Health Care Delivery Archives

Access to health care in Michigan: A brief for legislators

The Center for Health and Research Transformation (CHRT) has released an issue brief focused on access to health care. The brief, titled “Access to Health Care in Michigan,” describes barriers that affect health care access in the state. Health insurance coverage is a central element improving access to care, but insurance coverage alone is not sufficient to ensure access. This brief highlights additional critical factors such as provider location and availability, and unmet social needs. The analysis emphasizes disproportionate impacts on rural residents, low-income families, and young adults. It also discusses approaches used in MIchigan to improve access, including telehealth expansion and provider incentives.

Key Findings
1. Health Insurance Coverage
Adequate health insurance is linked to better health outcomes, preventive service engagement, reduced financial burden, and improved access to necessary medications. Individuals obtain health insurance through employer-sponsored plans, individual purchases via the ACA Marketplace, or government-funded programs like Medicare and Medicaid. As of October 2024, approximately 2.6 million Michiganders were enrolled in Medicaid. Despite a relatively low uninsured rate of 4.5% in 2023, certain groups—such as those without a high school diploma, and young adults aged 26-34—experience higher rates of uninsurance. Additionally, underinsurance remains a concern, since cost sharing such as high deductibles and coinsurance pose barriers even for those with coverage.

2. Provider Shortages
Michigan faces challenges with health care provider availability, particularly in rural areas. The state has implemented strategies to address these shortages, including expanding telehealth services and offering incentives to attract and retain providers in underserved regions.

3. Unmet Social Needs
Social needs for transportation, housing, and food security significantly influence health outcomes. They also hinder access to health care services, adherance to treatment plans, and maintenance of overall well-being. Michigan has initiated programs to integrate social care with health care delivery, aiming to address these barriers comprehensively.

Conclusion
Access to health care in Michigan is influenced by a complex interplay of insurance coverage, provider availability, and social determinants. Ongoing state efforts are necessary to improve access to care for all residents. Policymakers, health care providers, and community organizations must collaborate to address multifaceted challenges.

For a more detailed analysis and comprehensive recommendations, read the full brief.

Supporting behavioral health providers in public health emergencies

Support for behavioral health care providers is crucial, especially considering the significant stress and burnout they have experienced prior to and during the pandemic. To understand how to better support behavioral health care providers during public health emergencies, this study explores three topics.

Burnout

While the literature is limited, studies suggests that burnout can affect physical and mental health for many professionals. Burnout is associated with provider absenteeism and turnover. Factors associated with burnout may include high work demands, role conflict, role ambiguity, and other organizational factors. Interventions to support behavioral health care providers address the issue through one of two strategies.

Interventions addressing organizational factors, such as reducing workload and increasing job resources
Interventions addressing individual factors, such as improving resilience and coping

Providers interviewed in this study emphasized that common self-care interventions, such as meditation, sleep hygiene, and gratitude, were not effective in reducing chronic burnout for behavioral health providers. Many providers expressed a preference for organization-wide changes rather than interventions that address individual factors.

Service delivery

Providers and patients report that the transition to telehealth has been largely positive. Both populations reported that telehealth has offered more flexibility. But providers expressed concern that virtual care delivery was not as effective as in-person care and that some therapies, services, and client populations may not be well suited for telehealth.

Health care providers need assistance to strengthen their capacity to deliver effective, evidence-based practices to individuals.

Policy changes

Federal and state regulators, as well as public and private payers, made several adjustments to accommodate emerging needs in the healthcare landscape and support behavioral health care staff. For example:

Every state issued some type of policy change to provide coverage parity for telehealth services during the pandemic
Health insurers began to provide payment parity for telehealth services, allowing providers to bill health insurance companies for telehealth services at the same rate they would bill for in-person services.
Federal regulations temporarily relaxed to allow for the use of mainstream video conferencing software

But identifying new billing systems and codes can be challenging for providers. Additionally, at the time of this publication, policymakers have not expanded coverage for telehealth permanently. Therefore, behavioral health workers cannot guarantee their ability to provide care virtually.

READ THE BRIEF

Physicians screen patients for social needs: what happens next? Survey, analysis, and policy recommendations

One individual standing out from the rest

Increasingly, physicians are screening patients for social needs then connecting patients to local organizations that can provide the required services.

In Michigan, the U.S. Centers for Medicare & Medicaid Services provided funding to policymakers to launch new projects and partnerships to encourage physicians to screen for social needs like food and housing insecurity. The state also supported pilots that connected patients to community-based partners to address those needs⁽¹⁾CHRT provides backbone support to MI Community Care, which began as one of those initiatives.. COVID-19 may have also played a role. COVID reminded us about the connection between social advantages, like housing, white collar jobs, and cars, and health.

In this new brief, CHRT shares data from its 2021 Michigan Physician Survey, finding that:

The percent of Michigan primary care doctors who know where to refer patients for social needs has gone up. But there is still lots of room for improvement.
Screening for social needs and knowing where to refer patients for social needs do not always go hand in hand.
- For some social needs, such as social isolation and loneliness, more doctors screen patients than know where to refer them.
- For other social needs, such as food and housing, more doctors know where to refer patients than screen.

CHRT’s policy and practice advice:

While some debate the value of screening patients for social needs in the absence of routine referrals, screening is a necessary first step toward addressing important social needs and the health disparities associated with them.
To improve health and combat health disparities, we can provide Michigan physicians with the information and resources they need to refer patients for community support. But that alone won’t solve the problem.
We need to change reimbursement models to fund community-based organizations that address social needs. The community-based organizations that receive these referrals are still rarely reimbursed by the medical community for their contributions to patient health. Reimbursement would improve community capacity to meet patient referrals.

READ THE BRIEF

References[+]

References
↑1	CHRT provides backbone support to MI Community Care, which began as one of those initiatives.

Learning health for Michigan: The path forward

A physician in blue scrubs points at a screen with tiles showing health symbols, a representation of a health learning system.

In the United States, health care purchasers, consumers, and policymakers are demanding improvements in the quality and efficiency of medical care. A promising approach to meet this demand is the development of what is known as a learning health system (LHS). A learning health system has the capability to continuously study and improve itself. Among many types of benefits it can bring about, the learning health system makes it possible for providers to make faster and better decisions about which treatment options would produce the best outcomes for patients.

Today, the Michigan-based stakeholder initiative, Learning Health for Michigan (LH4M), is proposing the use of a learning health system approach to address persistent health care problems in Michigan. Unwarranted and costly hospital readmissions—which are discussed in this paper—are one example of a problem that could benefit from a learning health system approach.

In 2013, the Center for Healthcare Research and Transformation (CHRT) convened a group of patients, clinicians, researchers, public health professionals, and payers to discuss ways to apply the idea of the learning health system at a state level: to turn Michigan into what might be called a “learning health state.” The initiative was named “Learning Health for Michigan,” or LH4M. Later convenings of the LH4M stakeholder group were organized by the Michigan Health Information Network (MiHIN) Shared Services and the Department of Learning Health Sciences at the University of Michigan Medical School.

Michigan has many resources that are key ingredients for a state-wide learning health system.

READ THE BRIEF

Publications

Burnout

Service delivery

Policy changes

In this new brief, CHRT shares data from its 2021 Michigan Physician Survey, finding that:

CHRT’s policy and practice advice: