Bridge Magazine Archives

In the news: Maximizing opioid settlement funds for substance use recovery

A Healthcare professional talking about opioid use recovery

A new article, Michigan needs coordination, collaboration spending opioid funds, highlights CHRT’s mixed methods research on opportunities to speed substance use recovery through opioid settlement fund investments.

In Gaps and opportunities for substance use recovery: Considerations for spending opioid settlement funds, CHRT highlights guidance from the state’s recovery support providers, including many with lived substance use recovery experience, about ways state and local leaders could invest opioid settlement funds to address gaps in the state’s substance use disorder recovery care system.

Bridge Michigan health reporter Robin Erb writes, “Reversing an overdose — yanking someone back from the brink of death — can take minutes. Recovery takes years.” Substance use addiction isn’t easy to “cure.” It’s best to look at it as a chronic condition, one that requires ongoing treatment and support.

Melissa Riba, CHRT’s research and evaluation director and lead author of the report, says people in recovery need wraparound support to be successful. Sometimes this means transportation to group meetings, or supportive housing environments, or medication.

And just because someone isn’t ready to quit right now doesn’t mean they don’t need services. In fact, the evidence says that syringe exchanges, naloxone distribution, and other harm reduction efforts are a great way to build trust and dialogue with substance users so when they’re ready to quit, they already have a network to support them.

Medicare’s $35 per month insulin cap excludes many Michigan diabetics

CHRT Senior Policy Analyst Emma Golub was quoted in a Bridge Michigan article commenting on Medicare’s $35 per month insulin cap that went into effect on Jan. 1 and the broader issue of medication affordability.

The cap on insulin prices is a win for the estimated 122,000 diabetics in Michigan on Medicare, as without it this medication can cost up to $2,000 per month. However, the shift in Medicare coverage excludes more than 900,000 diabetics who don’t qualify for Medicare, and therefore won’t benefit from the insulin cap.

Additionally, some diabetics who are covered by Medicare still find themselves straddled with high costs for other medications.

Kent County resident Pam Bloink, who was interviewed for the Bridge Michigan article, is on Medicare and said she takes nine other medications in addition to insulin, for ailments including high blood pressure, cholesterol, depression, and heart issues. She spent more than $7,000 on medications last year, as Medicare left her without coverage for many of her prescriptions.

“Prescription drug affordability continues to be a major hole in our healthcare system,” says Golub. “Lifesaving drugs are only lifesaving if people can afford them.”

The American Association of Retired People (AARP) estimates that 32 percent of Michigan adults skip taking medications due to cost. Insulin prices have soared in the U.S. over the past decade—in 2020, they were more than eight times as high as prices in 32 other high-income nations, according to a RAND Corporation study.

Other drug prices have exponentially risen in recent years as well, such as EpiPen. A self-injecting device for a drug that neutralizes severe allergic reactions, its cost rose from just over $100 in 2009 to $608.61 in 2016.

In October, Michigan Governor Gretchen Whitmer issued an executive order to build an insulin manufacturing facility in Michigan for in-state residents, and designated $150 million for its construction in her fiscal 2024 budget. State health insurers endorsed the plan, applauding Whitmer’s efforts to lower insulin prices in Michigan.

But a 2020 study published in JAMA Internal Medicine found that insulin accounted for just 18 percent of out-of-pocket diabetes expenses for people with Type 1 diabetes on private insurance. Of the $2,500 per year average out-of-pocket cost for this population, insulin pumps, syringes, and glucose monitors accounted for the majority.

Pediatrician Kao-Ping Chua, a researcher at Michigan Medicine’s C.S. Mott Children’s Hospital and the study’s lead author, told Bridge, “The danger is that if you are solely focused on insulin, it doesn’t help people with diabetes with their other expenses.”

Bridge Michigan quotes Samantha Iovan on paramedics and insurance coverage.

Bridge Michigan quoted Samantha Iovan, health policy senior project manager at CHRT, in their recent article, “Home-visit programs save money, free ERs. Many insurers don’t cover them.”

Paramedics do much more than taking patients to the ER. However, most medical insurances only cover trips to the ER. According to Iovan, that payment model fails to recognize 911 calls that can be safely treated in a patient’s home. While this makes up a small portion of 911 calls, that portion is still significant. Spending time in a patient’s home also allows community paramedics to identify other forms of social assistance that would help patients with health issues, and ultimately prevent more trips to the ER.

“If the community paramedic is going into a house for someone unable to manage a chronic condition, maybe that’s because they don’t have transportation. If they are food insecure, they can connect them to a food pantry. The paramedic can serve as this connection to community organizations that can help.”—Samantha Iovan, Health policy senior project manager, CHRT

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Melissa Riba quoted in Bridge Michigan on reinstituted copays and deductibles for COVID-19 patient cost-sharing

Hospital billing statement for covid Bridge Michigan’s Robin Erb and Makayla Coffee quote Melissa Riba, director of research and evaluation at the Center for Health and Research Transformation (CHRT), in “Costs rising for Michigan COVID care with return of deductibles, copays.”

The story discusses an upcoming shift in patient cost burden for COVID-related illnesses—costs that have largely been waived by Michigan’s largest insurers for more than a year, ensuring that patient costs remained low.

By September 30, 2021, at least six insurers will resume charging copays and deductibles for COVID-related care.

Riba explains that while we’ve tried to encourage more Michigan residents to get vaccinated through a variety of incentives, this shift represents “the leading edge of the stick” in a carrot-and-stick approach.

She notes that shifting the COVID-19 cost burden to patients signals “moving away from the incentives to more of the penalties associated with making a choice to be non-vaccinated,” a shift that reflects a national trend among health plans as vaccines have become widely available to the public.

Dr. Michael Genord, CEO of Health Alliance Plan, agreed with her. “There’s been a lot of effort for people to take personal responsibility for the prevention of COVID that we didn’t have before.”

Insurers have noted that waivers for cost-sharing were intended to be temporary before vaccines were available.

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Marianne Udow-Phillips writes about the importance of maintaining access to clean water during the COVID-19 pandemic

Handwashing Image In a November Bridge Michigan opinion article, To protect all Michiganders, maintain access to clean water, Marianne Udow-Phillips writes about the relationship between access to clean water and health during the COVID-19 pandemic.

“On March 28, Gov. Gretchen Whitmer issued an emergency order requiring the reconnection of service to residents who had their water shut off. The Governor then extended this order in July to stop water shut offs through the end of this year,” writes Udow-Phillips. But in October, when the Michigan Supreme Court ruled that these emergency orders were unconstitutional, the decision to continue to water service restoration during the COVID-19 pandemic was left up to the Legislature.

One preventative measure taken to reduce the spread of COVID-19 is frequent hand washing. Without access to water, the ability to engage in this behavior quickly diminishes says Udow-Phillips. “For those who cannot afford their water bills, shutoffs not only endanger their lives, but the lives of others they come in contact with.”

Michigan Senator Stephanie Chang recently introduced Senate Bill 241 which would “maintain Gov. Whitmer’s water restoration order and make sure Michiganders’ water is not shut off while we battle COVID-19.”

Water protection has yet to be restored by the Legislature and, says Udow-Phillips, “families are again at risk of losing access to water solely because they cannot afford their water bills.” Sen. Chang’s bill could provide relief to these families until there is a widely accessible vaccine, she continues.

READ THE FULL STORY HERE

Udow-Phillips in Bridge Magazine: Here’s what Michigan nursing homes that escaped coronavirus did right

nursing home nurse holding a thermometer

Nursing homes that escaped the virus “took COVID-19 very seriously from day one,” Marianne Udow-Phillips, CHRT’s founding executive director, tells Patricia Anstett in “Here’s what Michigan nursing homes that escaped coronavirus did right.” Anstett’s Bridge Magazine story focuses on the practices these facilities employed to protect their residents from the pandemic.

“Consumers and their families need to ask assisted living facilities about the volume of COVID-19 cases and deaths; how often residents and staff are tested; whether a facility has adequate PPE, and their policies for visitation and delivery, “especially going into the fall’’ when the virus may resurge again,” Udow-Phillips says in the piece.

Another important practice, she says, is collecting data that will help us understand “whether the nursing home quality metrics measured by Medicare or others are sufficient to judge which homes have good track records for staying infection-free. Current yardsticks tend to identify “process measures, not outcomes, in healthcare,” she said, tallying things like adherence to medication administration, or the use of restraints.”

READ HERE’S WHAT MICHIGAN NURSING HOMES THAT ESCAPED CORONAVIRUS DID RIGHT

“They care for Michigan’s most vulnerable; we should care for them” writes 2020 policy fellow Michelle Meade in Bridge

Michelle Meade, co-director of the Center for Disability Health and Wellness at U-M and one of CHRT’s 2020 health policy fellows, is in Bridge Magazine. “They care for Michigan’s most vulnerable; we should care for them,” writes Meade, referring to the caregivers who have shown up to support “the lives, health, and functioning of others” during the coronavirus pandemic and, in the process, “put their own health and lives at risk.”

“Quality caregiving can allow [Michiganders] to obtain and maintain employment, to manage health and secondary conditions, and to stay out of hospitals and nursing homes,” writes Meade. But in Michigan, she says, unpaid caregivers put their own health, employment and income at risk and paid caregivers can typically make more working at McDonalds where they may also qualify for medical insurance and other benefits.

“While the low wages of these essential workers may be unlikely to change any time soon – particularly in light of the economic recession we expect to result from the COVID-19 pandemic,” writes Meade, “there are other steps that local and state players can take to support this class of essential workers.” Meade’s top three ideas include tax credits and deductions, subsidized health insurance, and strengthened transportation options.

“We know that permanently increasing wages for caregivers may seem overwhelming and infeasible; however, we cannot allow the perceived inability to do that thing prevent us from doing anything,” writes Meade.

READ THE FULL OP-ED

Marianne Udow-Phillips in Bridge Magazine on ways to battle COVID-19 in our state’s vulnerable nursing homes

In “Michigan nursing homes linked to 1 in 4 coronavirus deaths. Tally will grow,” a Bridge Magazine story, Marianne Udow-Phillips describes one practice that Michigan could employ to battle COVID-19 in our state’s highly vulnerable nursing homes.

State Rep. Peter Lucido, R-Shelby Township, in Michigan, has argued the state can’t protect nursing home residents with limited information. He has asked both state Attorney General Dana Nessel and federal prosecutors to investigate the state’s nursing home policies.

The disclosure of death counts by nursing homes should be a trigger for further action, Udow-Phillips told Bridge reporters.

She went on to describe nursing home “strike teams” other states have been using since early April. Maryland, for example, has sent teams composed of hospital healthcare workers, National Guard members, and state and local healthcare workers to nursing homes with COVID-19 outbreaks. The teams assist with testing and provide on-site medical support.

“The state could be deploying these teams to battle with infection control. It’s something the state could be working with the nursing home, to have these traveling teams be available,” she said.

People worry that their loved ones might contract the virus but are unaware of what is happening inside because they are not permitted to visit, said Alison Hirschel, managing attorney, of The Michigan Elder Justice Initiative.

READ THE FULL STORY

Related content

COVID-19 rapid response brief: Best practices for protecting populations in nursing homes, long-term care settings

Michigan’s independent doctors are facing new hardships during coronavirus pandemic: Udow-Phillips explains

Stethoscope The novel coronavirus is not only causing massive stress on hospital systems, but it is also threatening the existence of independent practices in Michigan. Ted Roelofs, in his latest story for Bridge Magazine, shares that as cases started to increase, and social distancing rules were implemented in March, private practices saw a dramatic decline in patients and revenue.

With this decline in patients, private practices are facing hardships in determining if they will be able to recover from the loss in business. Some are able to receive aid from the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the Paycheck Protection Program to continue essential operations and pay staff and bills for the near future. However, without the certainty of when this will all end, there is no indication if there will be more aid available to keep these operations running for longer.

The Center for Health Research and Transformation’s executive director Marianne Udow-Phillips shares that it is very possible to see a decline in medical practices, especially in rural Michigan, which already has a shortage of primary care physicians. She also points out that as more independent physicians become less available, there will be a decline in personalized care. and that smaller practices do not have the same infrastructure to get through a “massive disruption” like this pandemic.

READ THE FULL STORY HERE

–Summary by Emmen Ahmed

Rural hospitals continue to suffer financially due to coronavirus, even hospitals with few COVID-19 patients

As the COVID-19 pandemic forces hospitals to focus on essential procedures, reducing revenues at healthcare facilities across Michigan, many rural hospitals are struggling to stay open. In this Michigan Health Watch series, Bridge Magazine’s Ted Roelofs examines some of the ways the coronavirus response is squeezing operating margins for rural healthcare providers, even if they may not be treating many COVID-19 patients.

In 2019, before the COVID-19 crisis, 18 rural hospitals in Michigan were at risk of closing, threatening access to care for about one-quarter of Michigan’s rural communities. Long-term population loss, fewer revenue-generating procedures to help pay for expensive diagnostic tools, and costly staffing of 24-hour emergency rooms all contributed to precarious financial situations. Now, the March 10 Executive Order that puts a hold on “non-essential” procedures is further compounding an already-tenuous revenue situation for rural – and some non-rural – health facilities.

There may be some relief on the horizon, with possible federal assistance for hospitals that treated COVID-19 patients and, importantly, a loosening of restrictions on elective and outpatient procedures says Marianne Udow-Phillips, founding executive director of the Center for Health and Research Transformation. “I think there’s going to be some ability to be doing some of these procedures soon,” she reports.

The Bridge article also examines how hospitals in other states are responding to the focus on COVID-19 patients and looks at the financial impact of the coronavirus caseload on larger hospitals in Michigan.

READ THE FULL ARTICLE HERE

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