Table 3.
Adjusted Proportions of Primary Care Providers Reporting Medical Practice Changes Since the Launch of the Healthy Michigan Plan
| To what extent has your practice experienced the following since the Healthy Michigan Plan began in April 2014?* | Has your practice made the following changes in the past year? | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| Increase number of new patients | Existing patients who had been uninsured or self-pay gained insurance | Existing patients changed from other insurance to Healthy Michigan Plan | Increase in the number of new patients who have not seen a primary care practitioner in many years | Hired additional clinicians | Hired additional office staff | Consulted with care coordinator, case manager, or community health worker | Changed workflow processes for new patients | Colocated mental health within primary care | |
| All | 52.3% | 50.6% | 31.6% | 56.2% | 53.2% | 57.5% | 55.8% | 41.7% | 15.4% |
| Practice size | |||||||||
| Large (ref) | 51.4% | 50.0% | 28.9% | 54.0% | 71.8% | 67.8% | 68.2% | 49.0% | 18.3% |
| Small | 51.7% | 51.2% | 31.9% | 57.8% | 40.0%§ | 52.6%§ | 51.9%§ | 38.5%§ | 12.2%§ |
| Practice type | |||||||||
| FQHC (ref) | 58.8% | 64.9% | 32.6% | 63.7% | 62.4% | 70.0% | 72.6% | 44.2% | 29.9% |
| Non-FQHC | 50.5%† | 48.5%§ | 30.3% | 55.1%† | 52.1%† | 57.1%‡ | 56.1%§ | 42.8% | 11.8%§ |
| Academic (ref) | 52.9% | 53.5% | 29.9% | 59.2% | 49.2% | 51.6% | 52.1% | 39.6% | 13.9% |
| Non-academic | 51.3% | 50.2% | 30.8% | 55.7% | 54.3% | 60.1%‡ | 59.3% | 43.5% | 15.6% |
| Hospital-based (ref) | 51.5% | 49.5% | 28.3% | 56.9% | 51.6% | 59.3% | 55.1% | 42.8% | 11.2% |
| Not hospital-based | 51.6% | 51.3% | 31.7% | 55.8% | 54.6% | 58.8% | 59.9% | 43.1% | 17.8% |
| Predominant payer mix | |||||||||
| Private (ref) | 39.4% | 41.5% | 22.4% | 46.2% | 54.8% | 60.0% | 62.3% | 40.7% | 11.0% |
| Medicare | 43.8% | 44.8% | 25.0% | 50.5% | 50.9% | 58.8% | 55.8%‡ | 48.5%† | 13.1% |
| Medicaid | 69.7%§ | 64.7%§ | 43.0%§ | 72.4%§ | 53.2% | 60.1% | 55.5%§ | 44.0% | 19.7%§ |
| Uninsured | 79.4%† | 59.1% | 14.4% | 61.5% | 40.9% | 34.5% | 68.3% | 40.5% | 29.1% |
| Mixed | 49.9%† | 50.4% | 29.2% | 49.7% | 57.6% | 51.6%† | 59.9%† | 35.1% | 15.3% |
| MiPCT | |||||||||
| Yes | – | – | – | – | 52.8% | 60.0% | 78.0%§ | 44.4% | 22.0% |
| No | – | – | – | – | 53.8% | 58.6% | 52.3% | 42.5% | 13.1% |
| Urbanicity | |||||||||
| Urban (ref) | 51.0% | 49.5% | 28.6% | 56.7% | 53.6% | 60.0% | 58.1% | 41.5% | 13.6% |
| Suburban | 59.8%† | 55.6% | 33.1% | 60.3% | 52.6% | 50.5%† | 53.3% | 45.5% | 14.8% |
| Rural | 49.1% | 53.7% | 38.8%‡ | 51.3% | 53.9% | 58.9% | 62.2% | 48.3%† | 23.6%§ |
Proportions are the predictive margins from logistic regression models adjusted for each practice characteristic in the table, as well as PCP gender, specialty, ownership of practice, and years in practice. MiPCT indicates participation in the Michigan Primary Care Transformation (MiPCT) Project, a 3-year, multi-payer, state-wide project aimed at reforming primary care payment models and expanding the capabilities of patient-centered medical homes (PCMH) throughout the state. Analysis was done using Stata 14. All p values are based on logistic regression analysis
*Analyses based on sum of those who responded “to a great extent” or “to some extent” for the items below
†p < 0.05
‡p < 0.01
§p < 0.001