Thursday Thoughts for July 23, 2020

This week I wanted to share some information from a recent report about the Healthy Michigan Program (HMP) and make some comments on what still needs to happen in healthcare.  Healthy Michigan is Michigan’s version of Medicaid expansion that includes requirements and incentives for taking more personal responsibility for your healthcare.  The program began on April 1, 2014, and originally covered about 600,000 lower income Michigan residents.  With the COVID crisis, the program has grown to a record number of 755,000 participants.  Over a million participants have been in the program since many people go in and out of the program as their income levels go up or down.  I need to thank Jim Haveman for continuing updates and sharing these reports from the University of Michigan.  

It took a big lift from many to get the plan established.  The medical community was a great partner in speaking out and hosting events.  I did a series of town halls across Michigan on this topic. The stories about the need for this program were moving and in some cases heartbreaking.  I will always remember signing the bill into law at Beaumont Hospital in Dearborn.  Great champions who helped make it happen included Brian Calley, Jim Haveman, Nick Lyon, Jase Bolger, Mike Shirkey, and John Dingell

Why did I push for this program?  It was simple.  This program could save lives in addition to dramatically improving the quality of life for struggling families.  Too many people were not receiving healthcare and when they did it usually meant going to the emergency room.  At a town hall in Grand Rapids, I remember a man who told the story of being unable to hold a job because of recurring health problems.  He finally ended up in the ER in a coma-like state.  It turned out he was diabetic and never knew it.  With insulin, he was able to have a good job and take care of his family.

Many people challenged me about how I could support growing government through this new program.  First, it was the right thing to do from a human perspective.  Second, I believe it would actually be less expensive for society overall.  Getting preventive care vs. going to the ER is obviously more effective and less expensive.  We had been paying a huge cost in uncompensated care which would dramatically decline if people had health care coverage.  My view was not to focus on who in our society wrote the check, but how could we help more people at a lower overall cost.

There are two updates from the University of Michigan involving two- and five-year studies.  Here are some of the findings:

1. Access to a regular source of care increased and it moved to doctor’s offices:

Doctor’s office or clinic - Pre 49%; Post 83%

Emergency room - Pre 12%; Post 3%

No regular source - Pre 28%; Post 7%

2.  Preventive care increased:

85% had a preventive care visit in the prior year

48% had a dental visit

30% had a chronic condition that was newly diagnosed by the preventive care visit

3. Positive health outcomes have happened:

Since enrollment, participants reported - 

48% improved physical health

38% improved mental health

40% improved dental health

4. Health Risk Assessments have been valuable:

43% said they completed a Health Risk Assessment 

88% of those chose to work on a health behavior

5. Uncompensated care costs declined in 90% of Michigan hospitals

6. Cost to participants

51% were billed for contributions or copays

88% agreed that the amount they pay overall for HMP seems fair

89% agreed that the amount they pay for HMP is affordable

Here is a link to the University of Michigan article on the reports -  https://ihpi.umich.edu/news/medicaid-expansion-meant-better-health-most-vulnerable-low-income-adults-u-m-study-finds 

This program has been a great success and has really shown its importance during this pandemic.  Thanks to all who made it happen!

But, we need to continue to do more to reform our healthcare system.  Regarding HMP and other existing programs, we need to encourage more participants to do a health risk assessment and to complete recommended lifestyle improvements such as exercise and a healthier diet.  We need to continue to improve access to healthy foods, especially fruits and vegetables.  Our mental health system needs additional investment and it should be more integrated with physical health services.

On the big-picture front, we need to look at restructuring our entire health care system.  We have the world’s most advanced acute care system and we aren’t very healthy compared to many other nations.   Our spending is way too high for the outcomes which we achieve.  Too often the discussion at the federal level has been about money and coverage, not overall reform.  

Let’s figure out what we need in terms of health care professionals, equipment and facilities and look to minimize all of the administrative, marketing, and overhead costs.  We want well-paid and rewarded medical people.  How much money could we save if we got rid of drug ads for conditions we didn’t know existed and bills from hospitals or insurance companies that come six months after you had the services provided?  A lot!  

There are some interesting models of innovation such as concierge medical services.  Basically, a primary care physician and their team handle a limited number of patients for a monthly fee with basic services as needed.  Unfortunately, this model tends to be used for higher income people; but it also has been shown to work at all income levels.  Let’s explore similar new ideas.  

Also, we spend huge resources on sickness and very little on wellness.  We should be investing a lot more on the front end of diet and exercise instead of building more operating rooms for surgery.  In my venture capital days, I had the honor to be part of a company called HealthMedia that was focused on this topic.  It did great things.  I learned about the potential power of wellness from its founder, Vic Strecher, a brilliant professor and researcher.

When I became Governor, I made wellness a priority.  We created the Michigan Health and Wellness 4x4 program.  Practice four healthy behaviors:

1. Maintain a healthy diet
2. Engage in regular exercise
3. Get an annual physical exam
4. Avoid all tobacco use

Measure four key health indicators:

1. Weight or body mass index (BMI)
2. Blood pressure
3. Cholesterol level
4. Blood sugar (glucose) level

If all of us adopted the four healthy behaviors to achieve good numbers on the four indicators, healthcare costs in our nation would be dramatically lower and we would be living longer lives with higher quality.

Our Healthy Michigan Plan shows that we can move the needle on improving healthcare in our nation.  Let’s learn from it.  We need to look at more dramatic reforms such as a ground-up overhaul of our entire system.  We should begin by doing the obvious.  Let’s do more to stay well.

Remember, Relentless Positive Action in your life will help you and others. So, I wish you RPA every day!