As the country rolls out insurance exchanges and Medicaid expansions, experts across disciplines are working to understand what the new enrollment populations will look like and what health needs they may have. Health services research presented at AcademyHealth’s Annual Research Meeting (ARM) sheds valuable light on the subject. In October, some of that research was showcased at the National Academy for State Health Policy’s (NASHP) Annual Conference in Seattle, where researchers Lindsey Leininger, Sharon Long, and Tami Mark shared their findings for state health policymakers. The session provided a unique opportunity for researchers and policymakers to brainstorm how to put evidence into practice and discuss opportunities and gaps both parties can work to address. Dr. Sharon Long presented findings on the health status of individuals who will now have access to Medicaid. By comparing the health status of lower-income uninsured individuals to current Medicaid beneficiaries using national survey data, she found that the uninsured are less likely to be in poor health than the current Medicaid population. The uninsured are not entirely healthy, however, as one third are obese, one half smoke, and one quarter report functional limitations. The research also found that uninsured individuals with chronic conditions are less likely to know they have them or to have the conditions controlled, likely due to the fact that many have not seen a doctor in the past year. So what does this mean for health reform? The researchers suggest that supporting measures to increase the supply of primary care services (including increased payments) are critical to meet the need. Additionally, in both the insured and uninsured populations, there is great opportunity to both diagnose and treat large numbers of individuals. With a possible surge in individuals seeking services, how can Medicaid agencies prepare for the health needs of this population? Dr. Lindsey Leininger suggested embedding a health needs assessment (HNA) into the Medicaid application itself. Through a comparison of national survey data, Dr. Leininger and her research team found that individuals’ responses to questions about health conditions, quality of life (HRQOL), and prior utilization of medical services strongly predict their future health needs. While the feasibility of adding an HNA to the application in the short term may be low (as Medicaid agencies have their hands full), it could be used to classify high-risk individuals in the future. The research also hints that self-reported data may get a worse rap than it deserves! Dr. Tami Mark extended this conversation to include the behavioral health needs of newly enrolled individuals. Using national survey data, Dr. Mark compared behavioral health conditions in both the Medicaid expansion and exchange populations. She found that nearly 10 percent of both populations will seek mental health services, one third of which will be for substance abuse disorder (SUD). When addressing mental health service needs, Dr. Mark urged policymakers to plan smartly and use the data on these topics. For example, Maryland successfully addressed SUD through workforce realignment and the expanded use of buprenophrine, a drug that helps mitigate the effects of heroin and opioid drug withdrawal, resulting in the reduction of treatment waitlists and heroin-related deaths. In contrast, Wisconsin did little to address workforce needs when budgeting for their Medicaid expansion and consequently, their physician population was overwhelmed by the number of patients requiring psychiatric medications. Lessons from these examples and existing data can help policymakers craft successful programs in their states. Perhaps the most instructive part of the session was the interaction between the audience and panelists when the researchers solicited policymakers to tell them what questions keep them up at night so that they can best focus their research. The state and industry attendees thanked the presenters for their work and remarked that the findings were informative and they often are unaware of what research is out there. They agreed that having more conversations between policymakers and researchers was essential. Be it confirming an increased need for primary care and behavioral health services, or developing tools to identify high risk individuals, health services research can play an important role in policy and program development at the state level, and increased communication between the two parties will only bolster the usefulness of the research.   This post was written by AcademyHealth Research Assistant Chloe Berger.

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