Insurance Type Archives

Des Jardins contributes book chapter about ACO history, payment and delivery models

In a new book chapter for Springer’s Handbook Integrated Care (2021), CHRT’s executive director, Terrisca Des Jardins, communicates the history of ACOs and how they are being studied not only for improving the U.S. healthcare system, but as a model for other countries.

The chapter, “Innovative Payment and Care Delivery Models: Accountable Care Organizations in the USA,” also includes future potential areas of consideration, such as the impact of COVID-19.

Accountable Care Organizations (ACOs) are “groups of doctors, hospitals, and other healthcare providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients” (CMS 2015). They differ from Health Maintenance Organizations (HMOs) by allowing patients more free choice in choosing their providers, as well as participating in a particular ACO. They also focus more on patient-centered care—especially primary care—instead of strict control of access as a means of reducing utilization.

To qualify for shared savings, ACOs must meet quality standards across 23 measures, covering four domains: patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk population. An ACO’s performance is captured through a mix of surveys, claims data, and other sources.

The Centers for Medicare and Medicaid Services (CMS) at HHS remains active in promoting new ACO approaches to achieve high quality care and cost savings. Preliminary results show that Medicare’s flagship ACO program generally has good quality of care and outcomes, as well as modest cost savings. However, it is still too early to judge complete success or failure based on financial or quality indicators.

In 2018, the Pathways to Success redesign accelerated the timeline for ACOs to assume greater financial risk. ACOs that accepted downside risk (reimbursing payers if spending exceeds a set benchmark) were more likely to achieve shared savings than those that only accepted upside risk (no penalty for spending exceeding a benchmark). This suggests that greater financial responsibility is associated with a stronger commitment in transforming health care.

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Michigan Physician Survey: Primary care physician perspectives and practice trends

CHRT has been surveying primary care physicians (PCPs) in Michigan since 2012—tracking key trends in practice patterns, capacity, payer mix and care team composition. Our 2019 Michigan Physician Survey also asked physicians about care continuity and Medicaid work requirements legislation.

PCPs are a key component of a successful, high quality healthcare system. As the baby-boomer generation ages and the needs of this cohort increase, there is ongoing concern about how well the health care workforce can meet the increasing demands of an older and presumably sicker population.

Additionally, primary care is on the front lines of improving care delivery, such as increasing care management for complex cases, integration of behavioral health care and identifying and addressing social determinants of health.

Key findings of our 2019 Michigan Physician Survey include:

Primary care capacity in Michigan is good today, but there is some evidence it may decrease in the future. Capacity to accept new patients is high and has increased across all payer types since 2016. Almost two-thirds (62%) of PCPs indicated capacity for new Medicaid patients and over 80 percent reported capacity for Medicare and privately insured patients. However, 45% of PCPs indicate they intend to stop practicing medicine within the next 10 years— raising important questions about new PCPs or other practitioners in the training pipeline, and the need to continue tracking capacity over the next decade.
PCPs report more multi-disciplinary care team members than in 2016. Practices with a relatively higher volume of Medicaid patients were almost twice as likely to have Community Health Workers (CHW) and co-located psychiatrists on the care team. And, for the most part, hospitals and groups practices were more likely to have support staff, such as care managers and nurse practitioners, than single physician practices.
High deductibles and other cost issues threaten continuity of care. PCPs see cost and insurance-related issues as the biggest barriers to maintaining continuity of care with their patients; along with lack of transportation and limited health literacy.
The majority of PCPs are concerned about the impact Medicaid work requirements may have on care continuity and the complexity of the certification process. They are more evenly split in their opinions about how the new Medicaid work requirements could change the number of Medicaid patients in their practices, whether they would need to hire more staff, and the ethical issues of determining if someone is able-bodied.

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Access to health care in Michigan: Results from CHRT’s latest Cover Michigan Survey

The Center for Health and Research Transformation’s (CHRT) 2018 Cover Michigan Survey asked Michigan residents about their experiences in accessing health care, specifically how easy or difficult it was to get appointments with different providers.

The Cover Michigan Survey found that two factors—the presence of primary care providers (PCP), and whether or not people had a medical home—figured prominently in reported ease of access to care.

Additionally, ease of access to health care can vary and is not uniform for all populations. Over time, the percentage of respondents reporting ease of access or access challenges has been relatively consistent, but uninsured people continue to face challenges in accessing care, and access to some critical services like specialty and mental health care continues to be a problem for key groups. The 2018 Cover Michigan Survey report examines important indicators of access: self-reported ease of accessing primary, specialty, mental health, and dental care, and forgoing necessary medical and mental health care.

People in Michigan have varying experiences in accessing care. The 2018 Cover Michigan Survey
examined those variations by a number of factors and found important disparities. Key findings
include:

Variations in access to care exist: Primary and dental care were the least difficult services to access while specialty and mental health care were reported to be the most difficult. One in five people reported not seeking necessary medical care in the last six
months and one in ten reported not seeking necessary mental health care in the last year.
Connection to primary care matters: In comparison to Michiganders who had a PCP, people without a PCP were more likely to forgo medical and mental health care, and report difficulty accessing all types of care. Nearly half of those without a PCP had difficulty accessing specialty care and mental health care.
Having a medical home matters: People who relied on hospital ER/urgent care and clinic settings as their routine location of care reported more difficulty accessing care, and were more likely to report forgoing medical and mental health care, in comparison to those whose usual source of care was at a doctor’s office. The largest gaps were seen in mental health care, with hospital ER/urgent care and clinic users being twice as likely to report difficulty accessing care compared to people who typically access care through a doctor’s office.
Differences in access by type of insurance are evident: People with Medicaid and individually purchased plans were more likely to report difficulty accessing specialty and dental care, in comparison to those with Medicare or employer-sponsored plans. However, Medicaid beneficiaries were least likely to report difficulty in accessing mental health care. People who remain uninsured reported the greatest difficulty accessing all types of care, and were also most likely to report forgoing medical and mental health care they believed they needed.

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Health Insurance Marketplace 2019: Rate Analysis

The health insurance marketplaces created under the Affordable Care Act (ACA) have weathered several years of volatility and uncertainty. Following a tumultuous 2017 marked by Congressional “repeal and replace” debates, important administrative changes, and the termination of cost-sharing reduction payments to insurers, Michigan and other states experienced steep premium increases for 2018.

One year later, premiums in Michigan’s Health Insurance Marketplace have stabilized, with increases for 2019 far lower than they have been in recent years. Michigan also experienced its first new insurer entering the market since 2015.

With financial assistance tied to premium levels, low premium increases for 2019 mean that some individuals will experience changes in the amount of financial assistance they receive to purchase Marketplace coverage, so consumers should compare plan options, pricing, and benefits carefully to find coverage that meets their needs.

Key findings of our 2019 health insurance marketplace rate analysis include:

Premium increases for 2019 are substantially lower than premium increases in 2018. Across all counties, the average premium increase for the lowest cost and second-lowest cost silver plans is 0.6 percent and 1.5 percent, respectively. Premiums for the lowest cost bronze plan increased by 1.5 percent, and premiums for the lowest cost gold plan decreased by 0.2 percent.
Michigan continues to have a robust Marketplace. Nine insurers are participating in the health insurance marketplace in 2019, an increase of one from 2018. The new insurer, Oscar Insurance Company, offers coverage in five Southeast Michigan counties. All of Michigan’s 83 counties have at least two participating carriers.
Michigan consumers can select from a variety of Marketplace plans. There are 12 to 57 plans offered in each of Michigan’s 83 counties.
The 2019 Marketplace Open Enrollment Period remains the same length as it was for 2018: 45 days, beginning November 1 and ending December 15.
Federal financial support for Michigan Navigators to help with open enrollment has been reduced by 51 percent, from $627,958 in 2018 to $309,111 in 2019.
This is the second year in a row of substantial funding reductions for the Navigator program: from 2017 to 2018, Michigan’s Navigator funding decreased by 72 percent, from $2,228,692 in 2017 to $627,958 in 2018.

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Quick Facts: Chronic Pain in Michigan

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.

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