  46. Z. Song et al. 2012. The ‘Alternative Quality Contract.’
  47. Ibid.
  48. Ibid.
  49. 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. http://aspe.hhs.gov/health/reports/2014/MarketPlaceEnrollment/Apr2014/pdf/mi.pdf (accessed 7/1/14).
  50. 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. http://www.chrt.org/publications/cover-michigan/the-aca-s-coverage-expansion-in-michigan-demographic-characteristics-and-coverage-projections (accessed 7/1/14).
  51. 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. http://waysandmeans.house.gov/uploadedfiles/enrolltargets_09052013_.pdf (accessed 7/1/14).
  52. 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. http://www.urban.org/UploadedPDF/413112-Measuring-Marketplace-Enrollment-Relative-to-Enrollment-Projections-Update.pdf (accessed 7/1/14).
  53. 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.
  54. Fangmeier, Joshua; Udow-Phillips, Marianne. February 2014. Premium Cost Changes Attributable to the Affordable Care Act. Center for Healthcare Research & Transformation. Ann Arbor, MI. http://www.chrt.org/publications/price-of-care/premium-cost-changes-attributable-to-the-affordable-care-act/
  55. 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.
  56. 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.
  57. 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. http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/cancellation-consumer-options-12-19-2013.pdf (accessed 7/1/14).
  58. U.S. Department of Health and Human Services. May 2014.
  59. For example, unauthorized immigrants and incarcerated residents are ineligible to purchase coverage on the marketplace, regardless of income level or current coverage.
  60. 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. http://www.healthreformgps.org/wp-content/uploads/Rosenbaum-IRS-mec-2-10.pdf (accessed 7/1/14).
  61. 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.
  62. 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.
  63. 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.
  64. Fangmeier, Joshua. August 2014. Effects of the ACA on Insurance Affordability for the Uninsured in Michigan. Center for Healthcare Research & Transformation. Ann Arbor, MI. http://www.chrt.org/public-policy/policy-papers/effects-of-the-aca-on-insurance-affordability-for-the-uninsured-in-michigan/
  65. Ibid.
  66. Insurers have some flexibility with the specifics of their benefit designs as long as they meet the actuarial values of each CSR level.
  67. Pace, Matt. October 2013. Healthcare.gov Applications Increased 31% during ACA’s 2nd Week. Millward Brown Digital. https://blog.compete.com/2013/10/18/healthcare-gov-applications-increased-31-acas-2nd-week/ (accessed 7/1/14).
  68. CHRT calculation of HHS target enrollment compared to actual enrollments through November 2013.
  69. Specifically, the marketplace asks questions to confirm that applicants are not incarcerated and are legal U.S. residents.
  70. Centers for Medicare and Medicaid Services. Frequently Asked Questions on Health Insurance Marketplaces and Income Verification. August 2013. http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/income-verification-8-5-2013.pdf (accessed 7/1/14).
  71. Department of Health and Human Services, Office of the Inspector General. June 2014. Marketplace Faced Early Challenges Resolving Inconsistencies with Application Data. http://oig.hhs.gov/oei/reports/oei-01-14-00180.pdf (accessed 7/1/14).
  72. Goldstein, Amy; Eilperin, Juliet. December 2013. Health-care enrollment on Web plagued by bugs. Washington Post. http://www.washingtonpost.com/national/health-science/health-care-enrollment-on-web-plagued-by-bugs/2013/12/02/e3021b86-5b79-11e3-a49b-90a0e156254b_story.html (accessed 7/1/14).
  73. Cohn, Jonathan. December 2013. Exclusive: The Obamacare Error Rate Has Fallen Dramatically. The New Republic. http://www.newrepublic.com/article/115837/obamacare-834-error-rate-falls-25-percent-10-percent (accessed 7/1/14).
  74. Ornstein, Charles. April 2014. Medicaid Programs Drowning in Backlog. Pro Publica. http://www.propublica.org/article/medicaid-programs-drowning-in-backlog (accessed 7/1/14).
  75. 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.
  76. Werner, Erica. May 2014. Health insurers: Payment rates above 80 percent. Associated Press. http://m.apnews.com/ap/db_268808/contentdetail.htm?contentguid=0A4ZRF2q (accessed 6/2/14).
  77. Centers for Medicare and Medicaid Services. April 2014. Interim Payment Process Payment Timeline for May through September 2014. https://www.politicopro.com/f/?f=25686&inb (accessed 7/1/14).
  78. Avalere Health. May 2014. Exchange Enrollment Outpaces Expectations in 22 States. http://avalerehealth.net/expertise/managed-care/insights/avalere-analysis-exchange-enrollment-outpaces-expectations-in-22-state (accessed 7/1/14).