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ThedaCare’s potential merger part of trend

ThedaCare, a health system in Wisconsin, is considering consolidating its two largest hospitals. The potential merger would become the latest in a nationwide trend of merging health care operations. CHRT Director Marianne Udow-Phillips warns that using research on consolidation in the healthcare industry to predict effects on ThedaCare is the equivalent of comparing apples to oranges.

That’s because nearly all research on the consolidations in the health care industry focused on the merging of two health care companies, not the merging of two facilities within one company, as ThedaCare proposes.

It’s almost time for Michigan to start sharing Medicaid expansion costs

Starting in 2017, the State of Michigan will pay 5% of the Healthy Michigan Plan’s operating cost. Gov. Rick Snyder’s proposed 2017 budget, which requires the state Legislature’s approval, included over $100 million for Healthy Michigan, the state’s Medicaid expansion program that provides health insurance for about 600,000 Michiganders.

Marianne Udow-Phillips, CHRT’s director, tells Michigan Radio she predicts the Legislature’s eventual approval “because the state is still getting savings from the general fund as a result of this federal contribution.”

Survey notes drop in small businesses offering health insurance

CHRT Director Marianne Udow-Phillips explains why she does not believe the Affordable Care Act is behind a drop in the number of small Michigan companies offering health insurance between 2013 and 2014, and her predictions for future insurance offer rate trends among businesses.

Report: Michiganders who were underinsured in 2013 outnumbered the uninsured

The Center for Healthcare Research & Transformation at the University of Michigan today released a special report: The Underinsured in Michigan. The issue brief shows that in 2013, nearly 1.2 million Michigan residents with health insurance coverage had out-of-pocket medical spending that was high enough relative to income to be considered underinsured. These underinsured individuals exceeded the 1 million who were uninsured in Michigan in the same time period.

“Many of these are individuals struggling to pay medical expenses, often not seeking care or denying themselves needed treatments and prescriptions because they cannot afford their co-pays and/or deductibles,” said Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation. “Having health insurance coverage alone does not guarantee access to care.”

Insured individuals struggling to pay their share of medical expenses also pose a significant challenge for health care providers who, through 2013, faced increasing bad debt from uncollected patient bills.

In the report, an individual is defined as underinsured if their out-of-pocket obligations for health care expenses exceeded 10 percent of income in families that earned more than 200 percent of the federal poverty level (FPL), or exceeded 5 percent of income in families earning less than 200 percent of FPL.

Highlights of the report include:

  • In 2013, close to 40 percent of those who directly purchased insurance for themselves in Michigan were considered underinsured, the highest percentage of those with any type of insurance.
  • From 2012 to 2013, out-of-pocket health spending increased 5.8 percent. Yet, average worker wages increased by just 1.9 percent.
  • Workers in the leisure, hospitality and service industries were the least likely to be adequately insured (63.9 percent).

A CHRT survey of Michigan consumers found that more than one-fifth of those with insurance reported that they had delayed needed care, with the cost of that care cited most frequently as the reason for the delay. Nationally, a recent survey by The Commonwealth Fund showed that roughly 44 percent of underinsured adults did not get needed health care because of cost in 2013.

“This report focuses on 2013, the year before the ACA’s major coverage expansions took effect. As more individuals get coverage and the numbers of those that are uninsured decline, the issue of underinsurance is likely to have a more significant focus for providers and policy makers,” said Udow-Phillips. “The trends noted in this report will be important to monitor on an ongoing basis over time.”

This brief is a part of the Cover Michigan 2015 series. Read this report and other installments in the series at chrt.test.

Roundtable on 50th anniversary of Medicare

CHRT Director Marianne Udow-Phillips participated in the Ford School & IHPI roundtable discussion with U.S. Rep. Debbie Dingell and former U.S. Rep. John Dingell to commemorate the 50th anniversary of Medicare and 80th anniversary of Social Security.

Costs, Not Physician Choice, Most Important Factor In Individual Health Coverage Plan Selection

A report released today by the Center for Healthcare Research & Transformation (CHRT) shows that individuals selecting health coverage in Michigan are making their buying decision based on costs more than choice of physicians and network size.

The report, “Health Plan Selection: Factors Influencing Michiganders’ Choice of Health Insurance,” shows that consumers purchasing individual health insurance coverage were more than twice as likely to report that premium cost was very important in selecting a health plan as they were to report that the number of in-network physicians was a very important factor in their decision.

“We have known from consumer behavior that cost is very important, particularly when consumers are choosing and paying for health plans themselves. But, this study tells us more clearly just how much more important cost is in today’s marketplace than network size,” says Marianne Udow-Phillips, director of CHRT.

Highlights of report include:

  • 92 percent of respondents with individually purchased insurance reported that at least one cost measure (premium, deductible, co-pay or co-insurance) had been a very important factor in their selection of a health plan.
  • 41 percent of those with individually purchased health insurance—less than those with employer-sponsored insurance (50 percent)—noted that the physician network was a very important factor in their decision-making.
  • Nearly 20 percent of those with individual coverage changed primary care physicians as a result of their choice of plans.

In 2014, the first open enrollment for individual coverage, more than 272,000 Michigan residents enrolled in individual health coverage, choosing from 60 non-catastrophic plans. In most cases, consumers had a wide choice of plans representing different provider networks and levels of cost sharing.

“The fact that consumers in the individual marketplace are willing to change their primary care physician relationship based on price and select a health plan with a narrow provider network with lower costs is significant,” says Udow-Phillips. “Providers of care will want to pay close attention to these results as they think about which health plan products to participate in.”

In a separate CHRT survey, Michigan’s primary care physicians reported having capacity to see new patients, making them more willing to accept Medicaid patients and more likely to consider joining networks with lower negotiated payments in order to gain access to more patients.

The CHRT analysis has important insights for providers, payers and employers alike, says Udow-Phillips, who is a member of the U-M Institute for Healthcare Policy and Innovation and holds a faculty appointment in the U-M School of Public Health.

“For providers, consumer loyalty may not be as strong a factor in keeping patients as it once was, as they are more willing to shift providers for lower price. For employers, they may be able to offer more narrow-network plans, as consumers are more accepting of less choice in exchange for lower premiums, deductibles and out of pocket costs. For insurers, plan design and the ability to develop narrow quality networks are essential.”

CHRT’s analysis is based on results from a series of questions CHRT added to the Michigan State University Institute for Public Policy and Social Research (IPPSR) quarterly State of the State Survey conducted via landline and cell phones between September and November 2014. The margin of error for the sample of 1,002 Michigan adults was ±3.9 percent. The IPPSR State of the State Survey methodology can be found at: http//ippsr.msu.edu/soss/.

This survey brief is a part of the Cover Michigan Survey 2014 series. Future briefs will cover other aspects of health care in Michigan using the 2014 survey data. Read the full report, “Health Plan Selection: Factors Influencing Michiganders’ Choice of Health Insurance,” at chrt.test.