Publications

Here’s the current state of programs supporting Michigan’s 1.7 million caregivers

A caregiver supports the arm of an older man using a cane.Like most of the United States, Michigan’s population is aging. Accordingly, the number of unpaid family and informal caregivers—those who support others with tasks related to daily living, such as transportation, feeding, and bathing—has increased substantially over the last three decades.

The AARP Public Policy Institute estimated the economic value of unpaid caregiving at $470 billion in 2017. For reference, this value is greater than all out-of-pocket spending on health care in the U.S. in 2017 ($366 billion). It is also greater than the combined spending from all payers on long-term services and supports, including post-acute care, in 2016 ($366 billion).

There are new policies and programs to increase support for unpaid caregivers. However, continuous quality improvement can only come by understanding the true reach and efficacy of caregiver support programs. 

OUR WORK:

On behalf of the Michigan Health Endowment Fund, CHRT conducted a scan of Michigan’s caregiver support programs to explore: 

  • The reach, efficacy, and evidence of these programs, as documented in practical and scholarly literature.
  • The caregiver population in Michigan and the characteristics of those who do and don’t engage in caregiver support programs.
  • The levels of reach and engagement in Michigan-based programs and the capacity of organizations to meet the needs and demands of family and informal caregivers.
  • The ways that informed grant making could improve family and informal support programs around the state.

This report outlines the most common types of caregiver programs, how they are delivered, their reach, and the barriers they face as they seek to support diverse residents who might benefit from their programs.

The report also lists recommendations for expanding the reach and impact of Michigan’s caregiver programs.

Furthermore, CHRT researchers developed an infographic that outlines some of the most salient data on caregiver demographics, the services and benefits they provide, and the challenges they face within the state’s limited support system.

The infographic also includes important recommendations for supporting Michigan’s caregivers, specific to state legislators, funders, caregiver organizations, and community members.

Read the report

See the infographic

Comparing Recent Health Care Proposals: From building on the ACA to Medicare for All

Yellow road sign reading "Health insurance changes ahead", referring to the changes to the Healthy Michigan Plan.

A yellow road sign reading, "Health insurance changes ahead," indicating changes due to the health care proposals the author is comparing.Democratic lawmakers in Congress have made a variety of proposals to strengthen or reform the United States health care system. These proposals range from building upon the Affordable Care Act (ACA) to fully transitioning the U.S. to a single-payer system. This fact sheet categorizes and compares the major provisions of these proposals, including possible implications for consumers, health care providers, and federal and state governments.

The proposals that the fact sheet compares are: ACA 2.0, which increases Marketplace financial assistance, restores outreach and assistance funding, and creates a reinsurance program; Public Option, which creates a publicly-administered health insurance plan offered for purchase on the Marketplace; Medicaid Buy-In, which provides certain individuals with the opportunity to purchase Medicaid coverage; Medicare Buy-In, which provides certain individuals with the opportunity to purchase Medicare coverage; Medicare for America, which provides an option and incentives for all US citizens to switch to Medicare coverage; and Medicare for All, which replaces the current health insurance system with universal Medicare coverage for all U.S. citizens.

For each health care proposal, the sheet considers who would be affected, what would be covered, what cost-sharing would look like, how it would impact other types of coverage, how it could impact health care providers, how it would be financed, and how much it could cost. The fact sheet also lists the specific bills and proposals for each health care option.

This fact sheet combines information on all the recent health care proposals in a straightforward, objective format so the proposals can easily be compared and considered. 

READ THE REPORT

Quick Facts: Chronic Pain in Michigan

Pill bottle and red and orange pills over a sheet reading "Chronic pain".

Not everyone suffers from chronic pain in Michigan, but many people do. Our Cover Michigan Survey found that more than 35 percent of the state’s residents say they experienced chronic pain which limited their lives or work within the last year. This is similar result to research finding at least 30% of Americans report suffering from chronic pain.

These infographics from the Center for Health and Research Transformation are based on consumer response, and show how many people report suffering from chronic pain, along with who is most affected.
 
Some of the key information includes:
  • One in three people reported pain that limited their lives or work in the past year, and one in five were prescribed a pain medication.
  • Of those suffering pain in the past year, four in five people had chronic pain some or most days.
  • Chronic pain affects adults of all ages.
  • Women and men experience chronic pain equally.
  • African Americans were significantly more likely to suffer from chronic pain compared with all other groups.
  • Medicaid beneficiaries report chronic pain at a higher rate than adults with other kinds of insurance.
In the context of the opioid epidemic and the utilization of prescription pain medication, these findings demonstrate the need for providers to remain vigilant and become well-versed in alternative treatments for chronic pain.
 

Michigan at a crossroads: CHRT highlights key health policy issues for the incoming gubernatorial administration

Two feet standing on a road, with a red stripe going one direction and a yellow stripe going the other direction, showing how Michigan health policy issues are at a crossroads.The Michigan government has jurisdiction over a wide array of health policy issues. From the regulation of insurance products, to oversight of the state’s Medicaid program, to investing in local public health efforts, Michigan policymakers craft policies and budgets that impact the health of millions of Michiganders.

This brief provides an overview of four key and timely health policy topics:

  • Medicaid and the Healthy Michigan Plan;
  • the individual health insurance market and the federal Health Insurance Marketplace;
  • the opioid epidemic; and
  • the integration of services to address the social determinants of health.

With the expansion of Medicaid and the launch of the Affordable Care Act’s individual Health Insurance Marketplace, the numbers of uninsured Michiganders have been considerably reduced since 2013. Yet Michigan policy makers will still face numerous policy issues and decisions related to health care coverage, health disparities, and access to care in the years to come. Our state will continue to struggle with complex health issues such as substance use and access to mental health services.

Michigan policy leaders, local public health agencies, and the private sector are engaged in many innovative initiatives to address these issues and improve the health of communities. In particular, the state has committed to programs that are intended to improve health equity and focus on the social determinants of health.

All of this work is being conducted at a time of great political change and considerable turmoil at the federal level. The new governor and the 100th Legislature will be faced with both tremendous responsibility and opportunity to shape the health policy landscape for years to come.

READ THE BRIEF

Learning health for Michigan: The path forward

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.In the United States, health care purchasers, consumers, and policymakers are demanding improvements in the quality and efficiency of medical care. A promising approach to meet this demand is the development of what is known as a learning health system (LHS). A learning health system has the capability to continuously study and improve itself. Among many types of benefits it can bring about, the learning health system makes it possible for providers to make faster and better decisions about which treatment options would produce the best outcomes for patients.

Today, the Michigan-based stakeholder initiative, Learning Health for Michigan (LH4M), is proposing the use of a learning health system approach to address persistent health care problems in Michigan. Unwarranted and costly hospital readmissions—which are discussed in this paper—are one example of a problem that could benefit from a learning health system approach.

In 2013, the Center for Healthcare Research and Transformation (CHRT) convened a group of patients, clinicians, researchers, public health professionals, and payers to discuss ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later convenings of the LH4M stakeholder group were organized by the Michigan Health Information Network (MiHIN) Shared Services and the Department of Learning Health Sciences at the University of Michigan Medical School.

Michigan has many resources that are key ingredients for a state-wide learning health system.

READ THE BRIEF

Wellness program participation

A person sits at a computer. The screen shows a wellness program enrollment page.This brief examines the characteristics of Michigan residents who reported being invited to participate in wellness programs and their perceptions of these programs. The brief is based on data from the Center for Healthcare Research & Transformation’s (CHRT) 2015 Cover Michigan Survey of Michigan adults, fielded between October and December 2015.

Wellness programs have grown increasingly common in recent years. A Kaiser Family Foundation study found that 63 percent of organizations that employed and provided insurance for at least three employees offered some form of wellness program. Larger employers were more likely to offer their own wellness program and smaller employers were more likely to offer a program through their employees’ insurer.

Despite their increasing prevalence, evidence on the effectiveness of wellness programs is mixed, and the Rand Corporation has estimated that only 20–40 percent of eligible employees participate in wellness programs.

Key findings from our Cover Michigan Survey include:

A substantial share of Michiganders reported having participated in wellness programs, but they perceived limited benefits from these programs. Respondents reported participating in programs focused on mental health or stress management relatively infrequently, but those who participated in such programs reported the greatest perceived benefits.

  • One in five respondents (20 percent) reported having participated in a wellness program sponsored by their employer, insurer, or another organization within the year prior to the survey.
  • Wellness programs were most likely to focus on increased exercise, healthy eating, or preventive care. Eighty-two percent of those who participated in a wellness program reported that it emphasized exercise, 76 percent reported that it emphasized healthy eating, and 76 percent reported that it emphasized preventive care.
  • Only 27 percent of respondents who participated in a wellness program found the program to be “very helpful.”
  • Respondents who participated in a wellness program focused on mental health or stress management were most likely to report that they had found the wellness program “very helpful.” Forty percent of those who participated in programs focused on mental health or stress management reported that the program had been “very helpful” compared to only 23 percent of those who participated in programs focused on other topics.

READ THE BRIEF

Uncoordinated prescription opioid use in Michigan

White prescription opioids spilling out of orange container.Prescription opioids such as morphine, oxycodone, and hydrocodone provide pain relief to patients with chronic pain. However, these drugs also pose safety risks to patients. Opioid use can cause respiratory depression, resulting in overdose or death.

As prescription opioids have been used more extensively for pain control in the past two decades due to changing practice guidelines, overdose deaths surged in both Michigan and the United States. Notably, the majority of opioid-related disabilities and deaths result from patients taking opioids as prescribed, rather than from deliberate abuse or misuse. Furthermore, opioid-related deaths are frequently associated with concurrent use of prescribed antidepressants or benzodiazepines like Valium and Zanax.

Pain control is an essential part of patient care, and opioids are one of the primary pain treatments available. While most opioids are used and prescribed appropriately, a small number of patients receive numerous prescriptions from separate prescribers within a short period of time. This lack of coordination increases patients’ risk of accidental overdose and death. This issue brief analyzes accidental deaths from opioid overdoses in Michigan, uncoordinated opioid prescribing among privately insured Michigan patients in 2013, and policy options to improve safe prescribing in the state.

Key findings include:

  • Uncoordinated opioid prescribing is a critical patient safety issue in Michigan, particularly for patients who receive a large volume of opioids from multiple prescribers. It is essential that patients receive appropriate pain control, which may include the use of opioids, but pain treatment should not jeopardize patient safety.
  • Accidental overdose deaths involving opioids (including prescription drugs and heroin) increased sixfold in Michigan between 1999 and 2013 (from 81 to 519 deaths). These opioid-related deaths represented 38 percent of all accidental drug deaths in 2013, up from 23 percent in 1999.
  • Accidental overdose deaths involving prescription opioids represented 43 percent of total opioid deaths in 2013. The remaining 57 percent of deaths were from heroin, which is noteworthy since some patients first become addicted to prescription drugs and then turn to heroin, the strongest form of opioid.
  • In 2013, over 600 privately insured Michigan patients in the study group were defined as having uncoordinated opioid prescriptions (0.3 percent of all patients using prescription opioids). These patients filled at least ten opioid prescriptions from four or more providers within three months. As a result, they ran a higher risk of accidental overdose and death because their providers may not have been aware of all their opioid prescriptions.
  • In October 2015, the Michigan Prescription Drug and Opioid Abuse Task Force released its findings and recommendations.

Key recommendations to address these issues include:

  • Expanding provider education on safe opioid prescribing;
  • Requiring providers to have a bona-fide relationship with patients before prescribing controlled substances;
  • Launching a public awareness campaign;
  • Increasing access to the lifesaving overdose reversal drug naloxone;
  • Exploring the possibility of limiting criminal penalties for people who report or seek medical attention for overdoses; and
  • Improving the state’s database of controlled substance prescriptions and increasing its use by providers and pharmacists.

READ THE BRIEF

Health care spending for chronic conditions in Michigan

A person with a chronic condition takes a medical test.

Chronic conditions affect millions of Americans and have a major impact on U.S. health care spending each year, accounting for seven out of every ten deaths in the United States annually. 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.

In 2010, roughly 30 percent of total national health care spending—$347 billion—was associated with the following chronic conditions: heart conditions, cancer, chronic obstructive pulmonary disease, asthma, diabetes, and hypertension. The largest contributing factors to the increase in the prevalence of such conditions include physical inactivity, tobacco use, and poor diet. 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 members:

  • Coronary artery disease
  • Congestive heart failure
  • Chronic obstructive pulmonary disease
  • Depression
  • Diabetes

Suggested citation: A. Hammoud and M. Udow-Phillips. 2014. Healthcare Spending for Chronic Conditions in Michigan. Center for Healthcare Research & Transformation, Ann Arbor, MI.

Special thanks to Robyn Rontal and team.

READ THE BRIEF

Community mental health services: Coverage and delivery in Michigan

A cartoon profile with gears in the brain, symbolizing mental health.Since 1965, the number of Community Mental Health centers (CMHs) has increased from 12 covering 16 counties to 46 covering all 83 counties in Michigan.

Today, Medicaid is the major source of most funding for the publicly funded mental health system in Michigan, and care at CMHs is an entitled benefit under Medicaid. As such, individuals with Medicaid coverage are more likely to receive care through CMHs than uninsured and underinsured individuals.

Furthermore, CMHs providing care for non-Medicaid covered individuals in Michigan must use limited state general fund dollars to cover their care. State general fund dollars are allocated to each CMH based on historical funding formulas that are modified at the state’s discretion. Changes to the allocations have related to administrative expenses, previous general fund transfers between CMHs (under Public Act 236), and an effort to bring all CMHs to the same level of funds based on county populations.

Beginning in 2014, general fund dollars to CMHs were reduced substantially as a result of the state’s decision to expand Medicaid under the Patient Protection and Affordable Care Act. Medicaid funds are allocated monthly to each CMH through PIHPs according to the number of Medicaid beneficiaries in the PIHP’s service area. Decreases in general funds in recent years have threatened the ability of CMHs to deliver care to many of those in need. (See Appendix B for details about the flow of funding streams.) That is, only non-Medicaid patients with the most severe mental illness or developmental disabilities (“priority populations” under the Michigan Mental Health Code) receive care through CMHs.

Non-Medicaid eligibles may also be subject to waiting lists at CMHs, while individuals covered by Medicaid are not. Emergency cases are an exception, and are treated immediately regardless of a person’s ability to pay. Of the 227,020 people served at CMHs in Michigan in 2010, 69 percent were covered by Medicaid.

READ THE BRIEF

Autism spectrum disorder in Michigan

Child's hands hold two white puzzle pieces, a symbol of ASD.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. Federal agencies, advocacy groups, and states are paying more attention to the prevalence, diagnosis, and treatment costs for ASD, demonstrated by an influx in research and an increasing number of states that have mandated certain insurers to provide coverage for ASD diagnosis and treatment.

Autism spectrum disorder refers to a group of developmental disabilities that can cause substantial impairments in a person’s behaviors and social and communication skills. Signs of these impairments usually occur before
a child turns three years old, although children are often diagnosed between ages three and five. While the severity of symptoms may lessen by adulthood, core symptoms often last to some degree throughout the individual’s life. In recent years, researchers have found evidence that a small percentage of children with ASD, particularly those with milder symptoms, can overcome the diagnosis and reach social and cognitive functioning similar to that of their peers, though it is uncertain why some do and others do not.6,7 In 2013, the medical diagnosis for autism was redefined to include four autism-related disorders to better reflect the full “spectrum” of severity and complications associated with autism. Individuals with ASD will often have other medical conditions, including epilepsy, learning disabilities, anxiety, depression, sleep disorders, and gastrointestinal distress.9,10 As with other developmental disabilities, early diagnosis and intensive intervention can have a significant impact on the functional skills and quality of life for children with ASD.11 The American Academy of Pediatrics (AAP) recommends that all children be screened for developmental delays or disabilities during well-child visits at the age of 9 months, 18 months, and 24 or 30 months.

READ THE BRIEF

Suggested Citation: Peters, Claire; Lausch, Kersten; and Udow-Phillips, Marianne. Autism Spectrum Disorder in Michigan. October 2014. Center for Healthcare Research & Transformation, Ann Arbor, MI.

Special thanks to Lisa Grost.