The purpose of this document is to evaluate the Healthy Michigan Plan. The evaluation should include how success was measured, program reach, data sources, and stakeholder analysis, among other features.
| Healthcare Program/Policy Evaluation | |
| Description | The Healthy Michigan plan is an approved Medicaid expansion program that has been providing coverage to adults with incomes at most 133% of the federal poverty level |
| How was the success of the program or policy measured? | The effectiveness of the program was evaluated along the following domains: uninsurance, health behaviors, uncompensated care, health outcomes, access to care, financial well-being, and preventative services. The objective was to improve health care provision by given percentages with respect to each domain. |
| How many people were reached by the program or policy selected? How much of an impact was realized with the program or policy selected? | Though enrolment in the program fluctuates every month, the program has services over 1 million Michigan residents since its inception (Healthy Michigan Plan, 2018) |
| What data was used to conduct the program or policy evaluation? | The different data sources were Enrollee longitudinal surveys, primary care provider surveys, administrative data, CMS hospital cost report data, and American Community Survey (Ayainan, 2020). Other sources of information w ere HRAs, cost-sharing, and MI health accounts (Hirth et al., 2018). |
| What specific information on unintended consequences were identified? | The employment and financial wellbeing of the enrollees started to improve with time. For instance, while 36% of Michigan residents reported problems paying medical bills in the past year prior to enrollment, 85% of them reported that the burden has decreased significantly (Healthy Michigan Plan, 2018). |
| What stakeholders were identified in the evaluation of the program or policy? Who would benefit most from the results and reporting of the program or policy evaluation? Be specific and provide examples. | Throughout the reports, there is no direct mentioning of the stakeholders. However, deductive analysis revealed that the major stakeholders in the program are Michigan adults, Michigan state government, insurance providers, health care providers (nurses, primary care physicians, specialists), and employers. To a certain degree, the Federal government was a stakeholder because the program could only be successful due to the Section 1115 waiver (Hinton et al., 2019; Zhang et al., 2020) |
| Did the program or policy meet the original intent and objectives? Why or why not? | The program met its objectives across different domains. For instance, insurance coverage increased among low income Michigan residents. In 2013, 16% were uninsured. By 2017, the number had dropped to 7% (Healthy Michigan Plan, 2018). Furthermore, in 2013, the uninsured rate for adults was below 138% of FPL. By 2017, the number had dropped by 13%. The health outcomes for the enrollees also improved where 48%, 38%, and 40% of Michigan residents reported improvements in physical, mental, and dental health respectively (Healthy Michigan Plan, 2018). |
| Would you recommend implementing this program or policy in your place of work? Why or why not? | I would recommend implementing this policy in my place of work. The problem is that for it to be effective, it needs to be implemented at a state or national level. For instance, the benefits and waivers under section 1115 would not be applicable at the organizational level. Secondly, achieving the same results as the Healthy Michigan Plan would require the cooperation and dedication by various stakeholders who have no incentive to work together. |
| Identify at least two ways that you, as a nurse advocate, could become involved in evaluating a program or policy after one year of implementation. | A nurse advocate would be involved in evaluating a program of policy after one year of implementation in their position as a patient advocate. The nurse would, therefore, be involved in determining if the policy harms patients, includes room for patient preferences, provides patient education for informed decision-making, and support patient voices regarding the choices they make. A nurse advocate can also participate by exercising their role in shaping policy making and changing. In this case, the nurse advocate would participate in legislative action alerts, coalitions, meet with elected officials, and provide expert testimony that would inform policy decisions. |
| General Notes/Comments |
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Conclusion
In conclusion, the Healthy Michigan Plan has been successful in meeting its objectives. In other words, it has successfully, achieved the goal of improving health for Michigan residents across different domains, from uninsurance to changing health behaviors, uncompensated care, health outcomes, access to care, financial well-being, and preventative services. Nurse advocates have the opportunity to participate in this policy in the future in their position as patient advocates or their responsibility to inform the policy making and changing process.
References
Ayanian, J. (2020). Healthy Michigan Plan Evaluation: Healthy Michigan Plan Evaluation Final Summative Report.
Healthy Michigan Plan. (2018). Medicaid Expansion in Michigan Findings from the First Five Years of the Healthy Michigan Plan. Michigan: University of Michigan. Retrieved from https://ihpi.umich.edu/sites/default/files/2020-06/HMP%20summative%20report%20brief_06182020%5B2%5D.pdf
Hinton, E., Musumeci, M., Rudowitz, R., Antonisse, L., & Hall, C. (2019). Section 1115 Medicaid Demonstration Waivers: the current landscape of approved and pending waivers. Henry J. Kaiser Family Foundation Issue Brief.
Hirth, R., Cliff, E., Kullgren, J., Fendrick, A., Clark, S., Beathard, E., ... & Ayanian, J. (2018). Healthy Michigan Plan Evaluation: Report on the Impact of Cost Sharing in the Healthy Michigan Plan.
Zhang, E., Tipirneni, R., Beathard, E. R., Lee, S., Kirch, M. A., Salman, C., ... & Ayanian, J. Z. (2020). Health Risk Assessments in Michigan's Medicaid Expansion: Early Experiences in Primary Care. American Journal of Preventive Medicine, 58(3), e79-e86.
