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Journal of General Internal Medicine

, Volume 33, Issue 8, pp 1307–1316 | Cite as

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

  • Susan Dorr Goold
  • Renuka Tipirneni
  • Edith Kieffer
  • Adrianne Haggins
  • Cengiz Salman
  • Erica Solway
  • Lisa Szymecko
  • Tammy Chang
  • Zachary Rowe
  • Sarah Clark
  • Sunghee Lee
  • Eric G. Campbell
  • John Z. Ayanian
Original Research

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.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they do not have a conflict of interest.

Supplementary material

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Susan Dorr Goold
    • 1
    • 2
    • 3
  • Renuka Tipirneni
    • 1
    • 2
  • Edith Kieffer
    • 2
    • 4
  • Adrianne Haggins
    • 2
    • 5
  • Cengiz Salman
    • 2
    • 6
  • Erica Solway
    • 2
  • Lisa Szymecko
    • 7
  • Tammy Chang
    • 2
    • 8
  • Zachary Rowe
    • 9
  • Sarah Clark
    • 2
    • 10
  • Sunghee Lee
    • 11
  • Eric G. Campbell
    • 12
  • John Z. Ayanian
    • 1
    • 2
    • 3
    • 13
  1. 1.Department of Internal Medicine, Medical School University of MichiganAnn ArborUSA
  2. 2.Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  3. 3.Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborUSA
  4. 4.School of Social Work and the Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  5. 5.Emergency Medicine and the Institute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborUSA
  6. 6.Center for Bioethics and Social Sciences in MedicineUniversity of MichiganAnn ArborUSA
  7. 7.Department of Community PsychologyMichigan State UniversityEast LansingUSA
  8. 8.Family MedicineUniversity of MichiganAnn ArborUSA
  9. 9.Friends of ParksideDetroitUSA
  10. 10.Department of PediatricsUniversity of MichiganAnn ArborUSA
  11. 11.The Institute for Social ResearchUniversity of MichiganAnn ArborUSA
  12. 12.CU Center for Bioethics and HumanitiesUniversity of ColoradoDenverUSA
  13. 13.Gerald R. Ford School of Public PolicyUniversity of MichiganAnn ArborUSA

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