Primary Care Clinicians' Views About the Impact of Medicaid Expansion in Michigan: A Mixed Methods Study

Abstract

Background: Michigan's approach to Medicaid expansion, the Healthy Michigan Plan (HMP), emphasizes primary care, prevention, and incentives for patients and primary care practitioners (PCPs).

Objective: Assess PCPs' perspectives about the impact of HMP on their patients and practices.

Design: In 2014-2015, we conducted semi-structured interviews then a statewide survey of PCPs.

Setting: Interviewees came from varied types of practices in five Michigan regions selected for racial/ethnic diversity and a mix of rural and urban settings. Surveys were sent via mail.

Participants: Interviewees were physician (n = 16) and non-physician practitioners (n = 3). All Michigan PCPs caring for ≥ 12 HMP enrollees were surveyed (response rate 55.5%, N = 2104).

Measurements: PCPs' experiences with HMP patients and recent changes in their practices.

Results: Interviews include examples of the impact of Medicaid expansion on patients and practices. A majority of surveyed PCPs reported recent increases in new patients (52.3%) and patients who had not seen a PCP in many years (56.2%). For previously uninsured patients, PCPs reported positive impact on control of chronic conditions (74.4%), early detection of serious illness (71.1%), medication adherence (69.1%), health behaviors (56.5%), emotional well-being (57.0%), and the ability to work, attend school, or live independently (41.5%). HMP patients reportedly still had more difficulty than privately insured patients accessing some services. Most PCPs reported that their practices had, in the past year, hired clinicians (53.2%) and/or staff (57.5%); 15.4% had colocated mental health care. Few (15.8%) reported established patients' access to urgent appointments worsened.

Limitations: PCP reports of patient experiences may not be accurate. Results reflect the experiences of PCPs with ≥ 12 Medicaid patients. Differences between respondents and non-respondents present the possibility for response bias.

Conclusions: PCPs reported improved patient access to care, medication adherence, chronic condition management, and detection of serious illness. Established patients' access did not diminish, perhaps due to reported practice changes.

Fig. 1

PCP reports of difficulty accessing care for Healthy Michigan Plan and privately insured patients. PCP responses to two questions: How often do your Healthy Michigan Plan patients have difficulty accessing the following? How often do your privately insured patients have difficulty accessing the following? ^§p < 0.001 Wilcoxon signed-rank test comparing often/sometimes/rarely/never responses by PCPs to these paired questions. PCPs who answered do not know to either question were excluded from analysis. ^†p < 0.001 paired t test comparing do not know responses to these paired questions.