Jennifer E DeVoe1, Miguel Marino2, Rachel Gold3, Megan J Hoopes4, Stuart Cowburn4, Jean P O'Malley5, John Heintzman6, Charles Gallia7, K John McConnell8, Christine A Nelson4, Nathalie Huguet6, Steffani R Bailey9. 1. Oregon Health & Science University, Department of Family Medicine, Portland, Oregon OCHIN, Inc, Portland, Oregon. 2. Oregon Health & Science University, Department of Family Medicine, Portland, Oregon Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon. 3. OCHIN, Inc, Portland, Oregon Kaiser Permanente Northwest Center for Health Research, Portland, Oregon. 4. OCHIN, Inc, Portland, Oregon. 5. Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health & Science University, Portland, Oregon. 6. Oregon Health & Science University, Department of Family Medicine, Portland, Oregon. 7. Office of Health Analytics, Oregon Health Authority, Portland, Oregon. 8. Center for Health System Effectiveness, Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon. 9. Oregon Health & Science University, Department of Family Medicine, Portland, Oregon bailstef@ohsu.edu.
Abstract
PURPOSE: There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment"). METHODS: We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS: The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. CONCLUSIONS: Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.
RCT Entities:
PURPOSE: There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon's 2008 randomized Medicaid expansion (the "Oregon Experiment"). METHODS: We probabilistically matched demographic data from adults (aged 19-64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008-2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS: The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05-1.55) for laboratory tests to 1.58 (95% CI, 1.10-2.28) for referrals. CONCLUSIONS: Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings.
Keywords:
ACA; Medicaid; Oregon Experiment; Patient Protection and Affordable Care Act; community health centers; health policy; practice-based research; primary care utilization; vulnerable populations
Authors: Heather Angier; Megan Hoopes; Rachel Gold; Steffani R Bailey; Erika K Cottrell; John Heintzman; Miguel Marino; Jennifer E DeVoe Journal: Ann Fam Med Date: 2015 Jan-Feb Impact factor: 5.166
Authors: Jennifer E Devoe; Rachel Gold; Mark Spofford; Susan Chauvie; John Muench; Ann Turner; Sonja Likumahuwa; Christine Nelson Journal: J Am Board Fam Med Date: 2011 Sep-Oct Impact factor: 2.657
Authors: K John McConnell; Samuel H N Gast; M Susan Ridgely; Neal Wallace; Natalie Jacuzzi; Traci Rieckmann; Bentson H McFarland; Dennis McCarty Journal: Am J Psychiatry Date: 2011-09-02 Impact factor: 18.112
Authors: Rachel Gold; Steffani R Bailey; Jean P OʼMalley; Megan J Hoopes; Stuart Cowburn; Miguel Marino; John Heintzman; Christine Nelson; Stephen P Fortmann; Jennifer E DeVoe Journal: J Ambul Care Manage Date: 2014 Oct-Dec
Authors: Steffani R Bailey; Megan J Hoopes; Miguel Marino; John Heintzman; Jean P O'Malley; Brigit Hatch; Heather Angier; Stephen P Fortmann; Jennifer E DeVoe Journal: J Gen Intern Med Date: 2016-06-21 Impact factor: 5.128
Authors: Brigit Hatch; Steffani R Bailey; Stuart Cowburn; Miguel Marino; Heather Angier; Jennifer E DeVoe Journal: Am J Public Health Date: 2016-02-18 Impact factor: 9.308
Authors: Brigit Hatch; Miguel Marino; Marie Killerby; Heather Angier; Megan Hoopes; Steffani R Bailey; John Heintzman; Jean P O'Malley; Jennifer E DeVoe Journal: J Gen Intern Med Date: 2017-04-03 Impact factor: 5.128
Authors: Jean P O'Malley; Maureen O'Keeffe-Rosetti; Robert A Lowe; Heather Angier; Rachel Gold; Miguel Marino; Brigit Hatch; Megan Hoopes; Steffani R Bailey; John Heintzman; Charles Gallia; Jennifer E DeVoe Journal: Med Care Date: 2016-11 Impact factor: 2.983
Authors: O Kenrik Duru; Carol M Mangione; Hector P Rodriguez; Dennis Ross-Degnan; J Frank Wharam; Bernard Black; Abel Kho; Nathalie Huguet; Heather Angier; Victoria Mayer; David Siscovick; Jennifer L Kraschnewski; Lizheng Shi; Elizabeth Nauman; Edward W Gregg; Mohammed K Ali; Pamela Thornton; Steven Clauser Journal: Curr Diab Rep Date: 2018-02-05 Impact factor: 4.810