Grand Valley State University’s annual Health Check research report provides a wealth of granular data on trends that are affecting the West Michigan market.
What to do about some of the emerging and persistent West Michigan health care trends that were identified by the report’s authors is another question entirely. GVSU researchers that annually compile the report don’t provide a lot of deep context on what the statistics say, other than to call attention to needs in the marketplace and offer some basic explanations on the possible drivers.
That said, here are some of the highlights in the 11th annual Health Check report presented this month during GVSU’s monthly Health Forum in Grand Rapids.
Obesity
Nearly two-thirds of residents in West Michigan report they are either obese or overweight.
In surveys, 30 percent of respondents classified themselves as obese. Another 36 percent said they were overweight.
“If we’re looking for areas where we can not only have a direct impact on individuals’ health, given their risks of hypertension, diabetes, heart disease, depression, and many others that might follow on from obesity, this is one we like to highlight in terms of our reporting,” said Sebastian Linde, an assistant professor of economics at GVSU’s Seidman College of Business and author of the 2020 report. “This is an area where we can not only have an effect in improving individuals’ health, but an area where we can help curb future expenditures related to health care.”
Opioids
GVSU researchers for the first time collected data on the region’s opioid prescribing rate.
They found that doctors in Kent, Ottawa, Muskegon and Allegan counties began prescribing fewer opioids around 2015, as the epidemic moved more into the public consciousness. The opioid prescribing rate in the region as of 2017, the most recent year for which GVSU had data, averaged 0.62 per capita, down from a peak of about 1.50 per capita in 2013.
Yet despite that decline, deaths from overall drug overdoses have not seen a corresponding decline. Drug overdose deaths averaged 18 per 100,000 people in the region for 2017, a rate that’s more than triple that of 1999, according to data in the 2020 Health Check report.
In Southeast Michigan, the death rate from drug overdoses in 2017 was far higher and growing faster than in West Michigan, hitting nearly 35 per 100,000 people.
“While the volume of legal opioid dispensing has reverted down since 2012, the trend in deaths has continued to grow, particularly so in the Detroit region. As such, negative health consequences associated with drug usage and overdose must continue to remain a critical focus of intervention and policy initiatives,” according to the 2020 Health Check report.
The lack of a decline in the rate of overdose deaths as the opioid prescribing rate decreased suggests that people who can no longer obtain an opioid from a doctor are doing it illegally or moving on to other substances, Linde said.
“We would still hope that if we had this huge of an impact in terms of a reduction of opioid rates that we might see some reductions in terms of overall drug deaths. The fact that we don’t seems to imply, at least to me, that there might be some substitutions,” Linde said. “So if you have a harder time actually getting opioids from your physician that you previously got them from, you might go off and potentially seek these out in alternative markets.”
Hospitalization and costs
Hospital admissions in the Grand Rapids area were below the U.S. and Detroit area averages in 2017, at about 102 per 1,000 people, marking a steady decline from 120 admissions per 1,000 people in 2005. That trend could stem from more care occurring at the lower-cost outpatient level, which is “less resource intensive and less costly,” Linde said.
In West Michigan, outpatient visits grew from about 2,000 per 1,000 people in 2014 to about 2,400 in 2017.
“That can be viewed as a positive marker in terms of how expensive hospital admission tends to be,” he said.
However, total hospital expenses did not decline accordingly as more care gets delivered in outpatient settings. Total expenses instead grew steadily from an average of $19,700 in 2005 to $31,000 in 2017.
The Health Check report attributed that trend to “increasing utilization of new technology” and “increases in the overall illness severity of hospitalized patients.”
“One potential side effect with regards to having fewer admissions is that we might have to spread some of the costs that we have related to actually treating our patients across fewer individuals,” Linde said in his presentation. “We have fewer admissions, so when we have admissions, these might be for hard-to-treat and more intense cases, which might lead to higher expenditures.”
An aging population may also contribute to rising total expenditures with a “direct correlation between age and a demand for health care services, so naturally that will drive up utilization and in turn drive up overall costs for our communities,” Linde said. “That’s something definitely going on in the background and to be mindful of.”
Chronic illness costs
In West Michigan, expenditures to treat six chronic medical conditions — asthma, coronary artery disease, depression, diabetes, hyperlipidemia, and lower back pain — continued growing from 2017 to 2018. Expenditures on coronary artery disease recorded the largest one-year increase of 19.1 percent to about $32,250 per case, according to the Health Check report that uses data from Priority Health and Blue Cross Blue Shield of Michigan.
Even when risk adjusted, treating coronary artery disease in the Grand Rapids area cost 16.1 percent more than it did in Southeast Michigan.
Of the six chronic illnesses, coronary artery disease was the only condition where per-member expenditures in West Michigan exceeded the Detroit area. Linde cited price, utilization rates, practice patterns, market conditions and competition, and the health of the local population as possible drivers of the higher expenditures in West Michigan to treat coronary artery disease.
One interesting finding: The cost of drugs to treat the disease did not appear to have been a driving factor, Linde said.
“Much of this expenditure increase across the board here appears to be driven by medical expenditures,” he said.
Telehealth use
People in West Michigan in 2018 used telehealth to connect with a doctor treating them for the same six chronic medical conditions more often than patients in Southeast Michigan. The use of telehealth was 89 percent higher for two conditions, coronary artery disease and hyperlipidemia.
“These are interesting trends that we hope to continue to track, especially given the promise of not only reaching more individuals and providing care to them in terms of the convenience of this type of care, but with regards to potential cost savings that might come with regards to higher use of telehealth,” Linde.
In the panel discussion following Linde’s presentation, Darryl Elmouchi, president of the Spectrum Health Medical Group and chief medical officer for Spectrum Health, said the Grand Rapids health system wants to grow the number of virtual patient visits to primary care doctors and specialists through its telehealth service.
Spectrum Health wants half of its primary care visits to occur through telehealth within three years, Elmouchi said.
“We believe virtual is key not only for convenience but truly to lower the cost of care and make it easier for people to do the right thing,” he said.
