Evolutions in Health Insurance Reform

Big Changes, Tough Choices

Our nation’s healthcare landscape is undergoing its most significant transformation since the launch of Medicare and Medicaid in 1965. The evolving discussions on healthcare reform in the United States represent an unprecedented opportunity for IHPI to provide decision makers with critical evidence and expert perspectives on questions about access, quality, costs, and health outcomes, starting in our home state of Michigan.

Evaluating Michigan’s Medicaid Expansion

In 2013, the governor and state legislators enacted a Michigan-specific expansion of Medicaid under the Affordable Care Act (ACA). Named the Healthy Michigan Plan, the expansion includes a number of special features, including health risk assessments, financial incentives for healthy behaviors and new cost-sharing requirements.

The University of Michigan was selected by the Michigan Department of Health and Human Services and the federal Centers for Medicare and Medicaid Services (CMS) to conduct an independent evaluation of the plan. IHPI is spearheading this five-year evaluation to understand how the program impacts health outcomes and costs.

In the Healthy Michigan Plan’s first year, approximately 600,000 residents enrolled (many joining in the first 100 days), from the most rural corners of the Upper Peninsula to the inner-city neighborhoods of Detroit. Evaluating the plan is an opportunity to have a positive impact on these newly covered citizens, many of whom have had little or no access to care for many years. The research will consider a variety of perspectives, most importantly those of the people in communities who are directly affected by the changes unfolding in healthcare reform.

Seventeen faculty members from five U-M schools and colleges are collaborating on this complex project. Clinical, economic and policy experts, as well as top minds in data collection and analysis, are coming together to study the impact of health insurance on low-income Americans. In the coming years, the findings could be valuable for other states as they consider how to structure healthcare coverage in a way that best improves health outcomes, access to care, and contains costs.

Learn more here: Healthy Michigan Plan

Considering the legal aspects of healthcare reform

Countless legal questions have arisen in conjunction with the ACA’s original implementation, as well as what the provisions it established will look like over the longer term. As Americans debate these questions in courtrooms, legislatures and the public square, the need for informed voices and evidence-based recommendations has never been greater. IHPI has built a communications team to introduce the views and analysis of U-M scholars into the public debate. Commentary and quotes from IHPI members are being widely covered by the press and other influencers and, as a result, members of Congress, state lawmakers, and the general public are taking notice.

Right now in the U.S. we pay an extraordinary amount for healthcare, much of it very high quality but some of it appallingly low quality. The most significant and urgent issue is how to make sure we get good value for our healthcare dollars. – Nicholas Bagley, J.D., whose research on healthcare law considers questions pertaining to the legality of the complexities of health reform

Healthcare reform and ethical implications

Healthcare systems and health insurance markets are in the business of pooling resources to meet individual needs. How do we share these resources fairly? Issues of cost containment and resource allocation are central to deliberations on healthcare reform, and IHPI is home to research projects addressing these issues by surveying patients, payers, and providers in new ways.

One example: Choosing All Together (CHAT), an interactive tool developed at U-M to illustrate the tough tradeoffs of allocating limited health resources. Sometimes referred to as a ‘serious game,’ it forces ‘players’ to decide what insurance should cover (and should not cover) when it can’t cover everything. Already in use across the U.S. and in several other countries, CHAT offers a powerful way to provide researchers and policymakers with informed feedback from healthcare beneficiaries on the priorities that are most important to them.

How do we decide when patients don’t get something they want or need because it’s too expensive, or because someone else has a stronger claim to those limited resources?– Susan Dorr Goold, M.D., M.H.S.A., M.A., who developed CHAT, and is using the tool to glean public input on Medicaid spending priorities in Michigan communities

Learn more about CHAT here

How can healthcare reform help ensure a healthier (and more cost-effective) tomorrow?

One long-term goal in rethinking healthcare insurance and delivery has been to shift the focus from acute and chronic illness care to preventive care, with the intent of improving health and saving healthcare dollars “downstream.” Many IHPI members with clinical responsibilities have seen firsthand the effectiveness of introducing healthy lifestyle behaviors to control weight and prevent or manage chronic diseases like diabetes. Exciting results are seen when patients are given a healthy start toward exercising or losing weight. For the benefit of two-thirds of Americans who struggle with obesity and inactivity, and for the effectiveness of our healthcare system, the sooner we can establish proven interventions in these areas, the better.

One group affiliated with IHPI is evaluating the effectiveness of incentivizing individuals to participate in lifestyle modification programs for weight loss. Their initial findings indicate that offering insurance discounts can be effective in encouraging participation and bringing about weight loss, and that programs like these may contribute to lower healthcare costs.

The culture of our medical system can be a barrier to implementing the behavior changes needed to get and stay healthier. The challenge is finding ways to reach more people with health behavior interventions that are effective, efficient, and consistent.– Caroline Richardson, M.D., whose work focuses on helping people prevent or manage diabetes through physical activity and weight management

While prevention can save healthcare resources in the long run, cultural and behavioral changes can be time-consuming and expensive. IHPI members continue to pursue preventive interventions that help greater numbers of people more efficiently, freeing up resources for other healthcare priorities.

How to balance cost with quality? V-BID’s role in health insurance reform

Historically, consumer cost-sharing in most health insurance plans has followed a ‘one-size-fits-all’ model. This means that patient out-of-pocket costs are the same for every clinician visit within a network, for all diagnostic tests, and for all drugs within a formulary tier–even though these clinical services differ in the health benefits they provide, and their value depends on the individual receiving the service, who provides it, and where it is provided.

Value-Based Insurance Design (V-BID) is an approach pioneered at U-M that implements the concept of ‘clinical nuance’ to align consumer cost with clinical value, by setting cost-sharing in a way that encourages the use of high-value services and providers and discourage the use of low-value care. In 2005, the U-M Center for Value-Based Insurance Design was formed to develop, implement, and evaluate these innovations in health benefits. Through the years, the V-BID approach has earned widespread bipartisan support. Its principles have been upheld in numerous pieces of legislation and adopted across the public and private sectors. One of the most significant developments was the adoption of V-BID elements within the ACA, which provided more than 137 million Americans with enhanced coverage of preventive care. Specifically, it covers high-value preventive care without consumer cost-sharing, and grants Medicare-eligible individuals access to a free annual wellness visit and other preventive care. CMS also announced a V-BID demonstration program to begin in 2017.

As evidenced by the V-BID Center’s impact in the national policy arena, this IHPI-affiliated group has made tremendous strides in establishing V-BID as a critical element in making American healthcare smarter. They continue to pursue an ambitious agenda to help consumers, providers, insurers and policymakers work together to write the next chapter in healthcare transformation.