Advancing health equity: Working to close the gaps

As an Institute, much of our research is focused on identifying inequalities in healthcare access, delivery, quality, costs and outcomes, and developing and implementing solutions to help alleviate health disparities. This includes a wide-ranging body of health equity-focused work, from long-running research on the relationship between structural racism and poor health, to tackling COVID-19 disparities in communities of color.

Healthy Michigan Plan

IHPI’s evaluation of Michigan’s expansion of Medicaid, the public health insurance program for low-income individuals, is one cornerstone of our work in health equity. Since 2014, when the state broadened Medicaid eligibility to include adults with incomes up to 133% of the Federal Poverty Level—about $16,000 per year for a single adult—the program has provided health insurance coverage to some 1 million working-age adults in Michigan.

How has the expanded program, known as the Healthy Michigan Plan (HMP), affected health, access to effective healthcare, and healthcare spending? Since late 2014, IHPI has been studying these questions in partnership with the Michigan Department of Health and Human Services.

photo of doctor's office or medical lab with a doctor in lab coat showing patient information on a tablet

What have we learned?

The number of uninsured adults in Michigan has decreased substantially.

Most HMP enrollees have regular primary care visits and receive preventive care, while their reliance on emergency departments as a usual source of care has decreased

HMP enrollees report improved physical, mental, and oral health, and better access to primary care and preventive services (particularly for those with chronic health conditions, nearly half of whom were diagnosed after enrolling in the program). Access to some services such as specialty care remains challenging.

Enrollees generally say their financial well-being, ability to work, and ability to look for work (if unemployed) has improved considerably while covered by the HMP.

Michigan hospitals have seen sizable reductions in uncompensated care.

These findings have been informing critical policy decisions in Michigan and throughout the nation, as the project has provided guidance to other states on evaluation design and shared best practices and results. The evaluation team has completed its assessment of the first five years of HMP (2014-2018) and is continuing to evaluate the second five years (2019-2023).

Detroit Community Health Worker Project

Although some 115,000 Detroit residents have gained health insurance through Michigan’s Medicaid expansion, many enrollees still face barriers in accessing care and navigating health and social services, while continuing to live with disproportionately poor health and unmet social and economic needs. To address this, IHPI, in partnership with the Detroit Health Department, the Joy-Southfield Community Development Corporation, and three Medicaid health plans, developed, implemented, and evaluated a novel 18-month demonstration program for front-line community health workers (CHWs) to provide outreach, health education, and health and social services referrals to members of their community – in this case, Medicaid enrollees in Detroit’s Cody Rouge neighborhood. The evaluation found that participants had lower rates of emergency department (ED) visits, no difference in hospitalizations, and higher rates of ambulatory care visits, whose costs in the short-term exceeded cost savings from decreased ED visits. This evaluation examined the effects on healthcare use and costs of a real-world CHW demonstration program conducted by Medicaid health plans with their own salaried CHWs focused on beneficiaries in a specific urban neighborhood. The findings can inform other similar programs and public policy on sustainable financing of CHW services.

Workforce diversity in healthcare

A commitment to improving healthcare equity requires taking a hard look within - by examining issues of equity in the healthcare and health research workforce and the forces that shape its development. Since cultivating a diverse workforce is essential to improving access to high-quality care for underserved populations and increasing innovation in health research, IHPI recently created a dedicated team to collect and share findings on workforce diversity, focusing on issues of retention and recruitment, career advancement and leadership development, and equity-driven care delivery.

five diverse people seated around a circular table working on a flip-chart

photo of a medical clinic in Africa, a doctor crouching down to listen to the heart of a young child

Global health equity

IHPI is pleased to have played a role in helping to launch U-M’s Center for Global Health Equity in 2019 and supporting the center’s continued development, while helping many IHPI members engage and share their health services research expertise globally.

With a research lens focused on health equity, IHPI is working to ensure better health for all individuals and families in communities locally, nationwide, and around the globe.