Program Evaluation and Health Services Research

In 2016, the federal government declared the Flint Water Crisis an emergency and leveraged funds to assist residents facing immediate effects of the contaminated water. To address the sustained public health crisis directly, the Centers for Medicare and Medicaid Services (CMS) administered funds via the Michigan Department of Health and Human Services (MDHHS) to expand eligibility and access to healthcare for pregnant women and children under 21 years. The Flint Medicaid Expansion (FME) went into effect on May 1, 2016 (expansion date), two years after the water switch event (April 1, 2014). This Medicaid Section 1115 Waiver expanded eligibility and services in two ways: 1) increased the income eligibility from a maximum of 212% FPL to 400% FPL, and 2) included Targeted Case Management of specialized services. IHP is evaluating the expansion of Medicaid services in four domains: 1) access to services; 2) access to targeted case management; 3) improved health outcomes; and 4) lead hazard investigation.

Opioid over-prescribing and opioid prescription abuse is a major issue for individual and public health. In response, federal agencies are supporting states’ efforts to investigate the opioid epidemic using public payer billing and demographic data analytics. IHP collaborated with MDHHS on the execution of the Innovation Accelerator Program for Opioid Abuse Disorders. This work has identified additional analytic interests beyond the scope of the IAP. These include considerations of potential interactions between socio-demographic characteristics and impact(s) on opioid use and misuse. Moreover, while additional data review has provided information, the question remains about whether these metrics focus too late in the spectrum. The activities proposed for this project can be broadly defined in three goals.

1. Expanding use of statistical methods to describe the current state of the population with regard to prescription use and abuse of opioid and related medications.
2. Informing MDHHS reporting for opioid use in MI accounting for characteristics of opioid prescribing providers.
3. Exploring techniques to predict future trends of opioid abuse in the population, and identify potential high-risk or high-cost events of beneficiaries.

The Health Information Technology (HIT) Program of the IHP is funded by Michigan Medicaid to help achieve the goals of its Meaningful Use Electronic Health Record (EHR) Incentive Program and other Health Information Technology (HIT) programs. These programs improve the quality, safety, and efficiency of health care in Michigan. Current project activities include:

1. Assessing the effects of HIT, including ICD-9 “E” (external causes of injury) codes, redundant lab orders, electronic prescribing, recommended preventive service adherence, quality outcomes related to EHR adoption, and consumer perceptions of personal health records;
2. Describing the characteristics of eligible professionals who have successfully attested and received payments under the EHR incentive program;
3. Continued outreach for the Medicaid EHR Incentive program to eligible hospitals and professionals;
4. Analysis of clinician HIT use, including barriers to meaningful use of EHRs, physician workflow and decision-making behavior involving information technology tools;
5. Market analysis using tools such as geographical information systems (GIS) to help determine gaps in EHR incentive outreach, availability of HIE services, and resources to aid attainment of meaningful use;
6. Outreach efforts to address privacy and security concerns through education and outreach on HIPAA (as amended by HITECH), ONC policies, and state law; and
7. Evaluation of the outcomes related to meaningful use measures, such as the effects (if any) of providing patients with clinical summaries of each office visit.

The MI Choice waiver program focuses on providing long-term services and supports to individuals at risk for nursing facility admission. The goal of the program is to facilitate participant ability to remain in a community setting. The program is offered to a diverse group of Medicaid beneficiaries having a common element of requiring nursing home level of care. Standardized criteria exist for eligibility yet persons may join the waiver program through several methods. Key objectives of this program evaluation include evaluating enrollment and service delivery; monitoring client satisfaction; investigating direct care worker characteristics; and documenting setting adherence to federal guidelines.

The MI Health Link demonstration project is a CMS funded project intended to support the development of integrated care for persons who are eligible for Medicaid and Medicare as part of the Financial Alignment Initiative. The goal is to improve quality of and access to care by coordinating care between the agencies and integrating physical and behavioral health services with long term care and supports. The cohort of individuals who are dually covered by Medicare and Medicaid represents a unique subset of those who are low income elderly or younger and disabled. Literature suggests this population is more likely to have multiple health conditions and be at increased risk for fragmented care. This group often has multiple providers involved with their medical care and further may require social supports that may influence medical needs. Key objectives of this program evaluation include evaluating participation and service characteristics and providing comparison information available from other demonstration states.