Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study
Abstract Background The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care uti...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-11-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-020-05856-5 |
| _version_ | 1818870213235441664 |
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| author | Derek D. Satre Sujaya Parthasarathy Michael J. Silverberg Michael Horberg Kelly C. Young-Wolff Emily C. Williams Paul Volberding Cynthia I. Campbell |
| author_facet | Derek D. Satre Sujaya Parthasarathy Michael J. Silverberg Michael Horberg Kelly C. Young-Wolff Emily C. Williams Paul Volberding Cynthia I. Campbell |
| author_sort | Derek D. Satre |
| collection | DOAJ |
| description | Abstract Background The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care utilization and HIV clinical outcomes among individuals newly enrolled in insurance coverage following implementation of the ACA. Methods Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N = 880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1–$999 and > = $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts; viral suppression at HIV RNA < 75 copies/mL). Results Health care use was greatest immediately after enrollment and decreased over 3 years. Those with high deductibles were less likely to use primary care (OR = 0.64, 95% CI = 0.49–0.84, p < 0.01) or psychiatry OR = 0.59, 95% CI = 0.37, 0.94, p = 0.03) than those with no deductible. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR] = 0.40, 95% CI = 0.18–0.86; p = 0.02), but ADAP was associated with more psychiatry visits (RR = 2.22, 95% CI = 1.24–4.71; p = 0.01). Those with high deductibles were less likely to have viral suppression (OR = 0.65, 95% CI = 0.42–1.00; p = 0.05), but ADAP enrollment was associated with viral suppression (OR = 2.20, 95% CI = 1.32–3.66, p < 0.01). Black (OR = 0.35, 95% CI = 0.21–0.58, p < 0.01) and Hispanic (OR = 0.50, 95% CI = 0.29–0.85, p = 0.01) PWH were less likely to be virally suppressed. Conclusions In this sample of PWH newly enrolled in an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization, high deductibles were associated with worse HIV outcomes, but support from ADAP appeared to help patients achieve viral suppression. Race/ethnic disparities remain important to address even among those with access to insurance coverage. |
| first_indexed | 2024-12-19T12:03:27Z |
| format | Article |
| id | doaj.art-e2e9272c51cc42818e7897ab4904aaea |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-19T12:03:27Z |
| publishDate | 2020-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-e2e9272c51cc42818e7897ab4904aaea2022-12-21T20:22:25ZengBMCBMC Health Services Research1472-69632020-11-0120111210.1186/s12913-020-05856-5Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal studyDerek D. Satre0Sujaya Parthasarathy1Michael J. Silverberg2Michael Horberg3Kelly C. Young-Wolff4Emily C. Williams5Paul Volberding6Cynthia I. Campbell7Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of CaliforniaDivision of Research, Kaiser Permanente Northern CaliforniaDivision of Research, Kaiser Permanente Northern CaliforniaKaiser Permanente Mid-Atlantic States, Mid-Atlantic Permanente Research InstituteDepartment of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of CaliforniaHealth Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veteran Affairs (VA) Puget Sound Health Care SystemAIDS Research Institute, University of California San FranciscoDepartment of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of CaliforniaAbstract Background The Affordable Care Act (ACA) has increased insurance coverage for people with HIV (PWH) in the United States. To inform health policy, it is useful to investigate how enrollment through ACA Exchanges, deductible levels, and demographic factors are associated with health care utilization and HIV clinical outcomes among individuals newly enrolled in insurance coverage following implementation of the ACA. Methods Among PWH newly enrolled in an integrated health care system (Kaiser Permanente Northern California) in 2014 (N = 880), we examined use of health care and modeled associations between enrollment mechanisms (enrolled in a Qualified Health Plan through the California Exchange vs. other sources), deductibles (none, $1–$999 and > = $1000), receipt of benefits from the California AIDS Drug Assistance Program (ADAP), demographic factors, and three-year patterns of health service utilization (primary care, psychiatry, substance treatment, emergency, inpatient) and HIV outcomes (CD4 counts; viral suppression at HIV RNA < 75 copies/mL). Results Health care use was greatest immediately after enrollment and decreased over 3 years. Those with high deductibles were less likely to use primary care (OR = 0.64, 95% CI = 0.49–0.84, p < 0.01) or psychiatry OR = 0.59, 95% CI = 0.37, 0.94, p = 0.03) than those with no deductible. Enrollment via the Exchange was associated with fewer psychiatry visits (rate ratio [RR] = 0.40, 95% CI = 0.18–0.86; p = 0.02), but ADAP was associated with more psychiatry visits (RR = 2.22, 95% CI = 1.24–4.71; p = 0.01). Those with high deductibles were less likely to have viral suppression (OR = 0.65, 95% CI = 0.42–1.00; p = 0.05), but ADAP enrollment was associated with viral suppression (OR = 2.20, 95% CI = 1.32–3.66, p < 0.01). Black (OR = 0.35, 95% CI = 0.21–0.58, p < 0.01) and Hispanic (OR = 0.50, 95% CI = 0.29–0.85, p = 0.01) PWH were less likely to be virally suppressed. Conclusions In this sample of PWH newly enrolled in an integrated health care system in California, findings suggest that enrollment via the Exchange and higher deductibles were negatively associated with some aspects of service utilization, high deductibles were associated with worse HIV outcomes, but support from ADAP appeared to help patients achieve viral suppression. Race/ethnic disparities remain important to address even among those with access to insurance coverage.http://link.springer.com/article/10.1186/s12913-020-05856-5Health care reformDeductiblesAffordable Care ActAIDS Drug Assistance ProgramInsuranceMental health |
| spellingShingle | Derek D. Satre Sujaya Parthasarathy Michael J. Silverberg Michael Horberg Kelly C. Young-Wolff Emily C. Williams Paul Volberding Cynthia I. Campbell Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study BMC Health Services Research Health care reform Deductibles Affordable Care Act AIDS Drug Assistance Program Insurance Mental health |
| title | Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study |
| title_full | Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study |
| title_fullStr | Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study |
| title_full_unstemmed | Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study |
| title_short | Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study |
| title_sort | health care utilization and hiv clinical outcomes among newly enrolled patients following affordable care act implementation in a california integrated health system a longitudinal study |
| topic | Health care reform Deductibles Affordable Care Act AIDS Drug Assistance Program Insurance Mental health |
| url | http://link.springer.com/article/10.1186/s12913-020-05856-5 |
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