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Michigan must take steps to close health disparities

Posted on 10/03/18

Michigan’s rambling health care system is rife with disparities related to race, geography and income that create uneven access to care, treatment and wellness, according to a new AARP report released today.

“Disrupting Disparities: A Continuum of Care for Michiganders 50 and Older,” a nine-month, in-depth study of health care in the state, proposes a range of remedies including creation of a coordinated care network, maintaining Healthy Michigan Medicaid expansion, extending broadband technology to all corners of the state, enacting a Family Caregiver Tax Credit, and other solutions.

Find the full report here:  AARP Michigan Report: Disrupting Disparities

Eliminating disparities will lead to greater economic vitality in Michigan, according to a study by W.K. Kellogg Foundation, and an adjunct report by Public Sector Consultants of Lansing.

“Addressing these imbalances in health care will lead to healthier citizens and a healthier economy,” said Paula D. Cunningham, State Director of AARP Michigan, following the release of the report at the Crowne Plaza Hotel in Lansing. “Our report found widespread disparities, but the most important takeaway is that we can take common-sense steps to eradicate them.”

The study was led by AARP Michigan and Western Michigan University College of Health and Human Services, with collaboration from 19 other organizations. AARP Public Policy Institute conducted much of the research.

Dr. Earlie Washington, professor and former dean of the WMU College of Health and Human Services, said eliminating the inequalities is a key to a better Michigan.

“We know that health disparities exist across Michigan, and they are costly,” she said. “Living in one zip code versus another can mean a difference in years on your life, and what kind of care and comfort you can experience as you age.

“But it doesn’t have to be that way. By examining the data and talking to real people about their lives, we have been able to recommend actionable solutions that will positively impact the quality of life in our state.”

The two major party gubernatorial candidates, who commented on the report on video at the unveiling event, called for comprehensive health care for older adults and expanded broadband and telemedicine.

“We need to expand issues like telemedicine and broadband to assist people in more rural areas so they can have adequate and top-flight health care, and get connected as well,” said Republican gubernatorial nominee Bill Schuette. “It’s the 21st Century and we’ve got to get this done.”

Schuette added: “Healthy Michigan (Medicaid expansion) is the law, and it’s not going anywhere.”

Democratic gubernatorial nominee Gretchen Whitmer said: “Ensuring that Michigan is a great place to retire is really important. We want to keep seniors here and thriving in this state. Access to health care is a critical piece of that.”

Whitmer added that broadband “is a critical issue, it means quality of life for seniors. I want to get everyone in Michigan connected.”

Key findings of the report include:

  • Health disparities that begin at birth and continue into adulthood affect the lives of millions of racial and ethnic groups, according to a 2018 W.K. Kellogg Foundation study. The same study indicates eliminating the disparities could boost the state’s economy by $4.1 billion.
  • Two-thirds of Michigan seniors said in a 2018 AARP survey that they suffer from one or more health conditions. Most common among them was high blood pressure (45 percent), diabetes (22 percent), heart disease (14 percent) and depression or other mental health issues (14 percent). These conditions often contribute to premature death among older adults. 12 percent reported having gone without needed care because of cost, lack of transportation, or no available timely appointments.
  • Black senior Michiganders have poorer health status than their white counterparts. They have greater rates of diabetes and high blood pressure, increased likelihood to skip follow-up care and lower likelihood to use online health care services.
  • Michigan fails to provide sufficient home and community-based options for seniors and persons with physical disabilities. Michigan ranks 40th among states in the percentage of Medicaid and state long-term services and supports funding going to home and community-based services for seniors and other physically disabled adults.
  • Family members are the primary caregivers for seniors. Michigan has 1.28 million family caregivers who provide 1.2 billion hours of care to loved ones each year. The total estimated economic value of the uncompensated care is $14.5 billion a year.
  • About one-third (31.8%) of older adults surveyed by AARP are interested in using telehealth to communicate with their own health care providers or a specialist. But there are barriers to greater utilization.

Proposed calls to action include:

  • The state should preserve access to Healthy Michigan Medicaid expansion, which is providing health care to about 680,000 Michiganders. Research demonstrates that Medicaid expansion led to improvement in access to care, health care outcomes and greater financial security for low-income adults.
  • Michigan should create a coordinated care network comprised of a variety of health care providers who serve the Medicaid population enrollees. This model would provide a continuum of well-coordinated, evidence-based care, driven by measures of quality and cost.
  • Given that family caregivers are by far the largest part of Michigan’s home care workforce, Michigan must do a better job of supporting these individuals who provide care for a family member, partner, or friend with a chronic, disabling, or serious health condition. Without family-provided help, the economic cost to Michigan’s health and long-term services and supports systems would skyrocket. Financial support is needed to help offset their rising out-of-pocket costs.
  • The state should enact a Family Caregiver Tax Credit to help middle class Michiganders.
  • Michigan should increase access to home and community- based services. This state continues to spend the majority of its long-term care funding on nursing home care, despite the fact that most Michigan seniors wish to receive care in their homes and communities and despite the fact that on average, three Michiganders can be served in their own homes for every one served in a nursing home.
  • African American/Black Michiganders are disparately underserved by Medicaid-funded community supports. The governor-elect and state Legislature should appoint a task force on disparities in health and long-term systems and propose steps to begin to close these disparity gaps starting in 2019.
  • The state should expand access to broadband high-speed Internet in underserved areas, and facilitate the use of telehealth by eliminating barriers. These barriers include: lack of compacts with certain providers, and lack of Medicaid reimbursement for the home as an originating site and for remote patient monitoring.
  • Michigan should consider requiring insurers to include providers’ telehealth services and capabilities in provider directories.
  • Pilot the use of broadband in a remote, rural community to assess whether it is effective in helping to improve access to quality care.
  • State Legislature should pass measures granting local units of government the authority to allow special assessment districts for communications infrastructure, including broadband.

Reducing health care disparities can be an economic boon to the state. An analysis by Public Sector Consultants shows:

  • If Michigan can reduce the prevalence of diabetes among the senior population (65+) by one percent, it could decrease treatment costs by over $32.5 million.
  • If the state can delay entrance for 1 percent of the 38,801 Medicaid recipients currently in certified nursing care for one year and keep them on aged/disabled waivers, the state could save $3.15 million in general fund Medicaid expenditures. By doing so, the savings would allow the state to serve an additional 722 people through other home and community-based services.
  • An estimated 368,000 rural Michigan households do not have access to broadband internet. As a result, just over $2.5 billion in potential economic benefit is left unrealized among disconnected households.

Racial disparities in health and health care result in excess annual medical costs of $2.2 billion for the total Michigan population and $1.9 billion in lost productivity, according to the Kellogg study. Overall, 26 percent of African American/Blacks and 21 percent of Hispanics/ Latinos reported that they were in fair or poor health, compared to 16 percent of Whites.

Shortened life spans because of racial disparities in health cost Michigan $7 billion in lost economic activity. But the racial gap isn’t just a matter of dollars and cents. Eliminating racial disparities could save 140,000 life years in the state, according to the study.

“We cannot move forward together as a state unless these health care access issues are resolved,” AARP Michigan Director Cunningham said. “It’s not just the right thing to do; it’s the only course of action that makes any sense.”

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