Primary care providers say Michigan's Medicaid expansion helped patients' health and work

ANN ARBOR, MI - Extending medical insurance to low-income Michigan residents meant they had better access to health care, earlier detection of serious illnesses, better care for existing health problems and improved ability to work, attend school and live independently, according to a newly published survey of primary care providers.

Published in the Journal of General Internal Medicine by a team from the University of Michigan Institute for Healthcare Policy and Innovation, the results come from 2,104 primary care doctors, nurse practitioners and physician assistants who care for 12 or more people insured by the Healthy Michigan Plan, Michigan's expansion of the Medicaid insurance program to low-income adults.

IHPI's researchers conducted the survey as part of a contract with the Michigan Department of Health and Human Services to conduct the formal evaluation of the Healthy Michigan Plan required by the federal waiver that allowed Michigan to customize its Medicaid expansion.

The researchers note that the waiver allowed Michigan to require that new Medicaid expansion participants see a primary care provider within months of enrolling, and work with that provider to assess their health risks. The new findings suggest this could provide a model for other states currently considering expanding Medicaid, or working to expand it under recent policy decisions.

"While Michigan's Medicaid expansion has been looked at as an example of financial incentives for healthy behavior, I think the primary care part of it is an underappreciated strength," says Susan Goold, M.D., M.A., M.H.S.A., the professor of internal medicine who led the study. "Primary care practitioners said that people gained access to care they didn't have before, including preventive services, and care for chronic conditions and other problems that they might otherwise have ended up in the emergency department for."

One year after Medicaid expansion took effect in Michigan, the survey of primary care providers about their previously uninsured patients found:

• 74 percent said that Healthy Michigan Plan coverage had a positive impact on patients who have chronic diseases such as diabetes, asthma, heart disease and arthritis

• 71 percent said the coverage had led to earlier detection of serious illnesses in patients who had not previously been diagnosed; earlier detection can improve outcomes and reduce overall costs of care

• 69 percent said that patients stuck to their medication better because of their new insurance coverage; adherence to prescribed medicines can improve health outcomes

• 56.5 percent said their patients had improved their health-related behaviors. The Healthy Michigan Plan offers incentives such as gift cards and discounts to encourage participants to stop smoking, exercise more and engage in other healthy behaviors.

• 57 percent said coverage positively affected their patients' emotional well-being

• 46 percent said coverage improved their patients' ability to work or attend school

• 41 percent said patients' ability to live independently improved because of their coverage

In addition to its impact on patients, the survey showed that the Healthy Michigan Plan had a major impact on primary care providers' own practices. For example:

• 56.2 percent reported an increase in patients who were seeing a doctor or other health care provider for the first time in years

• 57 percent had hired additional office staff, and 53 percent had hired additional clinicians

• Nearly 56 percent said they had consulted with a professional who specializes in connecting high-need and underserved people to care and social services, either a case manager, a care coordinator or a community health worker

• 52.3 percent said they'd seen an increase in their number of new patients

• Nearly 51 percent said that patients they'd seen before who had lacked insurance or paid directly for their care had gained insurance

• 15 percent said their primary care site had begun offering mental health services

• Just under 16 percent said that their existing patients had experienced a decrease in their ability to get a same-day or next-day appointment because of the increase in patients covered by the Healthy Michigan Plan

Before designing the survey and sending it to all primary care providers who cared for 12 or more Healthy Michigan Plan participants in 2014, the researchers conducted in-depth interviews with a sample of primary care providers from around the state. Their paper contains anonymous quotes from some of those who gave interviews.

More than 77 percent of the providers who returned the survey were either family practice physicians or general internal medicine physicians, and 17 percent were nurse practitioners or physician assistants, who can provide a full range of primary care services when working with a supervising physician under Michigan law. Rural and Upper Peninsula providers were over-represented in the survey respondents, though three-quarters practiced in an urban setting and 31 percent were in the Detroit metropolitan region.

"According to primary care providers, it's working - it's getting patients in the door so providers can talk to them about what they need to do to stay or get healthy," says Goold, who also has a faculty appointment in the U-M School of Public Health. "I do think that other states can learn from our example."

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More about IHPI's evaluation of the Healthy Michigan Plan: http://michmed.org/Medicaid

Reference: J Gen Intern Med, DOI: 10.1007/s11606-018-4487-6

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