Dataset Information

Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan's Medicaid Expansion Program.

ABSTRACT:

Background

Health risk assessments (HRAs) and healthy behavior incentives are increasingly used by state Medicaid programs to promote enrollees' health.

Objective

To evaluate enrollee experiences with HRAs and healthy behavior engagement in the Healthy Michigan Plan (HMP), a state Medicaid expansion program.

Design

Telephone survey conducted in Michigan January-October 2016.

Participants

A random sample of HMP enrollees aged 19-64 with ??12 months of enrollment, stratified by income and geographic region.

Main measures

Self-reported completion of an HRA, reasons for completing an HRA, commitment to a healthy behavior, and choice of healthy behavior.

Key results

Among respondents (N?=?4090), 49.3% (95% CI 47.3-51.2%) reported completing an HRA; among those with a primary care provider (PCP) (n?=?3851), 85.2% (95% CI 83.5-86.7%) reported visiting their PCP during the last 12 months. Most enrollees having a recent PCP visit reported discussing healthy behaviors with them (91.1%, 95% CI 89.6-92.3%) and were more likely to have completed an HRA than enrollees without a recent PCP visit (52.7%, 95% CI 50.5-52.8% vs. 36.2%, 95% CI 31.7-41.1%; p?ConclusionsIn the Healthy Michigan Plan, PCPs appeared influential in enrollees' completion of HRAs and healthy behavior engagement, while knowledge of financial incentives was limited. Additional study is needed to understand the relative importance of financial incentives and PCP engagement in impacting healthy behaviors in state Medicaid programs.

SUBMITTER: Kelley AT

PROVIDER: S-EPMC7018899 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Publications

Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan's Medicaid Expansion Program.

Kelley A Taylor AT Goold Susan D SD Ayanian John Z JZ Patel Minal M Zhang Eunice E Beathard Erin E Chang Tammy T Solway Erica E Tipirneni Renuka R

Journal of general internal medicine 20191202 2

<h4>Background</h4>Health risk assessments (HRAs) and healthy behavior incentives are increasingly used by state Medicaid programs to promote enrollees' health.<h4>Objective</h4>To evaluate enrollee experiences with HRAs and healthy behavior engagement in the Healthy Michigan Plan (HMP), a state Medicaid expansion program.<h4>Design</h4>Telephone survey conducted in Michigan January-October 2016.<h4>Participants</h4>A random sample of HMP enrollees aged 19-64 with ≥ 12 months of enrollment, stra ...[more]

PMID: 31792865

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Project description:BackgroundMedicaid expansion substantially increased health insurance coverage, but its effect on the delivery of preventative health care is unclear.ObjectiveThe objective of this study was to assess the impact of Medicaid expansion on the receipt of 15 different measures of preventive care including cancer screening, cardiovascular risk reduction, diabetes care, and other primary care measures.Research designWe performed serial cross-sectional analysis of Behavioral Risk Factor Surveillance System (BRFSS) survey data from 2012 to 2017. We used a quasi-experimental design with difference-in-differences (DiD) analyses to examine changes in preventative health care delivery over 3 time periods in Medicaid expansion compared with nonexpansion states.SubjectsWe included low-income (<138% federal poverty level) nonelderly (age younger than 65 y) adults residing in 46 US states.MeasuresOur predictor was residing in a Medicaid expansion state (24 states) versus nonexpansion state (19 states). Our primary outcomes were preventative health care services, which we categorized as cancer screening (breast cancer, cervical cancer, and colorectal cancer); cardiovascular risk reduction (serum cholesterol screening in low-risk groups, serum cholesterol monitoring in high-risk groups, and aspirin use); diabetes care (serum cholesterol monitoring, hemoglobin A1c monitoring, foot examination, eye examination, and influenza vaccination, and pneumonia vaccination); and other primary care measures [influenza vaccination, alcohol use screening, and human immunodeficiency virus (HIV) screening].ResultsSurvey responses from 500,495 low-income nonelderly adults from 2012 to 2017 were included in the analysis, representing 68.2 million US adults per year. Of the 15 outcomes evaluated, we did not detect statistically significant differences in cancer screening (3 outcomes), cholesterol screening or monitoring (2 outcomes), diabetes care (6 outcomes), or alcohol use screening (1 outcome) in expansion compared with nonexpansion states. Aspirin use (DiD 8.8%, P<0.001), influenza vaccination (DiD 1.4%, P=0.016), and HIV screening (DiD 1.9%, P=0.004) increased in expansion states compared with nonexpansion states.ConclusionsMedicaid expansion was associated with an increase in aspirin use, influenza vaccination, and HIV screening in expansion states. Despite improvements in access to care, including health insurance, having a primary care doctor, and routine visits, Medicaid expansion was not associated with improvements in cancer screening, cholesterol monitoring, diabetes care, or alcohol use screening. Our findings highlight implementation challenges in delivering high-quality primary care to low-income populations.

Project description:ImportanceThe extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known.ObjectiveTo assess the association between state adoption of the Affordable Care Act's Medicaid expansion-which led to substantial improvements in health care organization finances-and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations.Design, setting, and participantsDifference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys.ExposureTime-varying state-level adoption of Medicaid expansion.Main outcomes and measuresPrimary outcome was annual earned income; secondary outcomes included receipt of employer-sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits.ResultsThe sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P = .005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P < .001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer-sponsored health insurance and increases in SNAP following Medicaid expansion.Conclusion and relevanceMedicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being.

Dataset Information

Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan's Medicaid Expansion Program.

Background

Objective

Design

Participants

Main measures

Key results

Publications

Engagement with Health Risk Assessments and Commitment to Healthy Behaviors in Michigan's Medicaid Expansion Program.

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