Susan Dorr Goold1,2,3, Renuka Tipirneni4,5, Edith Kieffer5,6, Adrianne Haggins5,7, Cengiz Salman5,8, Erica Solway5, Lisa Szymecko9, Tammy Chang5,10, Zachary Rowe11, Sarah Clark5,12, Sunghee Lee13, Eric G Campbell14, John Z Ayanian4,5,15,16. 1. Department of Internal Medicine, Medical School, University of Michigan, 2800 Plymouth Road, 425W, Ann Arbor, MI, 48109, USA. sgoold@umich.edu. 2. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. sgoold@umich.edu. 3. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA. sgoold@umich.edu. 4. Department of Internal Medicine, Medical School, University of Michigan, 2800 Plymouth Road, 425W, Ann Arbor, MI, 48109, USA. 5. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 6. School of Social Work and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 7. Emergency Medicine and the Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. 8. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA. 9. Department of Community Psychology, Michigan State University, East Lansing, MI, USA. 10. Family Medicine, University of Michigan, Ann Arbor, MI, USA. 11. Friends of Parkside, Detroit, MI, USA. 12. Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA. 13. The Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. 14. CU Center for Bioethics and Humanities, University of Colorado, Denver, CO, USA. 15. Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA. 16. Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Michigan's approach to Medicaid expansion, the Healthy Michigan Plan (HMP), emphasizes primary care, prevention, and incentives for patients and primary care practitioners (PCPs). OBJECTIVE: Assess PCPs' perspectives about the impact of HMP on their patients and practices. DESIGN: In 2014-2015, we conducted semi-structured interviews then a statewide survey of PCPs. SETTING: Interviewees came from varied types of practices in five Michigan regions selected for racial/ethnic diversity and a mix of rural and urban settings. Surveys were sent via mail. PARTICIPANTS: Interviewees were physician (n = 16) and non-physician practitioners (n = 3). All Michigan PCPs caring for ≥ 12 HMP enrollees were surveyed (response rate 55.5%, N = 2104). MEASUREMENTS: PCPs' experiences with HMP patients and recent changes in their practices. RESULTS: Interviews include examples of the impact of Medicaid expansion on patients and practices. A majority of surveyed PCPs reported recent increases in new patients (52.3%) and patients who had not seen a PCP in many years (56.2%). For previously uninsured patients, PCPs reported positive impact on control of chronic conditions (74.4%), early detection of serious illness (71.1%), medication adherence (69.1%), health behaviors (56.5%), emotional well-being (57.0%), and the ability to work, attend school, or live independently (41.5%). HMP patients reportedly still had more difficulty than privately insured patients accessing some services. Most PCPs reported that their practices had, in the past year, hired clinicians (53.2%) and/or staff (57.5%); 15.4% had colocated mental health care. Few (15.8%) reported established patients' access to urgent appointments worsened. LIMITATIONS: PCP reports of patient experiences may not be accurate. Results reflect the experiences of PCPs with ≥ 12 Medicaid patients. Differences between respondents and non-respondents present the possibility for response bias. CONCLUSIONS: PCPs reported improved patient access to care, medication adherence, chronic condition management, and detection of serious illness. Established patients' access did not diminish, perhaps due to reported practice changes.
BACKGROUND: Michigan's approach to Medicaid expansion, the Healthy Michigan Plan (HMP), emphasizes primary care, prevention, and incentives for patients and primary care practitioners (PCPs). OBJECTIVE: Assess PCPs' perspectives about the impact of HMP on their patients and practices. DESIGN: In 2014-2015, we conducted semi-structured interviews then a statewide survey of PCPs. SETTING: Interviewees came from varied types of practices in five Michigan regions selected for racial/ethnic diversity and a mix of rural and urban settings. Surveys were sent via mail. PARTICIPANTS: Interviewees were physician (n = 16) and non-physician practitioners (n = 3). All Michigan PCPs caring for ≥ 12 HMP enrollees were surveyed (response rate 55.5%, N = 2104). MEASUREMENTS: PCPs' experiences with HMP patients and recent changes in their practices. RESULTS: Interviews include examples of the impact of Medicaid expansion on patients and practices. A majority of surveyed PCPs reported recent increases in new patients (52.3%) and patients who had not seen a PCP in many years (56.2%). For previously uninsured patients, PCPs reported positive impact on control of chronic conditions (74.4%), early detection of serious illness (71.1%), medication adherence (69.1%), health behaviors (56.5%), emotional well-being (57.0%), and the ability to work, attend school, or live independently (41.5%). HMP patients reportedly still had more difficulty than privately insured patients accessing some services. Most PCPs reported that their practices had, in the past year, hired clinicians (53.2%) and/or staff (57.5%); 15.4% had colocated mental health care. Few (15.8%) reported established patients' access to urgent appointments worsened. LIMITATIONS: PCP reports of patient experiences may not be accurate. Results reflect the experiences of PCPs with ≥ 12 Medicaid patients. Differences between respondents and non-respondents present the possibility for response bias. CONCLUSIONS: PCPs reported improved patient access to care, medication adherence, chronic condition management, and detection of serious illness. Established patients' access did not diminish, perhaps due to reported practice changes.
Authors: Renuka Tipirneni; Karin V Rhodes; Rodney A Hayward; Richard L Lichtenstein; HwaJung Choi; Elyse N Reamer; Matthew M Davis Journal: Am J Manag Care Date: 2016-06 Impact factor: 2.229
Authors: Gillian K Steelfisher; Robert J Blendon; Tara Sussman; John M Connolly; John M Benson; Melissa J Herrmann Journal: N Engl J Med Date: 2009-10-21 Impact factor: 91.245
Authors: Nakela L Cook; LeRoi S Hicks; A James O'Malley; Thomas Keegan; Edward Guadagnoli; Bruce E Landon Journal: Health Aff (Millwood) Date: 2007 Sep-Oct Impact factor: 6.301
Authors: Daniel Polsky; Molly Candon; Brendan Saloner; Douglas Wissoker; Katherine Hempstead; Genevieve M Kenney; Karin Rhodes Journal: JAMA Intern Med Date: 2017-04-01 Impact factor: 21.873
Authors: Andrea S Christopher; Danny McCormick; Steffie Woolhandler; David U Himmelstein; David H Bor; Andrew P Wilper Journal: Am J Public Health Date: 2015-11-12 Impact factor: 9.308
Authors: A Taylor Kelley; Susan D Goold; John Z Ayanian; Minal Patel; Eunice Zhang; Erin Beathard; Tammy Chang; Erica Solway; Renuka Tipirneni Journal: J Gen Intern Med Date: 2019-12-02 Impact factor: 5.128
Authors: Eunice Zhang; Renuka Tipirneni; Erin R Beathard; Sunghee Lee; Matthias A Kirch; Cengiz Salman; Erica Solway; Sarah J Clark; Adrianne N Haggins; Edith C Kieffer; John Z Ayanian; Susan D Goold Journal: Am J Prev Med Date: 2020-01-15 Impact factor: 5.043
Authors: C Daniel Myers; Edith C Kieffer; A Mark Fendrick; Hyungjin Myra Kim; Karen Calhoun; Lisa Szymecko; Lynnette LaHahnn; Charo Ledón; Marion Danis; Zachary Rowe; Susan Dorr Goold Journal: J Health Polit Policy Law Date: 2020-06-01 Impact factor: 2.977