Most who enrolled in Michigan's Medicaid expansion either already work or can't work, study shows

Nearly half of the people who enrolled in Medicaid after it expanded in Michigan have jobs, a new study finds. Another 11 percent can't work, likely due to serious physical or mental health conditions.

About 1 in 4 enrollees are out of work but also are much more likely to be in poor health, according to the findings published in JAMA Internal Medicine by lead author
Renuka Tipirneni, M.D., M.Sc., a clinical lecturer in general internal medicine at U-M, and colleagues from Institute for Healthcare Policy and Innovation.

The findings, from a detailed survey of more than 4,000 people enrolled in Michigan's program for more than a year, may inform discussions of potential work requirements for the poor and near-poor Americans who qualify for expanded Medicaid in the 31 states and the District of Columbia that offer it, and other states that are considering expansion.

Study: People in high-deductible plans aren't acting like consumers, may need more help

More and more Americans have health insurance that requires them to open their wallets for the first few thousand dollars' worth of care they receive every year, before the insurance coverage kicks in.

But a new study suggests that despite the rise in these high-deductible health plans (HDHPs), most Americans who have them aren't saving, shopping around for better prices, talking to their doctors about costs, or making other consumer-type moves.

And even when they do, they get help only about half the time, according to the new study published in JAMA Internal Medicine by lead author Jeffrey Kullgren, M.D., M.S., M.P.H., an assistant professor of general medicine.

Nursing homes can prevent infections through performance improvement collaboratives

Each year, 150,000 U.S. nursing home residents will receive a urinary catheter-half of whom will develop a catheter-associated urinary tract infection (CAUTI). While 70 percent of facilities report having an infection preventionist (IP) on staff, many nursing home IPs often have limited time to advance their training on infection control.

But as a new assessment reports, participation in a national health collaborative that promotes evidence-based infection prevention and control (IPC) can curb the risk of infection by streamlining how IPC practices are shared among nursing home staff. The paper, published in the December issue of the American Journal of Infection Control (AJIC) by lead author Sarah L. Krein, Ph.D., R.N., a professor at the U-M Department of Internal Medicine, reviewed the benefits and challenges of the Agency for Healthcare Research and Quality (AHRQ)'s Safety Program for Long-Term Care.

Opioid epidemic: Right-sizing surgical prescribing, the potential use of litigation and prescription tracking policy

From post-surgery painkiller prescribing to the legal and policy realm, IHPI members' recent work is taking on the nation's opioid epidemic from several angles.

Two teams recently published papers showing that surgeons can cut back on their painkiller prescriptions dramatically, to match them with actual patient use and reduce the risk of misuse. One paper, by a team led by Michael Englesbe, M.D., shows that dialing back prescriptions for opioid pain medicines in gallbladder surgery patients didn't change patients' pain scores. These results formed the basis for a new surgical opioid prescribing guide. The other paper, by a team led by Sawsan As-Sanie, M.D., found that hysterectomy patients only use about half the opioids prescribed to them, opening the door to lower prescription amounts.

On the policy front, two bills approved by Michigan legislators this month were informed by the testimony of Rebecca Cunningham, M.D., and the research of Rebecca Haffajee, Ph.D., J.D., M.P.H., and others. The bills, expected to be signed by year's end, mandate use of the state's prescription drug monitoring program. Haffajee also explores the potential use of litigation against opioid medication manufacturers, similar to what was done against tobacco manufacturers.
Observation care may save more than thought

In the world of health care spending policy, it usually works that as Medicare goes so goes private insurance on matters of managing the cost and quality of care.

But new research reported in the December issue of Health Affairs by senior author and U-M Public Health Professor Andy Ryan, Ph.D., suggests that when it comes to the growth in use of observation care, concerns about high out-of-pocket spending are unfounded for those with private coverage.

In what is believed to be the first study to look at the observation care experience of privately insured patients, Michigan researchers found substantial differences in both total and out-of-pocket spending in observation care and short-stay inpatient settings.

Study shows major shift in ocular surgery from hospitals to surgery centers

National data shows a major shift in eye surgeries from hospitals to less expensive ambulatory surgery centers where care may be delivered faster and closer to home for some patients.

University of Michigan Kellogg Eye Center researchers, led by Joshua Stein, M.D., a glaucoma specialist at Kellogg Eye Center, revealed the increased use of surgery centers for cataract surgery, but say more research is needed to determine if there's a difference in safety between hospitals and surgery centers.

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The Institute brings great minds together to address healthcare's biggest challenges. More than 500 investigators come to IHPI from U-M's top-ranked schools of medicine, nursing, public health, engineering, social work, law, business, and public policy, among others, as well as members of affiliated local research organizations.
What's it worth? New shingles vaccine offers a chance to measure the value of prevention

A newly approved shingles vaccine may be much more effective and longer-lasting than the existing vaccine, which has been around for about a decade. The vaccine is expected to be widely available by early 2018 ---- just months after the federal committee that sets national vaccine guidelines voted to recommend immunization for nearly anyone ages 50 and older.

In a rare decision, the committee also narrowly voted to endorse the new vaccine, Shingrix, over the existing one, Zostavax. These policy decisions were based in part on evidence developed by researchers such as Lisa Prosser, Ph.D., M.S. , professor of pediatrics and health management, who led an economic evaluation of the new vaccine.

Lisa Prosser_ Ph.D.

Saini receives NQF award to create new colon cancer screening quality measure

A U-M/VA team led by Sameer D. Saini, M.D., M.S., will develop a new measure to assess quality in colorectal cancer screening ---- one that better incorporates individual benefit and patient preferences, and could help ensure more appropriate use of this and other preventive services.

Saini's team received a 2017 National Quality Forum (NQF) Innovation Challenge Award to support the development of the new measure, which builds on a body of work funded by VA Health Services Research & Development.

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Opioid experts from across IHPI take part in free U-M "teach out" course

U-M's Office of Academic Innovation, in collaboration with IHPI, hopes to answer questions about the opioid crisis through a free, online "teach-out" ---- that is open to all.

Faculty experts from across the university will share their research and expertise on opioids, and put the epidemic into perspective. James DeVaney, associate vice provost for academic innovation said, "We have a great deal to learn from the lived experiences of our teach-out participants, and our faculty experts have much to share as we look to design solutions to this crisis." 

Lansing Medicaid reform forum brings together state officials and stakeholders

Nearly one in four Michiganders receives health insurance through Medicaid, including the Healthy Michigan Plan approved four years ago this month, and the Children's Health Insurance Program (CHIP). And since Medicaid funding comes from both the federal and state government, pressure from both to explore ways to maximize efficiencies within the program is also expected in the near future.

On December 4 in the Capitol building in Lansing, IHPI partnered with the Michigan Department of Health and Human Services and the Bipartisan Policy Center to bring key players together in a forum focused on current Medicaid challenges. Michigan Department of Health and Human Services Director Nick Lyon and IHPI director John Z. Ayanian, M.D., M.P.P., served as co-hosts.

Former CMS director Gail Wilensky (L), John Ayanian (C), and MDHHS Director Nick Lyon (R)

The Center for Evaluating Health Reform is charged with advancing our knowledge of health system reform through improving the process of academic research. Directed by Andrew Ryan, Ph.D., a U-M associate professor of health management and policy, the center aims to improve the quality of healthcare in the U.S. by both identifying the incentive systems and practices that reduce quality of care, and identifying new models of quality improvement. 

The Institute for Healthcare Policy and Innovation is committed to improving the quality, safety, equity, and affordability of healthcare services.

To carry out our ambitious mission, our efforts are focused in four areas:
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IHPI Informs is published monthly by the University of Michigan Institute for Healthcare Policy & Innovation.
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