Michigan will allow pregnant women and children with green cards to access state-sponsored
insurance without a 5-year wait, reports CBS Detroit. Pregnant women and children with green
cards will now be able to access Medicaid as well as ACA Marketplace subsidies. The change
is slated to start October 1, 2023, and will impact roughly 3,000 people in Michigan.

Michigan's governor signed a series of pharmacy benefit management (PBM) reforms into law, according to Fierce Healthcare. The legislation prohibits PBMs from preventing pharmacists from telling consumers it's less expensive to purchase drugs out-of-pocket, and will require PBMs to file transparency reports telling consumers about the backend costs and profits of their medications, among other provisions.  

Multiple Michigan behavioral health clinics will now be able to seek Medicaid reimbursement for mental health services, according to MLive News. Thanks to the new "transforming behavioral health initiative," thirteen selected Certified Community Behavioral Health Clinics will be reimbursed through Medicaid for expanded services, including 24-hour psychiatric crisis services. The new model, supported by both federal and state funding, is intended to address disparities in who can afford and/or access mental health services.

One out of eight Michigan hospitals failed to meet federal price transparency requirements, according to State of Reform. The study surveyed hospitals and found many were noncompliant for a variety of reasons, including lack of complete standard charge files, lack of negotiated rates and lack of payer and plan data. 

The Michigan Coronavirus Racial Disparities Task Force reduced COVID-19-related cases and mortality among Black residents and may serve as a model for other states, according to a case study from the National Governors Association. The authors identified some of the task force’s best practices, including: establishing clear objectives with specific metrics; ensuring cross-sectoral collaboration and diversity within the task force; and enabling leadership and state leaders who are committed to work and provide the right mix of expertise to minimize staff fatigue and stress. Michigan’s Task Force and Governor also contributed to reductions in health inequities by: distributing six million free masks; declaring racism a public health crisis; requiring implicit bias training for all state employees; and improving the quality of data reporting on racial disparities.

Since August, the rates of COVID cases and deaths per million people for Black residents were the same or lower than those for white residents, according to data provided by Michigan’s health department, Modern Healthcare reports. The racial disparity of coronavirus' impact was prevalent in the early days of the pandemic, with Black residents representing 29.4 percent of cases and 40.7 percent of deaths, despite making up just 15 percent of Michigan's population. State officials credit the work of the Coronavirus Task Force on Racial Disparities for implementing programs like the Rapid Response Grant program, which awarded 31 grants from federal CARES Act funding worth $20 million to help provide underserved communities with food and housing assistance and access to COVID-19 and flu testing.

A legislative effort to curtail surprise medical billing in Michigan has gained attention from national healthcare organizations shifting their focus to states amid stalled federal efforts, according to MiBiz. The legislation would require care providers to inform patients in advance of a scheduled procedure that their health insurer may not cover all of their medical services and that they can request care from an in-network provider. In emergency situations, the out-of-network provider would have to accept payment that’s the median amount within the region that a health insurer pays an in-network provider or accept 150 percent of what Medicare pays for a medical service, whichever is greater. If enacted, the legislation would require the Michigan Department of Finance and Insurance Services to conduct an annual survey on surprise billing that includes the number of out-of-network billing complaints and the adequacy of insurers’ care networks in Michigan.

The Michigan Department of Health and Human Services (MDHHS) is launching the We Treat Hep C Initiative to bring down the cost of hepatitis C medication for the state’s Medicaid program and the Michigan Department of Corrections, according to Upper Michigan Source. The agency will seek proposals from Direct-Acting Antivirals (DAA) manufacturers to provide a significant discount to these programs. In return for this discount, the product will be the preferred DAA for Medicaid and MDOC, with minimal prior authorization requirements.
 

Michigan’s proposed budget contains $5 million in funding to create a five-employee office to transform how the state pays for healthcare through Medicaid, according to Modern Healthcare. The ultimate goal of the Medicaid transformation office in the Department of Health and Human Services is to come up with a variety of new or enhanced "value-based" reimbursement systems for health plans, hospitals, physicians, nursing homes and home and community-based providers. The office would evaluate best practices in other states, develop programs and offer recommendations.

The Hospital-Acquired Condition Reduction Program did not improve patient safety in Michigan beyond existing trends, according to an independent evaluation published in Health Affairs. While rates of all hospital-acquired conditions declined from 133 per 1,000 discharges in the pre-program period to 122 in the post-program period, greater improvements were observed for non-targeted measures.  

The Michigan Department of Health has proposed removing pharmacy benefit managers (PBMs) from overseeing prescription drug claims and negotiating prices for the state’s Medicaid program in a hope to save Medicaid dollars, according to Modern Healthcare. The department expects the proposal will save the state about $40 million, streamline administrative processes and ensure uniform drug coverage for Medicaid enrollees. Other states have stopped outsourcing prescription drug services to PBMs after studies found that PBM prices often exceed Medicaid fee-for-service drug prices. While PBMs defend their practices by stating that they address high drug prices by negotiating payment rates from pharmaceutical companies by leveraging formularies and utilization management tools; critics assert that PBMs have an incentive to prioritize high-priced drugs over more cost-effective alternatives.

Certificate of need (CON) laws are restricting access to innovative cancer immunotherapies in Michigan, according to Reason. Immunotherapies attempt to program the body's own immune system to attack and kill cancer cells, and have become an increasingly attractive way to combat cancer. However, under new rules adopted by the Michigan Certificate of Need Commission, hospitals will need to go through third-party accreditation processes before being able to offer these CAR T-cell therapies. Though cancer research organizations, patient advocates and pharmaceutical companies oppose the new accreditation requirements, the University of Michigan Health System, the largest in the state, argue they are necessary for patient safety. CON laws vary from state to state but require that hospitals get a state agency’s permission before offering new services, expanding facilities or installing new medical technology. 

Policymakers in Grand Rapids, Michigan worked with Invest Health, a project of the Robert Wood Johnson Foundation and Reinvestment Fund, used data from the NYU School of Medicine’s City Health Dashboard (CHDB) to compare Grand Rapids’ data to the national average for many social and economic factors, physical environment, health outcomes, health behavior and clinical care, according to a blog post. The project’s Economic Opportunity Dashboard shows economic inequities and brings together historical data on city investments, citywide and by neighborhood. Based on findings from the Dashboard, academics and policymakers developed strategies to address the social and economic barriers identified as leading to disparate health outcomes in the Neighborhoods of Focus (the city’s first and third wards).

A new poll from the University of Michigan has revealed that older Americans, between ages 50 and 64, are worried about healthcare coverage as they head towards retirement, according to FierceHealthcare. About a quarter of respondents feared that they wouldn’t be able to afford their insurance and nearly half expressed little to no confidence in being able to afford their insurance when they retire. Additionally, 13 percent said they postponed medical care due to cost concerns. Nearly 20 percent said they were delaying retirement to keep their employer-sponsored health plan.

A study conducted by the University of Michigan Institute for Healthcare Policy & Innovation found that nearly half of the people covered by Michigan’s expanded Medicaid program felt their physical health improved in the first year or two after they enrolled. Of those who were employed, more than two-thirds said having Healthy Michigan Plan coverage had helped them do a better job at work, according to the Institute’s analysis. Another quarter of the respondents were out of work when they took the telephone survey—yet more than half of them said their Healthy Michigan Plan coverage improved their ability to look for a job.

Michigan has secured federal approval to negotiate Medicaid drug prices based on how well the medications work. This will give the state the authority to use additional rebate agreements for “outcomes-based” contracts with manufacturers, according to Modern Healthcare. This change comes after a congressional advisory panel on Medicaid found that drug spending increases have been higher for Medicaid than for other payers. Though it is too early to forecast savings, Oklahoma, which is using a similar amendment, has entered into alternative payment contracts for two drugs.

Michigan has asked CMS for permission to enter into outcomes-based contracts with drug manufacturers under its Medicaid program in order to make drugs more accessible for beneficiaries, according to Inside Health Policy. Outcomes-based contracts stipulate that if patients using the medications do not meet specified benchmarks, manufacturers could be on the hook for paying additional rebates. Proponents are optimistic that outcomes-based contracts can give Medicaid beneficiaries access to higher-cost medications more quickly, and that risk would be transferred to manufacturers. However, a study published by the Commonwealth Fund found that outcomes-based contracts have a limited capacity to reduce costs because they only apply to a small subset of medications. If the request is approved, Michigan would be the second state allowed to enter into outcomes-based contracts, behind Oklahoma.  

A University of Michigan study has revealed that enrollment in Michigan's expanded Medicaid program boosted the finances of many low-income residents as well as their healthcare status, according to The Detroit News. Residents who gained coverage through the state’s Healthy Michigan Plan have experienced fewer financial issues, like unpaid debts, medical bills, overdrawn credit cards, evictions and bankruptcies. One of the main goals of the Healthy Michigan Plan is to address social determinants of health in order to promote positive health outcomes. The greatest financial gains were experienced by people with chronic illnesses or ones who had a hospital stay or emergency department visit after they enrolled.

Blue Cross Blue Shield of Michigan will begin a new policy on Feb. 1, 2018, that limits opioid prescriptions to members to 30 days and in some cases five days, according to an article in Modern Healthcare. Members who haven't had a recent prescription filled and are prescribed a short-acting agent will have their initial fill limited to five days. Blue Cross limits short-acting agents to 15 days and will be moving to a five-day fill limitation. In Michigan, 1,365 people died of opioid overdoses in 2016, compared to 884 in 2015 and 426 in 2012, meaning Michigan's overdose rate has tripled since 2012.

Nearly 20,000 people enrolled in Michigan’s Medicaid program, Healthy Michigan, could lose public coverage by April if they have not participated in at least one healthy behavior, according to Modern Healthcare. Healthy behaviors include things such as participating in smoking cessation programs, or obesity reduction programs, or proving they received a health risk assessment. The idea is to entice current Medicaid expansion enrollees that are at 100 to 138 percent of the federal poverty level and not medically frail to engage in preventive, healthy behaviors or be removed from the program and be offered private health coverage on the insurance exchange, which are eligible for federal subsidies.

Michigan is one of the highest spending states on health care for its inmate population according to a new report from The Pew Charitable Trusts and the Vera Institute of Justice. The report examined data from state surveys as well as interviews with state officials in order to build a comprehensive picture of how states fund and deliver prison health care. A spokesperson for the Michigan Department of Corrections said that it has the highest percentage of inmates 55 years or older in the country, and aggressively treats Hepatitis C within its inmate population according to an article by Dominic Lynch. Officials report being satisfied with its spending level on health care for its inmates and is confident it is getting the best value from its contractors.

Michigan was recognized by the U.S. Health Resources and Services Administration as one of the top performing states for critical access hospitals over the last year, according to the Michigan Health & Hospital Association. These critical access hospitals typically serve rural communities, having 25 beds or fewer, having lower volume and voluntarily report on quality measures that are specific to rural environments.

Health plans and hospitals are expanding telemedicine services in new ways to help patients research prices and gain access to medical specialists, according to Crain’s Detroit Business. Most hospitals and health insurers in Michigan have developed telemedicine programs to create convenience and lower out-of-pocket costs for patients. They have typically started with primary care visits for such ailments as ear infections and sore throats.

Detroit Medical Center’s Gateway to Health program--which aims to reduce costs, improve care continuity and connect high users of DMC’s four emergency departments--has led to significant reductions in unnecessary ED visits, hospitalizations and readmissions, according Modern Healthcare.

The Blue Cross Blue Shield of Michigan’s Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians, has yielded modestly lower spending with no reduction in quality from 2008 to 2011, according to Health Affairs.

Despite declining unemployment and rising wages in recent years, the share of Michigan residents considered to be working poor (a quarter of state households) has remained unchanged. These households struggle to afford increasing out-of-pocket medical expenses, among other things, according to The Center for Michigan. A report by the Michigan Association of United Ways found that many working poor are unable to afford even the lowest-premium insurance plans on the federal marketplace and often make too much money to be eligible for Medicaid.

While critics of the Affordable Care Act (ACA) contend it has failed consumers by being difficult to find doctors to treat them under ACA plans that does not seem to be reality in Michigan, according to this Health Affairs blog post. In fact, the authors argue that access to care has improved for many Michigan residents. Results indicate that consumers in Michigan have increased satisfaction, improved access and a reduction in medical debt since the ACA’s implementation. The ACA has not fixed all the issues in the healthcare system, however it has not failed millions of Americans as critics contend. 

Primary care practices with a greater proportion of high-need patients -- those with multiple physical, mental or behavioral health conditions -- perform better on a range of measures, including, cost and utilization, according to this Health Affairs study. Small practices (those with one or two physicians) also had lower overall spending, but not less utilization, compared to large practices. These findings suggest the opportunity exists to experiment with care sites that specialize in complex care to drive better value for high-need patients.  

A new task force, the Task Force on Responsible Retirement Reform for Local Government, has been created to address problems with pension and healthcare costs in Michigan, according to MI News. Recommendations from the task force are expected to be submitted to the Gov. Snyder in Spring of 2017. Members include subject matter experts who represent labor and management, investment managers, insurance and finance professionals and legislators.

The US Department of Transportation awarded more than $1.8 million to fund three public transportation programs in Michigan. The programs aim to provide better access to care, promote better health outcomes, and lower healthcare costs for the most at-risk communities in the state. The money will be divided between efforts to expand a coordination software and scheduling software, as well as develop a mobility management program.

Michigan hospitals will be required to post their master list of fees for services, procedures and medical supplies under a bill pending in the state Senate, according to Modern Healthcare. The effort, introduced more than a year ago by state Sen. Joe Hune, is the latest in a growing movement — in Michigan and across the country — to make health care providers more transparent about their pricing and quality data.

An electronic database central to a project intended to coordinate healthcare for some of the system's most expensive patients is a "work in progress" nearly one year into the three-year program, according to Crain's Detroit Business. The system, called Care Bridge, is supposed to seamlessly transfer patient information among health plans, mental health organizations and physicians for people who qualify for both Medicaid and Medicare—known as "dual-eligible" patients.

A partnership between insurer Molina Healthcare of Michigan and mental health provider Common Ground in Bloomfield Hills, Mich., is tackling arguably the most expensive and chronically ill patients in the healthcare system: those who are dually enrolled in the Medicare and Medicaid programs, according to Crain's Detroit Business. The partnership seeks to provide quality alternatives to psychiatric inpatient hospitalization, while ensuring people are still admitted to the hospital when needed.

Health Affairs Blog: As part of the legislation to pass Medicaid expansion in Michigan, the state required the Michigan Department of Health and Human Services to submit two 1115 waiver applications. The first waiver, submitted on Nov. 8, 2013, included a number of provisions, notably, the establishment of a cost-sharing structure connected to a health savings account for most recipients. The second waiver request was submitted to CMS in September 2015 in order to continue the Healthy Michigan Plan beyond April 30, 2016.

Crain's Detroit Business: Michigan struggles with whether or not to require state health insurers to contribute claims data into an all-payer claims database, in part because of concerns about how it would be paid for and also because there isn't agreement on whether such databases save patients money.

Slightly less than half of the hospitals in Southeast Michigan earned positive margins on Medicare, according to a Crain's analysis of IRS Form 990 reports and hospital interviews. Although hospitals have improved efficiency and quality over the past decade; payment reductions, financial penalties for inappropriate hospital readmissions and overbilling have caused Medicare hospital margins to drop to negatives nationally from an average positive 2 percent margin in 2002.

Crains Detroit Business: Michigan's 12 accountable care organizations (ACOs) fared better than national averages in saving Medicare money, generating profits of their own and improving quality, according to data for 2014 from CMS and interviews with ACO executives. The article does not assess why this group did so well.

A Michigan regional collaborative improvement program, which was paid for by a large private insurer, yielded improvements for a range of clinical conditions and reduced costs in several important areas, according to Health Affairs. For example, general and vascular surgery patients in the Michigan Surgical Quality Collaborative experienced a 2.6 percent drop in surgical morbidity rates. That translates to approximately 2,500 fewer Michigan patients with surgical complications each year. The results suggest that hospitals in regional collaboratives can improve upon healthcare quality metrics more quickly than hospitals abstaining from participation.