Health service usage patterns among Michigan Adult Benefit Waiver health plan enrollees: Use of office visits vs. emergency room admissions

Background: The purpose of this study is to determine if the Adult Benefit Waiver program (ABW) is effective in getting very low income enrollees to seek non-emergent and preventive health services with their primary care provider rather than through the emergency room. The ABW program is funded through a SCHIP HIFA 1115 Demonstration Waiver, which requires analysis of effectiveness in increasing access.

Methods: Research involved secondary analysis of the billing data collected on ABW enrollees and housed by the Michigan Department of Community Health. Data was analyzed for enrollees during a 12 month consecutive period. Enrollees included 18,111 adults who are at or below 35% of the Federal Poverty level. Mann-Witney, Kruskal-Wallis and Kendall Tau statistical tests were used.

Results: Results showed that 32% of continuous enrollees had no routine checkup during the year of observation. This proportion is within the confidence interval of the generalized, and of very low income, MI population who had a routine checkup in the last year (BRFSS). There was a positive correlation between visiting the office and visiting the ER and several utilization differences based on demographics.

Conclusions: This study was one of the first attempts to quantify the effectiveness of Michigan's ABW program, one of the only SCHIP waiver programs providing coverage to childless adults. Unexpectedly, enrollees were equally likely than the general population to have not visited the doctor with the year and still averaged 1-2 ER visits annually. Increased office visits did not correlate with decreased ER visits in this population.