By Sara Heath

– Medicaid expansion in Michigan not only led to an influx of patient care access, but also more patient engagement and preventive care, according to two new studies from Michigan Medicine.

Healthy Michigan Plan, the state’s Medicaid program, took the opportunity to revamp its benefits when designing its expanded health plan as a part of the Affordable Care Act (ACA).

Specifically, the plan emphasized patient access to primary care and patient health literacy, including how well patients understand their health risks and the preventive actions they need to take to keep disease at bay or intervene early on.

Healthy Michigan Plan developers embedded certain financial incentives aimed at driving patient engagement in care, like a cut in fees after completing a health risk assessment (HRA).

The studies, both of which were recently published in the Journal of General Internal Medicine, confirmed that Medicaid expansion led to greater patient access to care. The first study, spearheaded by Susan Dorr Goold, MD, MHSA, MA, revealed that more patients were able to access primary care after enrolling in the updated Healthy Michigan Plan.

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“Customizing Medicaid expansion to emphasize primary care and prevention took extra effort, but appears successful, at least according to the snapshot of enrollees that these data represent,” said Goold, who is also a professor of internal medicine at U-M.

In a survey of nearly 6,000 members who enrolled in Healthy Michigan Plan after 2014, Goold and colleagues observed an influx of patients accessing primary care. Fifty-eight percent of respondents said they didn’t have health insurance a year before enrolling in the health plan.

And that lack of insurance led to one-third of respondents delaying care access at least one year prior to Medicaid enrollment. One-fifth of enrollees said they hadn’t seen a primary care provider in the five years prior to Medicaid enrollment; only two-fifths said they had been to the primary care provider within a year prior to enrollment.

Instead, 25.3 percent of members were using the emergency department or urgent care as a regular source for care. After Healthy Michigan Plan enrollment, that number dropped to 7 percent. Ultimately, 90 percent of all survey respondents said Medicaid expansion reduced their stress and worry about their healthcare.

But that’s not all. Further analysis showed that not only did Medicaid expansion improve patient access to care, but it improved patient engagement, as well. This is likely the result of better primary care access and meaningful patient-provider communication, authors of the second paper said.

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“The role of primary care providers, and their teams, in helping low-income and working-poor people understand what health risks they face, and encouraging them to modify the risk factors they can change, is crucial,” says Renuka Tipirneni, MD, MSc, senior author of the second paper and an assistant professor of internal medicine.

More than half of all survey respondents completed the HRA, and four-fifths of those patients said they decided to work on at least one healthy behavior change as a result. Over half of those patients said they focused on diet and exercise goals, while one-fifth said they looked into smoking cessation.

Nearly half of those who completed the health risk assessment said they did so because their provider recommended it. Only 2.5 percent said they completed the assessment to receive a financial incentive, and only 28 percent said they were even aware of that incentive.

Enrollment in the Healthy Michigan Plan also resulted in better patient engagement with preventive care services, the second paper reported. Seventy percent of women over age 50 received breast cancer screening after enrolling in Healthy Michigan Plan, and more than half of all adults over age 50 received a colon cancer screening.

More than 10 percent who reported tobacco use said they received a prescription for a smoking cessation treatment.

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Contrary to the HRA financial incentives, patients were more likely to receive preventive care when they knew of the monetary payoff. Specifically, patients were more likely to take advantage of preventive care services when they knew those services were free of charge under the Healthy Michigan Plan.

These findings are good news for Medicaid expansion advocates and those who promote access to primary care, according to Taylor Kelley, MD, MPH, MSc, the former IHPI National Clinician Scholar and who now works at the University of Utah.

 “While too early to tell whether the program will lead to sustained behavior change, it is clear more conversations are happening between doctors and patients about lifestyle change, and patients have been surprisingly eager to commit to healthy behaviors,” Kelley, who was also the lead author of the second paper, concluded.

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MI Medicaid Expansion Improved Patient Engagement, Preventive Care –