News

Regional variation in rates of cardiac procedures on the rise in Michigan

Regional differences in rates of cardiac procedures have increased in Michigan over the past decade—not fully explained by differences in health risk factors, heart attack or cardiac mortality rates—according to a report released today by the Center for Healthcare Research & Transformation (CHRT). The report compares the state’s hospital referral regions (HRRs) using claims data from Blue Cross Blue Shield of Michigan’s (BCBSM’s) under-65 commercial subscribers and Medicare data from The Dartmouth Atlas of Health Care in Michigan.

According to the report, even though overall rates for cardiac procedures (angioplasty and bypass surgery) declined by 19 percent for the BCBSM under-65 population, regional variation increased among HRRs: In 1997, the rate varied from 27 percent below the state average to 30 percent above; by 2008, the range was 37 percent below the state average to 48 percent above. Although variation is not necessarily of concern in and of itself, it can be of concern when it appears to be driven by factors other than individual patient characteristics and fully-informed decisions about the relative risks and benefits of invasive vs. noninvasive treatments.

Read moreRegional variation in rates of cardiac procedures on the rise in Michigan

New fellowship pairs University of Michigan researchers with state policy makers to better connect research and policy

The Center for Healthcare Research & Transformation (CHRT) announced today the inaugural class of the CHRT Policy Fellowship at the University of Michigan, a new fellowship program focused on building connections between health services research and policy for more effective, evidence-based health policy decisions.

The fellowship, thought to be the first of its kind in the nation, will bring together five researchers from the University of Michigan and five Lansing policy makers to work on joint projects and learn from each other. The fellowship will include interactive seminars as well as hands-on experience.

Read moreNew fellowship pairs University of Michigan researchers with state policy makers to better connect research and policy

Survey shows 81 percent of Michigan primary care physicians have capacity, willing to serve more patients, including those with Medicaid

Survey results released today by the Center for Healthcare Research & Transformation (CHRT), in partnership with the Child Health Evaluation and Research Unit (CHEAR) at the University of Michigan, show that Michigan primary care physicians will continue accepting new patients—including Medicaid recipients—as the state’s insured population grows under health care reform.

Results of the statewide survey reveal that a majority (81 percent) of Michigan primary care physicians anticipate being able to accommodate patients who become newly insured in 2014, when health insurance coverage expands significantly under the Patient Protection and Affordable Care Act (ACA). Of those physicians, nearly all indicated that they would accept newly eligible Medicaid patients.

Read moreSurvey shows 81 percent of Michigan primary care physicians have capacity, willing to serve more patients, including those with Medicaid

Planning tool helps midsize, large employers prep for health coverage decisions

The Center for Healthcare Research & Transformation (CHRT) today released a policy brief that explains the most significant effects of the Affordable Care Act (ACA) on midsize and large employers in Michigan and the United States.

Many surveys have predicted the likely actions of employers when the ACA goes into full effect in 2014—but the accuracy of those predictions depends largely on how well employers understand the relevant provisions of the ACA. In reality, it is likely that many employers do not yet have a full picture of the ACA and its effects on their particular business situations.

Read morePlanning tool helps midsize, large employers prep for health coverage decisions

Wacky BackQuack™ game is helping consumers and physicians determine the best course of treatment for acute back pain

A new back pain game created by a University of Michigan doctor aims to teach doctors and patients how to improve management of back pain by demonstrating what not to do. BackQuack™, a humorous but real attempt to educate, is the subject of serious research into consumerism and physician management of back pain. This online video game was developed by spine experts to help consumers and clinicians determine the best course of treatment for acute back pain. The game is meant to be both fun and educational. To play BackQuack visit www.backquack.net.

BackQuack is being piloted over a six-month period in three Michigan communities—Jackson, Muskegon and Flint—as part of a cooperative effort by area hospitals, Jackson Physician Association, Hackley Physician Organization and Blue Cross Blue Shield of Michigan (BCBSM) to reduce overutilization of scans and surgeries.

Read moreWacky BackQuack™ game is helping consumers and physicians determine the best course of treatment for acute back pain

Survey shows health coverage is important — but not sufficient to guarantee access to care

The second annual Cover Michigan Survey, released today by the Center for Healthcare Research & Transformation (CHRT), shows that people who lack health coverage are more likely to seek medical treatment in costlier care settings and less likely to have regular, preventive care.

The survey of 1,000 Michigan adults also reveals that simply having health coverage does not guarantee access to care.

Among those with health coverage, those with Medicaid coverage reported the greatest difficulty gaining access to preferred primary care providers or specialists and were the most likely to delay seeking care when needed.

The uninsured—who reported more difficulty accessing care when compared to the insured—appeared to be sicker or more acutely ill at the point they sought health care services. And among the uninsured, nearly one in three (32 percent) reported having been diagnosed with depression, compared to one in ten (11 percent) of the insured.

“This second-year survey tells us that having any kind of health insurance is better than being uninsured. Those with coverage—including Medicaid—are better linked to primary care doctors who can provide regular, preventive care,” says Marianne Udow-Phillips, director of CHRT. “But when we see the level of difficulty in finding providers to accept their coverage and provide them with the care they need reported today by Medicaid beneficiaries, it raises concerns about the ability of Michigan’s Medicaid system to handle the expected increase in enrollment when the expanded eligibility provision of the Affordable Care Act goes into effect in 2014.”

Read moreSurvey shows health coverage is important — but not sufficient to guarantee access to care

Michigan’s collaborative quality improvement programs cut health care costs and improve quality of care; Serve as successful national model for improvement

In a paper published today in the professional health care journal, Health Affairs, Blue Cross Blue Shield of Michigan and the University of Michigan report that their model for collaborative health care quality improvement has measurably improved safety and quality in several clinical areas, and has saved millions in health care costs.

Collaborative Quality Initiatives (CQI), the term given to the payer-hospital initiatives aimed at improving safety and quality of specific surgical procedures and clinical practices, have been shown to outpace the positive results of similar, national programs. For example, an initiative aimed at reducing 30-day post-surgical complication rates accomplished faster improvement in Michigan (from 13.1% to 10.5%) than a similar national program (from 12.5% to 11.5%).

Read moreMichigan’s collaborative quality improvement programs cut health care costs and improve quality of care; Serve as successful national model for improvement

Report shows high rates of inappropriate antibiotic use continue, despite educational efforts to improve prescribing patterns

The Center for Healthcare Research & Transformation (CHRT) today released an issue brief showing continued high rates of inappropriate antibiotic use, despite a 15-year national outreach campaign by the Centers for Disease Control (CDC) to educate providers and consumers on the dangers of antibiotic overuse.

According to the CDC, antibiotic-resistant infections in the U.S. create $20 billion in excess healthcare costs and eight million additional hospital days. Antibiotics do not help or cure viral infections, such as bronchitis or the flu.

Read moreReport shows high rates of inappropriate antibiotic use continue, despite educational efforts to improve prescribing patterns

CHRT report shows pre-term births are leading cause of health problems in infants and significant contributor to health care spending

The Center for Healthcare Research & Transformation (CHRT) based at the University of Michigan today released its Prematurity Issue Brief that shows pre-term births—births at less than 37 weeks of gestation—are the leading cause of health problems in infants and estimated to cost the U.S. more than $26 billion annually. In addition, the report shows that a black infant in Michigan is 70% more likely to be born prematurely than an infant of any other race.

“One in eight babies is born prematurely in the U.S. and Michigan with serious consequences for infant morbidity and mortality,” said Marianne Udow-Phillips, director of CHRT.

“Premature infants are at high risk for respiratory problems and mortality and, are among the most significant cost drivers in health care. Yet, risk factors for preterm birth are complex and not fully understood including why black infants are more likely to be born prematurely than infants of other races.”

Highlights of the Prematurity Issue Brief, a compilation of national and Blue Cross Blue Shield of Michigan (BCBSM) data, include:

  • Late preterm births in Michigan, those between 34 and 37 weeks of gestation, increased by 20% from 1996 – 2006 while premature births, those less than 34 weeks gestation, remained stable. While nearly all of the increase in late preterm births was Cesarean section (C-section), available data do not show if these C-sections were medically indicated or elective.
  • There is a significant disparity in the rate of premature births among blacks as compared to white, Asian and Hispanic populations. Black infants are 70 percent more likely to be born prematurely than white infants. Eleven percent of white and Hispanic infants and 9.9% of Asian infants are born prematurely, while almost 19 percent of black infants are born prematurely. This contributes to disparities in infant mortality rates within these groups. Theory suggests that black mothers experience more stress during pregnancy than mothers of other races, leading to more premature births.
  • Prematurity/low birth weight is the single largest cause of infant mortality in Michigan. Preterm infants born to black mothers are more likely to die in the perinatal period (after 22 weeks’ gestation or within 7 days of birth) than those born to white mothers.
  • Known risk factors for premature birth are history of preterm birth, being pregnant with multiple fetuses, use of in vitro fertilization even in singleton births, smoking, inadequate prenatal care, and being a relatively younger or older mother.
  • The average charge per discharge for premature birth and low birth weight babies in Michigan was $102,103, approximately 14 times higher than the average charge per discharge of $7,182 for a healthy infant birth.
  • Preterm births represent just 10.3% of BCBSM births in Michigan but comprise 52.6% of medical spending in the first year of life.

“Prematurity is recognized as the single most important area in maternal child health where we need research to improve outcomes,” said Timothy R. B. Johnson, M.D., professor and chair, Obstetrics & Gynecology Department, University of Michigan School of Medicine. “The fact that there are profound disparities in the U.S. and in Michigan in the incidence and outcomes of prematurity makes attention to this topic even more critical.”

The Prematurity Issue Brief is the fifth in a series examining the price of health care in Michigan. While the report identifies important trends, costs and disparities, more research is needed to begin to understand the causes of premature birth.

“We don’t know enough about the risk factors and causes of the rise in premature births. We can speculate about the impact of technology and fertility interventions but these births represent only a small percentage of total births. More study is needed so that we can improve outcomes, reduce disparities, and reduce the real and human cost of premature birth,” says Udow Phillips.

CHRT Report Shows Patterns of Health Practice Vary Across Michigan

A report released today by the Center for Healthcare Research & Transformation (CHRT) on the use of health care services in Michigan shows a high degree of variation in the use of certain tests and procedures—including back surgery, Cesarean section, hysterectomy, and angioplasty—among different regions throughout the state. The “Thumb”/Saginaw area had among the highest use rates for all procedures studied. The use of medication for pediatric attention-deficit/hyperactivity disorder (ADHD) also varied widely from region to region, with the Grosse Pointe, Grand Haven, and Kalamazoo areas having the highest reported rates in the study.

CHRTBook: Health Care Variation in Michigan compares the state’s Blue Cross commercially insured population to the Medicare population, and looks at changes within the commercial population in overall use and geographic variation over the past 10 years. It was modeled after the groundbreaking Dartmouth Atlas of Health Care study.

“Geographic variation has been well-documented nationally and was a significant topic of discussion during the debate on health reform,” said Marianne Udow Phillips, director, Center for Healthcare Research & Transformation. “Developing a better understanding of variation in the use of health care services could support state and national efforts to improve quality and contain costs in the health care system.”

The report depicts an improving picture in some key areas, showing notable reductions in overall use for some procedures often considered to be “over-utilized.” For example, while rates of coronary angiography and angioplasty procedures have increased nationally, they have decreased for Michigan’s Blue Cross commercial population. This improvement may be the result of a statewide cardiovascular quality collaborative, launched in 1996 by Blue Cross and hospitals throughout the state to improve safety and outcomes for patients undergoing angioplasty.

Read moreCHRT Report Shows Patterns of Health Practice Vary Across Michigan