1
|
Vuong NX, Woods NK. On the Relationship Between Stakeholder Affiliation and Attitudes Toward Behavioral Health Reform in Kansas. Kans J Med 2023; 16:28-34. [PMID: 36845265 PMCID: PMC9957591 DOI: 10.17161/kjm.vol16.18542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 02/24/2023] Open
Abstract
Introduction The lack of access to behavioral health care, trends in behavioral health issues, and the impact of social determinants of health underlie the need for behavioral health reform in Kansas. However, stakeholders may affect progress toward behavioral health reform. This study examined stakeholders' attitudes toward behavioral health reform. Methods The authors analyzed data from a survey administered to elected officials, members of health advocacy groups, state employees, and payers in Kansas. Main outcome measures included attitudes toward the perceived benefit of certain behavioral health and social determinants of health policies and the perceived performance of the primary care and behavioral health care systems in Kansas. Results Payers perceived legislation to improve insurance coverage for behavioral health issues as less beneficial than state employees and members of health advocacy groups. Elected officials perceived legislation to address various social determinants of health as less beneficial than health advocates. Members of health advocacy groups rated the behavioral health care system more poorly than elected officials did. Conclusions Preliminary findings reflected both the barriers and facilitators to behavioral health reform in Kansas. However, several limitations undermined the generalizability of these findings. Future studies should consider more representative sample sizes, additional variables in behavioral health and social determinants of health policies, and more comprehensive, validated measures.
Collapse
Affiliation(s)
- Ngoc X. Vuong
- Dorothy and Bill Cohen Honors College, Wichita State University, Wichita, KS
| | - Nikki K. Woods
- Department of Public Health Sciences, Wichita, KS,Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| |
Collapse
|
2
|
Kelly RP, Marcu G, Hardin A, Iovan S, Tipirneni R. Health Navigator Perspectives on Implementation of Healthy Michigan Plan Work Requirements. JAMA HEALTH FORUM 2022; 3:e221502. [PMID: 35977249 PMCID: PMC9187957 DOI: 10.1001/jamahealthforum.2022.1502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/19/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- R. Patrick Kelly
- Michigan Medicine, University of Michigan, Ann Arbor
- Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor
| | - Amber Hardin
- School of Information, University of Michigan, Ann Arbor
| | - Samantha Iovan
- Center for Health and Research Transformation, Ann Arbor, Michigan
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor
| |
Collapse
|
3
|
Tipirneni R, Kieffer EC, Ayanian JZ, Patel MR, Kirch MA, Luster JE, Karmakar M, Goold SD. Longitudinal trends in enrollees' employment and student status after Medicaid expansion. BMC Health Serv Res 2022; 22:233. [PMID: 35183170 PMCID: PMC8857876 DOI: 10.1186/s12913-022-07599-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medicaid community engagement requirements previously received federal approval in 12 states, despite limited data on their impact on enrollees' employment-related activities. Our objective was to assess longitudinal changes in enrollees' employment and student status after implementation of Michigan's Medicaid expansion. METHODS Longitudinal telephone survey of Michigan Medicaid expansion enrollees in 2016 (response rate [RR] = 53.7%), 2017 (RR = 83.4%), and 2018 (N = 2,608, RR = 89.4%) serially assessing self-reported employment or student status. Survey responses were benchmarked against statewide changes in assessed similar low-income adults in the U.S. Census Bureau Current Population Survey. We used mixed models with individual random effects to assess changes in the proportion of enrollees who were employed or students by year. RESULTS Most respondents had incomes < 100% FPL (61.7% with 0-35% of the federal poverty level [FPL], 22.9% with 36-99% FPL, and 15.4% with 100-133% FPL), 89.3% had at least a high school diploma/equivalent, and they ranged in age (39.6% age 19-34, 34.5% age 35-50, 25.9% age 51-64). Employment or student status increased significantly among Michigan Medicaid expansion respondents, from 54.5% in 2016 to 61.4% in 2018 (P < 0.001), including among those with a chronic condition (47.8% to 53.8%, P < 0.001) or mental health/substance use disorder (48.5% to 56.0%, P < 0.001). In contrast, the statewide proportion of low-income non-elderly adults who were employed or students did not change significantly (from 42.7% in 2016 to 46.0% in 2018, P = 0.57). CONCLUSIONS Medicaid expansion, absent a community engagement requirement, was associated with increased employment and related activities. The role of Medicaid in providing safety-net coverage to individuals during times of economic stress is likely to grow.
Collapse
Affiliation(s)
- Renuka Tipirneni
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA.
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA.
| | - Edith C Kieffer
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- School of Social Work, University of Michigan, Ann Arbor, MI, 48109, USA
| | - John Z Ayanian
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- University of Michigan Gerald R. Ford School of Public Policy, Ann Arbor, MI, 48109, USA
| | - Minal R Patel
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Matthias A Kirch
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
| | - Jamie E Luster
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
| | - Monita Karmakar
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
| | - Susan D Goold
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, 48109, USA
- Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Bldg 16, Rm 419W, Ann Arbor, MI, 48109, USA
- School of Public Health, University of Michigan, Ann Arbor, MI, 48109, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, 48109, USA
| |
Collapse
|
4
|
Care Management Intervention to Address Determinants of Health for Individuals With Multiple Behavioral Health Readmission. Prof Case Manag 2022; 27:47-57. [PMID: 35099417 DOI: 10.1097/ncm.0000000000000531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE OF STUDY To examine the effectiveness of a care management intervention to decrease readmissions and to better understand clinical and social determinants associated with readmission. PRIMARY PRACTICE SETTING Inpatient mental health (MH) and substance use disorder (SUD) facilities, nonhospital SUD withdrawal management and rehabilitation facilities. METHODOLOGY AND SAMPLE The authors identified 3,950 Medicaid-enrolled individuals who received the intervention from licensed clinical staff of a behavioral health managed care organization; 2,182 individuals were eligible but did not receive the intervention, for treatment as usual (TAU). We used logistic regression to examine factors associated with readmission. Determinants of readmission were summarized through descriptive tests. RESULTS The intervention was associated with lower readmissions to SUD facilities compared with TAU (6.0% vs. 8.6%, p = .0002) and better follow-up to aftercare. Controlling for clinical differences between groups, regression results found increased odds of readmission for male gender (odds ratio [OR]: 1.33; 95% confidence interval [CI]: 1.16-1.52, p < .0001) and dual MH and SUD diagnoses (OR: 1.52; CI: 1.29-1.79, p < .0001). Prior inpatient and case management services were also associated with increased odds for readmission. In the regression model, the intervention was not associated with decreased odds for readmission. Individuals with readmission (n = 796) were more likely to report being prescribed psychotropic medication and having housing difficulties and less likely to report having a recovery plan than those without readmission. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Characteristics of Medicaid populations with hospitalization may contribute to readmission, which may be mitigated through care management intervention.
Collapse
|
5
|
Blazoski C, Maio V. Medicaid Expansion's Importance to Mental Health Care. Am J Med Qual 2020; 36:200-202. [PMID: 32930000 DOI: 10.1177/1062860620958611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
6
|
Patel MR, Tipirneni R, Kieffer EC, Kullgren JT, Ayanian JZ, Chang T, Solway E, Beathard E, Kirch M, Lee S, Clark S, Skillicorn J, Rowe Z, Goold SD. Examination of Changes in Health Status Among Michigan Medicaid Expansion Enrollees From 2016 to 2017. JAMA Netw Open 2020; 3:e208776. [PMID: 32648922 PMCID: PMC7352154 DOI: 10.1001/jamanetworkopen.2020.8776] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Evidence about the health benefits of Medicaid expansion has been mixed and has largely come from comparing expansion and nonexpansion states. OBJECTIVE To examine the self-reported health of enrollees in Michigan's Medicaid expansion, the Healthy Michigan Plan (HMP), over time. DESIGN, SETTING, AND PARTICIPANTS A telephone survey from January 1 to October 31, 2016 (response rate, 53.7%), and a follow-up survey from March 1, 2017, to January 31, 2018 (response rate, 83.4%), were conducted in Michigan, which expanded Medicaid in 2014 through a Section 1115 waiver permitting state-specific modifications. Four thousand ninety HMP beneficiaries aged 19 to 64 years with at least 12 months of HMP coverage and at least 9 months in a Medicaid health plan were eligible to participate. Data were analyzed from April 1 to November 30, 2018. MAIN OUTCOMES AND MEASURES Surveys measured demographic characteristics and health status. Analyses included weights for sampling probability and nonresponse. Comparisons between 2016 and 2017 included those who responded to both surveys (n = 3097). RESULTS Of the 3097 respondents to the 2017 follow-up survey, 2388 (77.1%) were still enrolled in HMP (current enrollees) and 709 (22.9%) were no longer enrolled when surveyed (former enrollees). Among all follow-up respondents, a weighted 37.5% (95% CI, 35.3%-39.9%) were aged 19 to 34 years, 34.0% (95% CI, 31.8%-36.2%) were aged 35 to 50 years, and 28.5% (95% CI, 26.7%-30.3%) were aged 51 to 64 years; 53.0% (95% CI, 50.8%-55.3%) were female. Respondents who reported fair or poor health decreased from 30.7% (95% CI, 28.7%-32.8%) in 2016 to 27.0% (95% CI, 25.1%-29.0%) in 2017 (adjusted odds ratio [AOR], 0.66 [95% CI, 0.53-0.81]; P < .001), with the largest decreases observed in respondents who were non-Hispanic black (from 31.5% [95% CI, 27.1%-35.9%] in 2016 to 26.0% [95% CI, 21.9%-30.1%] in 2017; P = .009), from the Detroit metropolitan area (from 30.7% [95% CI, 27.0%-34.4%] in 2016 to 24.9% [95% CI, 21.6%-28.3%] in 2017; P = .001), and with an income of 0% to 35% of the federal poverty level (from 37.6% [95% CI, 34.2%-40.9%] in 2016 to 32.3% [95% CI, 29.1%-35.5%] in 2017; P < .001). From 2016 to 2017, the mean number of days of poor physical health in the past month decreased significantly from 6.9 (95% CI, 6.5-7.4) to 5.7 (95% CI, 5.3-6.0) (coefficient, -6.10; P < .001), including among current (from 7.0 [95% CI, 6.5-7.5] to 5.6 [95% CI, 5.1-6.0]; P < .001) and former (from 6.8 [95% CI, 5.9-7.7] to 5.8 [95% CI, 5.0-6.7]; P = .02) enrollees, those with 2 or more chronic conditions (from 9.9 [95% CI, 9.3-10.6] to 8.5 [95% CI, 7.8-9.1]; P < .001), across all age groups (19-34 years, from 4.3 [95% CI, 3.7-4.9] to 3.0 [95% CI, 2.5-3.5]; P < .001; 35-50 years, from 8.2 [95% CI, 7.3-9.0] to 6.9 [95% CI, 6.1-7.7]; P = .002; 51-64 years, from 9.0 [95% CI, 8.2-9.8] to 7.6 [95% CI, 6.9-8.3]; P = .001), and among non-Hispanic white (from 7.5 [95% CI, 7.0-8.1] to 6.1 [95% CI, 5.6-6.6]; P < .001) and black (from 5.9 [95% CI, 5.1-6.8] to 4.4 [95% CI, 3.6-5.1]; P < .001) respondents. No changes in days of poor mental health or usual activities missed owing to poor physical or mental health were observed. CONCLUSIONS AND RELEVANCE These findings suggest that HMP enrollees in Michigan have experienced improvements in self-reported health over time, including minority groups with a history of health disparities and enrollees with chronic health conditions.
Collapse
Affiliation(s)
- Minal R. Patel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Renuka Tipirneni
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Edith C. Kieffer
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- School of Social Work, University of Michigan, Ann Arbor
| | - Jeffrey T. Kullgren
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- US Department of Veterans Affairs VA Ann Arbor Healthcare System, Ann Arbor, Michigan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | - John Z. Ayanian
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Tammy Chang
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Family Medicine, University of Michigan, Ann Arbor
| | - Erica Solway
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Erin Beathard
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Matthias Kirch
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Sunghee Lee
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Institute for Social Research, University of Michigan, Ann Arbor
| | - Sarah Clark
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Jennifer Skillicorn
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
| | | | - Susan D. Goold
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| |
Collapse
|
7
|
Christine PJ, Tipirneni R. Substance Use Disorder Treatment Availability Among States Considering Medicaid Work Requirements. J Gen Intern Med 2020; 35:2234-2236. [PMID: 31916209 PMCID: PMC7351994 DOI: 10.1007/s11606-019-05623-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Paul J Christine
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Renuka Tipirneni
- Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|