Medicaid Expansion Improved Access to Cardiac Care Without Diminishing Outcomes Interview with:

Donald Likosky, Ph.D., M.S. Associate Professor Head of the Section of Health Services Research and Quality Department of Cardiac Surgery. University of Michigan

Dr. Likosky

Donald Likosky, Ph.D., M.S.
Associate Professor
Head of the Section of Health Services Research and Quality
Department of Cardiac Surgery.
University of Michigan What is the background for this study? What are the main findings?

Response: Michigan was one of several states to expand Medicaid. Current evaluations of the Michigan Medicaid expansion program have noted increases in primary care services and health risk assessments, but less work has evaluated its role within a specialty service line. There has been concern among some that Medicaid patients, who have traditionally lacked access to preventive services, may be at high risk for poor clinical outcomes if provided increased access to cardiovascular interventions.

Using data from two physician-led quality collaboratives, we evaluated the volume and outcomes of percutaneous coronary interventions and coronary artery bypass grafting 24mos before and 24mos after expansion. We noted large-scale increased access to both percutaneous coronary interventions (44.5% increase) and coronary artery bypass grafting (103.8% increase) among patients with Medicaid insurance. There was a decrease in access for patients with private insurance in both cohorts. Nonetheless, outcomes (clinical and resource utilization) were not adversely impacted by expansion. What should readers take away from your report?

Response: Expansion of Medicaid in the state of Michigan improved access to cardiovascular services without adversely impacting clinical outcomes. What recommendations do you have for future research as a result of this work? 

Response: Future work should focus on evaluating changes in 90-day episode expenditures associated with Medicaid expansion. Is there anything else you would like to add? 

Response: Dr. Likosky received a grant from the Agency for Healthcare Research and Quality (R01HS022535). Support for the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative and the Blue Cross Blue Shield of Michigan (BCBSM) Cardiovascular Consortium Percutaneous Coronary Intervention Quality Improvement Initiative is provided by the BCBSM and Blue Care Network as part of the BCBSM Value Partnerships program. This work was also supported by funding from the National Institute of Aging (grant no. P01-AG019783). Dr. Sukul was supported by the National Institutes of Health T32 postdoctoral research training grant (T32-HL007853). Dr. Gurm has a consulting role with Osprey Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. 


Association Between Medicaid Expansion and Cardiovascular Interventions in Michigan
Donald S. Likosky, Devraj Sukul, Milan Seth, Chang He, Hitinder S. Gurm, Richard L. Prager
Journal of the American College of Cardiology Mar 2018, 71 (9) 1050-1051; DOI: 10.1016/j.jacc.2017.12.044 

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Last Updated on April 12, 2018 by Marie Benz MD FAAD