The Center for Healthcare Research & Transformation (CHRT) released a policy paper that shows how the Patient Protection and Affordable Care Act (ACA) in 2014 will streamline eligibility categories and may also help between 400,000 and 500,000 citizens to become newly eligible for Medicaid coverage. Currently, there are at least 40 different ways—each with varying eligibility requirements—to qualify for Medicaid in Michigan.

Whether or not Michigan decides to expand coverage for Medicaid, the paper shows that enrolling in Medicaid and maintaining that coverage should become easier for Michigan residents starting in 2014, when the ACA requires states to eliminate asset tests—a review of an individual’s assets to ensure they do not exceed certain limits—and consolidate existing eligibility categories.Continue Reading Medicaid changes under the Affordable Care Act will simplify enrollment, reduce number of uninsured 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.Continue Reading Regional variation in rates of cardiac procedures on the rise in Michigan

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

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

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.”Continue Reading Survey shows health coverage is important — but not sufficient to guarantee access to care

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

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.

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.Continue Reading CHRT Report Shows Patterns of Health Practice Vary Across Michigan

Chronic conditions, such as asthma, diabetes, and coronary artery disease, are attacking our wallets in Michigan. According to a new issue brief from the Center for Healthcare Research and Transformation (CHRT), average annual spending for someone with a chronic condition can cost from $3,785 to $38,270 more than someone with no chronic condition.

Chronic conditions are also disproportionally costly. Data from Blue Cross Blue Shield of Michigan showed that the 35% of its patients with at least one chronic condition accounted for more than 64% of its total spending.

Not only are chronic conditions expensive, but personal health risk factors such as smoking and obesity have been shown to contribute to many of these conditions. At 20.5%, Michigan’s smoking rate is higher than the national average of 18.4 percent, and accounted for $3.3 billion in smoking-related health care expenditures.Continue Reading Chronic Conditions Equal High Expenditures in Michigan

Cover Michigan 2010, a comprehensive view of health coverage in the U.S. and Michigan released today by the Center for Healthcare Research & Transformation (CHRT), shows upward negative trends from the 2009 report: more people lacking health insurance, more employers dropping coverage, higher costs for those with health insurance, and a growing strain on the health care safety net including hospitals.

This year, the report also provides a projected picture of how the state’s health coverage would look if the newly passed Patient Protection and Affordable Care Act (P.L. 111-148) were already in effect.Continue Reading Cover Michigan 2010 Finds Health Safety Net Still Critical Despite Health Reform