The University Record, March 29, 1993

RESEARCH HIGHLIGHTS

Medicaid Health Care Demonstration Project

The existing Medicaid program allows patients to seek care anywhere Medicaid payment is accepted, which may encourage increased and inappropriate demand for care. At the same time, many physicians do not accept Medicaid patients. If they do, the care is often judged to be inferior. It is thought that this is due to the relatively low fees paid by Medicaid for office visits while lab test reimbursement is excellent.

Michael Klinkman, assistant professor of family practice, is working with the Michigan Department of Social Services (DSS) on a project to improve service to Medicaid recipients.

Klinkman is introducing a Physician Sponsor Plan (PSP) that pays a small monthly fee in addition to standard Medicaid fee-for-service reimbursement to physicians willing to act as health care “gatekeepers” for Medicaid patients. Costs should decline because patients will need authorization for specialty and elective hospital services, inappropriate emergency room use will be addressed through patient education, and physicians will be encouraged to avoid unnecessary lab tests.

This two-year study is funded by a $238,700 grant from Washtenaw County, under a $1.2 million grant from the Michigan DSS. Washtenaw County coordinates the grant for a consortium consisting of M-Care, Catherine McAuley Health System, Beyer Hospital, and Washtenaw County Human Services Department.

Aging-Related Reactivation of X Chromosome Genes

Diseases of old age are becoming the largest health care problem in the developed world. Genetics influences many of the ills associated with aging, such as coronary artery disease, hypertension, and Alzheimer’s disease.

Genes direct cells to manufacture proteins. This process, called gene expression, changes as mammals age. Incorrect regulation of gene expression may be one factor in diseases of aging.

David Burke, assistant professor of human genetics, is investigating mechanisms by which genes are maintained in a repressed or “packed” form known as heterochromatin. Burke hopes to learn more about the connection of heterochromatin to gene inactivation.

Burke is exploring DNA activation on X chromosomes using female mice. As some strains of mice age, inactive genes may become reactivated. Whether this is a general phenomenon of X-linked genes is not known. By using mice bred with a known genetic make-up, Burke can apply the techniques of molecular biology to determine whether a particular gene is active.

This project is funded by a five year, $902,000 grant from the National Institutes of Health.

Travel Behavior Home Interview Survey

Mass transit in the United States has had spotty success. Buses are the only mass transit system available in most cities, and they usually require significant government subsidy. Waiting time for passengers is a big problem, too, deterring many people from riding buses.

Advanced Public Transit System (APTS) technologies represent ways to improve bus service. One APTS technology is automatic vehicle location to riders and potential riders via cable television, phone or computer. Another APTS technology is traffic signal preemption, enabling a bus to send signals to change traffic lights to avoid delays at red lights.

Jonathan Levine, assistant professor of urban planning, is assessing APTS technologies through a survey conducted in cooperation with the Ann Arbor Transportation Authority (AATA). The project is funded by a $10,462 grant fromAATA.