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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 434 Research Studies DisplayedAtherly A, Feldman R, van den Broek-Altenburg EM
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
The purpose of this study was to explore the growth in the Medicare Advantage plan market share during a time period of dramatic increase. The authors investigated the factors behind the significant increase in market share of the Medicare Advantage (MA) program during a period where no structural changes were made. The study drew data from 2007-2018 and concluded that Medicare Advantage was becoming more preferred to more educated and nonminority beneficiaries compared to the past, with minority and lower-income beneficiaries also were more likely to choose the program.
AHRQ-funded; HS024281.
Citation: Atherly A, Feldman R, van den Broek-Altenburg EM .
Understanding factors associated with increases in Medicare Advantage enrollment, 2007-2018.
Am J Manag Care 2023 Apr; 29(4):e111-e16. doi: 10.37765/ajmc.2023.89351..
Keywords: Medicare, Access to Care, Health Insurance
Ellison JE, Kumar S, Steingrimsson JA
Comparison of low-value care among commercial and Medicaid enrollees.
Inefficient healthcare practices, known as low-value care, can be expensive and negatively impact patient outcomes. Despite increased utilization of low-value services, little is understood about the variation in low-value care across different payment systems. The purpose of this retrospective observational study was to examine disparities in low-value care utilization between patients with commercial insurance and those covered by Medicaid. Using the 2017 Rhode Island All-payer Claims Database, this study estimated the likelihood of receiving one of 14 low-value services among commercial and Medicaid enrollees, while accounting for patient sociodemographic and clinical factors. Medicaid and commercial insurance enrollees aged 18-64 who had continuous coverage and an encounter where they could potentially receive a low-value service. The study found that of the 110,609 patients, those enrolled in Medicaid were younger, possessed more comorbidities, and were predominantly female compared to commercial insurance enrollees. Medicaid patients exhibited higher utilization rates for 7 low-value care measures, while commercial insurance patients had higher rates for 5 measures. Overall, commercial insurance patients received more low-value services than Medicaid patients. Furthermore, commercial insurance patients were more likely to receive low-value services typically conducted in emergency departments and less costly services.
AHRQ-funded; HS000011
Citation: Ellison JE, Kumar S, Steingrimsson JA .
Comparison of low-value care among commercial and Medicaid enrollees.
J Gen Intern Med 2023 Mar;38(4):954-60. doi: 10.1007/s11606-022-07823-8.
Keywords: Medicaid, Health Insurance
Kirby JB, Nogueira LM, Zhao J
AHRQ Author: Kirby JB
Past disruptions in health insurance coverage and access to care among insured adults.
This AHRQ-authored study investigated whether disruptions in health insurance coverage continued to be associated with poor access even after coverage was regained. The study used a nationally representative cohort of insured adults aged 18-64 years (N=39,904). The authors estimated the association between past disruptions in coverage (occurring at least 1 year before) and the risks of lacking a usual source of care provider and having unmet medical need. Among insured nonelderly adults, the risk of being without a usual source of care provider was between 18% and 75% higher than for those with continuous coverage and the risk of having unmet medical needs was between 41% and 66% higher.
AHRQ-authored.
Citation: Kirby JB, Nogueira LM, Zhao J .
Past disruptions in health insurance coverage and access to care among insured adults.
Am J Prev Med 2023 Mar; 64(3):405-13. doi: 10.1016/j.amepre.2022.10.005..
Keywords: Health Insurance, Access to Care
Treasure G, Anderson DM, Hatcher L
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
This study’s goal was to describe individual Patient Protection and Affordable Care Act (ACA) marketplace enrollees’ metal tier selections by risk score and assess enrollees’ health spending by metal tier, risk score, and spending type. This retrospective, cross-sectional study analyzed claims data from the Wakely Consulting Group ACA database including enrollees with continuous, full-year enrollment in on-exchange or off-exchange ACA-qualified health plans during the 2019 contract year. Enrollment totals, total spending, and out-of-pocket cost were calculated, stratified by metal tier and the Department of Health and Human Services (HHS) Hierarchical Condition Category (HCC) risk score for 2019. Enrollment and claims data were obtained for 1,317,707 enrollees (53.5% female; mean age, 46.35 years) across all census areas, age groups, and sexes. Of this cohort, 34.6% were on plans with cost-sharing reductions (CSRs), 75.5% did not have an assigned HCC, and 84.0% submitted at least 1 claim. Enrollees were more likely to be classified in the top HHS-HCC risk quartile if they selected platinum (42.0%), gold (34.4%), or silver (29.7%) plans compared with enrollees in bronze plans (17.2%). Median total spending was lower among bronze plan enrollees ($593; interquartile range (IQR), $28-$2100) vs platinum ($4111; IQR, $992-$15,821) or gold ($2675; IQR, $728-$9070).
AHRQ-funded; HS026395.
Citation: Treasure G, Anderson DM, Hatcher L .
Plan selection, enrollee risk, and health spending on the Patient Protection and Affordable Care Act individual marketplaces, 2019.
JAMA Netw Open 2023 Mar; 6(3):e234529. doi: 10.1001/jamanetworkopen.2023.4529..
Keywords: Health Insurance, Healthcare Costs, Policy
Ding Y, Miller GE
AHRQ Author: Ding Y, Miller GE
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
The purpose of this study was to estimate the effect of sharing drug rebates at the point of sale on out-of-pocket spending by connecting estimated rebates to administrative claims data for employer-sponsored insurance enrollees in 2018. The researchers utilized the drug rebate rate with the retail price of each brand name drug fill, and the reductions were allocated to out-of-pocket spending based on cost-sharing provisions. Individual out-of-pocket spending was aggregated across drug fills. It was assumed that generic drugs have no rebates for employer-sponsored insurance. The impact of sharing rebates at the point of sale on out-of-pocket spending overall, for therapeutic classes and specific drugs with the highest average out-of-pocket spending per user, and by health plan type was assessed. The study found that across four simulations with different assumptions about cross-fill effects, 10.4% to 12.2% of enrollees in the sample would have realized savings on out-of-pocket spending if rebates were shared at the point of sale. Among those with savings, approximately half would save $50 or less, and 10% would save more than $500 annually. A premium increase of $1.06 to $1.41 per member per month among the continuously enrolled, insured population would be sufficient to finance the out-of-pocket savings in the sample.
AHRQ-authored.
Citation: Ding Y, Miller GE .
The impact of sharing drug rebates at the point of sale on out-of-pocket payments for enrollees in employer-sponsored insurance.
Value Health 2023 Feb; 26(2):226-33. doi: 10.1016/j.jval.2022.08.001..
Keywords: Health Insurance, Medication
Maclean JC, McClellan C, Pesko MF
AHRQ Author: McClellan C
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
This AHRQ-authored research studied the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. The authors applied two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. They found that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although they interpreted findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, their findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
AHRQ-authored.
Citation: Maclean JC, McClellan C, Pesko MF .
Medicaid reimbursement rates for primary care services and behavioral health outcomes.
Health Econ 2023 Jan 6;32(4):873-909. doi: 10.1002/hec.4646.
Keywords: Medicaid, Payment, Primary Care, Behavioral Health, Outcomes, Access to Care, Substance Abuse, Health Insurance
Steenland MW, Wherry LR
Medicaid expansion led to reductions in postpartum hospitalizations.
The purpose of this study was to assess whether the Medicaid expansions of the Affordable Care Act (ACA) affected rates of postpartum hospitalization. The researchers compared states that did and did not expand Medicaid under the ACA as they related to changes in hospitalizations among birthing people with a Medicaid-financed delivery. The study found a 17% reduction in hospitalizations during the first 60 days postpartum associated with the Medicaid expansions, and evidence of a lesser decrease in hospitalizations between 61 days and 6 months postpartum. The researchers concluded that Medicaid coverage expansion under the ACA resulted in improved postpartum health for low-income birthing people.
AHRQ-funded; HS027464.
Citation: Steenland MW, Wherry LR .
Medicaid expansion led to reductions in postpartum hospitalizations.
Health Aff 2023 Jan; 42(1):18-25. doi: 10.1377/hlthaff.2022.00819..
Keywords: Healthcare Cost and Utilization Project (HCUP), Medicaid, Hospitalization, Maternal Care, Women, Health Insurance, Access to Care
Moriya AS, Chakravarty S
AHRQ Author: Moriya AS
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
This AHRQ-authored paper examined whether the 2014 Affordable Care Act (ACA) Medicaid expansions mitigated existing racial or ethnic disparities in preventable hospitalizations and emergency department (ED) visits. The authors used inpatient data from twenty-nine states and ED data from twenty-six states for the period 2011 to 2018. They found that Medicaid expansions decreased disparities in preventable hospitalizations and ED visits between non-Hispanic Black and White nonelderly adults by 10 percent or more. There were no significant effects on disparities between Hispanic and non-Hispanic White nonelderly adults. Their findings highlight sustained improvements in community-level care for non-Hispanic Black populations, but also suggest access barriers experienced by Hispanic adults that need to be addressed beyond Medicaid eligibility expansion.
AHRQ-authored.
Citation: Moriya AS, Chakravarty S .
Racial and ethnic disparities in preventable hospitalizations and ED visits five years after ACA Medicaid expansions,.
Health Aff 2023 Jan; 42(1):26-34. doi: 10.1377/hlthaff.2022.00460..
Keywords: Healthcare Cost and Utilization Project (HCUP), Racial and Ethnic Minorities, Emergency Department, Hospitalization, Disparities, Medicaid, Health Insurance, Access to Care
Auty SG, Daw JR, Wallace J
State-level variation in supplemental maternity kick payments in Medicaid managed care.
The purpose of the cross-sectional study described in this research letter was to assesses the prevalence and magnitude of state-level delivery event–triggered kick payments to Medicaid managed care (MMC) plans for covering pregnant patients and the association of such payments with delivery costs. MMC kick payment rates were compared with average state Medicaid fee-for-service (FFS) payments for delivery hospitalizations and state kick payment rates compared with the Medicaid-Medicare fee index. The authors found “substantial and potentially unwarranted” state variation in delivery kick payment rates within MMC. They noted that if kick payment rates are set too low, plans may attempt to avoid pregnant enrollees by limiting coverage of certain services or restricting maternity care clinicians in their networks, with consequences for Black and Indigenous maternity patients.
AHRQ-funded; HS028754.
Citation: Auty SG, Daw JR, Wallace J .
State-level variation in supplemental maternity kick payments in Medicaid managed care.
JAMA Intern Med 2023 Jan; 183(1):80-82. doi: 10.1001/jamainternmed.2022.5146..
Keywords: Care Management, Health Insurance, Access to Care, Payment, Maternal Care
Tabb KM, Dalton VK, Tilea A
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
This study examined trends in antenatal depression and suicidal ideation among commercially insured childbearing individuals from 2008 to 2018. The study included 536,647 individuals aged 15-44 continuously enrolled in a single commercial health insurance plan for one year before childbirth from 2008 to 2018. Primary outcomes included depression or suicidal ideation based on relevant ICD-9 and ICD-10 diagnosis codes during pregnancy. Rates of depression increased by 39% from 540 per 10,000 individuals in 2008 to 750 per 10,000 individuals in 2018. Suicidal ideation increased by 100% from 15 per 10,000 individuals in 2008 to 44 per 10,000 individuals in 2018. Black persons experienced the sharpest proportional increases.
AHRQ-funded; HS027640.
Citation: Tabb KM, Dalton VK, Tilea A .
Trends in antenatal depression and suicidal ideation diagnoses among commercially insured childbearing individuals in the United States, 2008-2018.
J Affect Disord 2023 Jan 1;320:263-67. doi: 10.1016/j.jad.2022.09.120..
Keywords: Pregnancy, Maternal Care, Depression, Behavioral Health, Women, Health Insurance
Creedon TB, Zuvekas SH, Hill SC
AHRQ Author: Zuvekas SH, Hill SC, McClellan C
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
The purpose of this study was to explore the impact of Affordable Care Act (ACA) Medicaid expansion on insurance coverage and health services use for adults with disabilities newly eligible for Medicaid. The researchers utilized the 2008-2018 Medical Expenditure Panel Survey data and the Agency for Healthcare Research and Quality (AHRQ) PUBSIM model to identify adults between the ages of 26-64 years with disabilities who were newly Medicaid-eligible in expansion states or would have been eligible in non-expansion states if those states had opted in to ACA Medicaid expansion. The study found that among adults with disabilities who were newly eligible for Medicaid, Medicaid expansion was associated with significant increases in full-year Medicaid coverage, receipt of primary care, receipt of flu shots and a significant decrease in out-of-pocket spending. There were greater improvements for adults with disabilities compared to those without disabilities in full-year Medicaid coverage and receipt of flu shots. The researchers concluded that Medicaid expansion was associated with improvements in full-year insurance coverage, receipt of primary and preventive care, and out-of-pocket spending for adults with disabilities who were newly eligible for Medicaid, and there were greater improvements for adults with disabilities than for adults without disabilities.
AHRQ-authored.
Citation: Creedon TB, Zuvekas SH, Hill SC .
Effects of Medicaid expansion on insurance coverage and health services use among adults with disabilities newly eligible for Medicaid.
Health Serv Res 2022 Dec;57(suppl 2):183-94. doi: 10.1111/1475-6773.14034..
Keywords: Medical Expenditure Panel Survey (MEPS), Medicaid, Health Insurance, Disabilities, Policy, Access to Care
Chu J, Roby DH, Boudreaux MH
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
The purpose of this study was to estimate the effects of the Children's Health Insurance Reauthorization Act (CHIPRA) on insurance coverage, access, utilization, and health outcomes among immigrant children. The researchers utilized the restricted use 2000-2016 National Health Interview Survey (NHIS)with a sample which included immigrant children between the ages of 0 and 18 born outside the United States, with family income below 300% of the Federal Poverty Level (FPL). The study found that CHIPRA was related with a decrease in uninsured rates and an increase in public insurance enrollment for immigrant children. The effects of CHIPRA became small and statistically not significant 3 years after adoption. The researchers found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA. The researchers concluded that the eligibility expansion of CHIPRA was related with increases in public insurance coverage for low-income children. However, no effect of CHIPRA on access to care and health was found.
AHRQ-funded; HS028532.
Citation: Chu J, Roby DH, Boudreaux MH .
Effects of the Children's Health Insurance Reauthorization Act on immigrant children's healthcare access.
Health Serv Res 2022 Dec;57(suppl 2):315-25. doi: 10.1111/1475-6773.14061..
Keywords: Children/Adolescents, Children's Health Insurance Program (CHIP), Health Insurance, Access to Care, Vulnerable Populations, Uninsured
Yabroff KR, Han X, Zhao J
AHRQ Author: Kirby J
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
This cohort study assessed associations of a prior coverage disruption with mortality risk among large, nationally representative cohorts of working-age adults aged 18 to 64 with public or private health insurance coverage. Most research had previously been conducted among Medicaid enrollees, and little is known about insurance disruption among privately insured adults. The study used data from the 2000 to 2018 National Health Interview Survey (NIHS), specifically from the NHIS Linked Mortality files which contain data from the National Death Index. All data was deidentified and publicly available. The authors found that disruptions were associated with a higher mortality risk in either publicly or privately insured adults.
AHRQ-authored.
Citation: Yabroff KR, Han X, Zhao J .
Association of health insurance coverage disruptions with mortality risk among US working-age adults.
JAMA Health Forum 2022 Nov;3(11):e224258. doi: 10.1001/jamahealthforum.2022.4258..
Keywords: Health Insurance, Mortality, Risk, Access to Care
Scott JW, Scott KW, Moniz M
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
This cross-sectional study linked insurance claims and consumer credit report data to evaluate the experience of financial distress in commercially insured adults after traumatic injury. Data from Blue Cross Blue Shield of Michigan’s preferred provider organization insurance claims from 2019 through 2021 were included. The authors identified working-age adults aged 21 to 64 whose January 2021 credit reports occurred more than 6 months after hospital admission for traumatic injury. This cohort of 3164 adults was compared demographically to 2223 patients in the comparison cohort. Relative to the comparison cohort, the post injury cohort had a 23% higher likelihood of having medical debt in collections, a 70% higher amount of medical debt in collections, and a 110% higher bankruptcy rate. For many commercially insured patients, the burden of out-of-pocket costs after hospitalization exceeded their ability to pay and could be associated with bankruptcy risk.
AHRQ-funded; HS028672; HS025465; HS028817.
Citation: Scott JW, Scott KW, Moniz M .
Financial outcomes after traumatic injury among working-age US adults with commercial insurance.
JAMA Health Forum 2022 Nov;3(11):e224105. doi: 10.1001/jamahealthforum.2022.4105..
Keywords: Trauma, Healthcare Costs, Health Insurance
Eliason Gordon, Gordon SH
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
This study assessed the association between postpartum insurance instability and access to postpartum mental health services. The authors used data from the 2018-2019 Colorado Health eMoms survey, which sampled mothers from the 2018 birth certificate files at 3-6 months and 12-14 months postpartum. Respondents were classified at each time point as stably insured or unstable insured based on postpartum insurance status. Of respondents with public coverage at childbirth, 33.2% experienced postpartum insurance changes compared with 9.5% with private coverage. Respondents were more likely to experience unstable postpartum insurance if they were younger, had incomes of less than $50,000, and were of Hispanic ethnicity. Respondents who experienced postpartum insurance instability had lower odds of reporting that they discussed mental health at a postpartum check-up and received postpartum mental health services.
AHRQ-funded; HS000011.
Citation: Eliason Gordon, Gordon SH .
The association between postpartum insurance instability and access to postpartum mental health services: evidence from Colorado.
Womens Health Issues 2022 Nov-Dec;32(6):550-56. doi: 10.1016/j.whi.2022.06.010..
Keywords: Maternal Care, Access to Care, Women, Behavioral Health, Health Insurance
Li J, Wu B, Flory J
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
The purpose of this study was to assess the impact of the Affordable Care Act's Physician Payments Sunshine Act (PPSA) and its mandate of disclosing pharmaceutical and medical industry payments to physicians for prescribing branded statins. The study found that the PPSA contributed to a 7% decrease in monthly new prescriptions of brand-name statins over the study period. There was no significant change in generic prescribing. The reduction was concentrated among physicians with the highest tercile of drug spending prior to the enactment of the PPSA, with a decrease of 15% in new branded statin prescriptions. The researchers concluded that the PPSA mandate reduced the prescribing of branded statin prescriptions in the time period following its announcement, especially in physicians who were taking part in excessive prescribing of the branded statins.
AHRQ-funded; HS027001.
Citation: Li J, Wu B, Flory J .
Impact of the Affordable Care Act's Physician Payments Sunshine Act on branded statin prescribing.
Health Serv Res 2022 Oct;57(5):1145-53. doi: 10.1111/1475-6773.14024..
Keywords: Payment, Policy, Medicare, Health Insurance
Donohue JM, Cole ES, James CV
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
This article is a literature review of the Medicaid program focusing on Medicaid eligibility, enrollment, and spending and examined areas of Medicaid policy, including managed care, payment, and delivery system reforms; Medicaid expansion; racial and ethnic health disparities; and the potential to achieve health equity. The authors included peer-reviewed articles and reports published between January 2003 and February 2022. Medicaid covered approximately 80.6 million people per month in 2022, representing 16.3% of US health spending. Managed care plans run by states enrolled 69.5% of Medicaid beneficiaries in 2019 and adopted 139 delivery system reforms from 2003 to 2019. Over half (56.4%) of Medicaid beneficiaries were from racial and ethnic minority groups in 2019, and disparities in access, quality, and outcomes are common among these groups within Medicaid. The authors felt that additional Medicaid reforms are needed to reduce health disparities by race and ethnicity and to achieve equity in access, quality, and outcomes.
AHRQ-funded; HS026727.
Citation: Donohue JM, Cole ES, James CV .
The US Medicaid program: coverage, financing, reforms, and implications for health equity.
JAMA 2022 Sep 20;328(11):1085-99. doi: 10.1001/jama.2022.14791..
Keywords: Medicaid, Healthcare Costs, Policy, Health Insurance
Dragan KL, Desai SM, Billings J
Association of insurance mix and diagnostic coding practices in New York state hospitals.
This study’s goal was to estimate whether, for the same Medicaid enrollee with multiple hospitalizations, a hospital's share of privately insured patients is associated with the number of diagnoses on claims since privately insured hospitals may invest more in intensive coding than hospitals serving publicly insured patients. This cross-sectional study used patient-level fixed effects regression models on inpatient Medicaid claims from Medicaid enrollees with at least 2 admissions in at least 2 different hospitals in the state of New York between 2010 and 2017. This analysis included 1,614,630 hospitalizations for Medicaid-insured patients (mean age, 48.2 years; 51.4% women and 48.6% men). Overall, 74,998 were Asian, 462,259 Black, 375,591 Hispanic, 486,313 White, 128,896 unknown, and 86,573 other. When the same patient was seen in a hospital with a higher share of privately insured patients, more diagnoses were recorded. Patients discharged from hospitals in the bottom quartile of privately insured patient share received 1.37 more diagnoses when they were subsequently discharged from hospitals in the top quartile, relative to patients whose admissions were both in the bottom quartile. This suggests that payment policy may drive differential investments in infrastructure to document diagnosis, causing a feedback loop that exacerbates resource inequity.
AHRQ-funded; T32HS000055; K01HS026980.
Citation: Dragan KL, Desai SM, Billings J .
Association of insurance mix and diagnostic coding practices in New York state hospitals.
JAMA Health Forum 2022 Sep 2;3(9):e222919. doi: 10.1001/jamahealthforum.2022.2919..
Keywords: Health Insurance, Hospitals
Roberts ET, Mellor JM
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
This study compared access to, use of, and satisfaction with care among dual eligibles enrolled in Dual Eligible Special Needs Plans (D-SNPs) versus those enrolled in Medicare Advantage (MA) plans and traditional Medicare. Findings showed that, compared with those in traditional Medicare, dual eligibles generally reported greater access to care, preventive service use, and satisfaction with care in D-SNPs. There were, however, fewer differences in these outcomes among dual eligibles in D-SNPs versus other MA plans. Overall, these findings suggested that D-SNPs altogether have not provided consistently superior or more equitable care, and they highlight areas where federal and state policy could strengthen incentives for D-SNPs to improve care.
AHRQ-funded; HS026727; HS025422.
Citation: Roberts ET, Mellor JM .
Differences in care between special needs plans and other Medicare coverage for dual eligibles.
Health Aff 2022 Sep;41(9):1238-47. doi: 10.1377/hlthaff.2022.00463..
Keywords: Medicare, Medicaid, Health Insurance, Access to Care
Kirby JB, Nogueira L, Zhao J
AHRQ Author: Kirby JB
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
Researchers investigated the association between having a usual source of care provider (USCP) and past disruptions in insurance coverage among insured adults using a longitudinal, nationally representative sample. Using MEPS data, they found that, compared to people who were continuously insured, those with previous insurance coverage disruptions, even short ones, were less likely to have a USCP.
AHRQ-authored.
Citation: Kirby JB, Nogueira L, Zhao J .
Do disruptions in health insurance continue to affect access to care even after coverage is regained?
J Gen Intern Med 2022 Aug;37(10):2579-81. doi: 10.1007/s11606-021-07187-5..
Keywords: Medical Expenditure Panel Survey (MEPS), Health Insurance, Access to Care
Fung V, Yang Z, Cook BL
Changes in insurance coverage continuity after Affordable Care Act expansion of Medicaid eligibility for young adults with low income in Massachusetts.
The purpose of this cohort study was to describe changes in insurance coverage continuity for Medicaid enrollees who turned age 19 years before and after eligibility policy changes from the 2014 Medicaid expansion of the Patient Protection and Affordable Care Act. Between November 1, 2020, and May 12, 2022 the researchers analyzed data from the Massachusetts All-Payer Claims Database (2012 to 2016) to compare coverage for Medicaid beneficiaries turning age 19 years before and after Medicaid expansion. A total of 41,247 young adults turning age 18 to 19 years in the baseline year were included in the study. The researchers found that enrollees who turned age 19 after vs before the Medicaid eligibility expansion were less likely to have 3 or more uninsured months at18 to 19 years of age and 19 to 20 years of age and more likely to have continuous insurance coverage for 12 or more months. Differences in the likelihood of having 3 or more uninsured months decreased at 20 to 21 years of age, when both groups had access to Medicaid. The study concluded that among Medicaid enrollees entering adulthood, the expansion of Medicaid to lower-income adults through the 2014 Patient Protection and Affordable Care Act was associated with a decreased possibility of becoming uninsured.
AHRQ-funded; HS024725.
Citation: Fung V, Yang Z, Cook BL .
Changes in insurance coverage continuity after Affordable Care Act expansion of Medicaid eligibility for young adults with low income in Massachusetts.
JAMA Health Forum 2022 Jul;3(7):e221996. doi: 10.1001/jamahealthforum.2022.1996..
Keywords: Young Adults, Health Insurance, Policy, Medicaid, Access to Care, Low-Income
Ellison J, Wang C, Yarrington C
Insurance and geographic variations in non-invasive prenatal testing.
The purpose of this study was to estimate the population-level rate of non-invasive prenatal testing (NIPT) uptake in Massachusetts and identify disparities based on patient zip-code and insurance type. The researchers identified pregnant patients aged 35 years or older at their delivery between 7/1/2015 to 12/31/2015 who were eligible for NIPT use, to assess the role of area‐level sociodemographic characteristics and NIPT uptake. The study reported that considerable geographic variation was discovered. Patients living in zip‐codes within and surrounding the Boston metropolitan area were more likely to receive NIPT, as were those living in Eastern MA. The observed NIPT rate (per 1000 pregnant individuals aged 35 and over) was 48.7 for Medicaid enrollees and 272.1 for commercial enrollees; 123.0 and 223.2 for patients living in a zip‐code with a high versus low proportion of Black/Hispanic residents; and 107.7 and 218.4 for those in a zip‐code with a high versus low proportion of low‐income residents. The researchers reported that birthing people covered by Medicaid were over five times less likely to receive NIPT than their counterparts with commercial coverage. Lower NIPT rates in zip‐codes with a high proportion of low‐income or Black/Hispanic residents also suggests that geographic variations in uptake may reflect racial/ethnic and income disparities independent of insurance coverage. The researchers concluded that the study findings emphasize the presence of substantial disparities in NIPT uptake based on insurance and zip-code of residence, and that further research is needed to identify barriers and facilitators to uptake and to evaluate interventions to address inequities in NIPT use.
AHRQ-funded; HS000011.
Citation: Ellison J, Wang C, Yarrington C .
Insurance and geographic variations in non-invasive prenatal testing.
Prenat Diagn 2022 Jul;42(8):1004-07. doi: 10.1002/pd.6155..
Keywords: Pregnancy, Maternal Care, Women, Health Insurance, Screening
Anderson KE, Alexander GC, Ma C
Medicare Advantage coverage restrictions for the costliest physician-administered drugs.
This study examined the use of step therapy, prior authorization, and Part D formulary exclusion by 4 large Medicare Advantage (MA) insurers to manage 20 physician-administered drugs with the highest total Medicare expenditures (top 20 drugs). The authors used data from United Healthcare, CVS/Aetna, Humana, and Kaiser plans to create a database of 2020 Part B coverage restrictions and conducted a retrospective analysis of 2018-2020 Part D formularies. For each insurer, they calculated the number of top 20 physician-administered drugs subject to prior authorization and step therapy. Among the 4 insurers, 16 physician-administered drugs were covered on all or some of the Part D formularies in 2018, which decreased to 6 in 2020.
AHRQ-funded; HS000029.
Citation: Anderson KE, Alexander GC, Ma C .
Medicare Advantage coverage restrictions for the costliest physician-administered drugs.
Am J Manag Care 2022 Jul;28(7):e255-e62. doi: 10.37765/ajmc.2022.89184..
Keywords: Medicare, Health Insurance, Medication
Jazowski SA, Wilson L, Dusetzina SB
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
The purpose of this study was to evaluate the relationship between High-deductible health plan (HDHP) enrollment with out-of-pocket spending and uptake of and adherence to lenalidomide anti-cancer therapy. The researchers found that among the highest spenders (95th percentile), HDHP enrollees paid $376 and $217 more for their first and any lenalidomide prescription fill, respectively, compared with non-HDHP enrollees in the 6 months after initiation. High-deductible health plan enrollment was also associated with an increased risk of paying more than $100 for the initial lenalidomide prescription fill. The study concluded that enrollment in HDHP was associated with higher out-of-pocket spending per lenalidomide prescription fill; however, no statistically significant differences in adherence patterns between HDHP and non-HDHP enrollees were observed.
AHRQ-funded; HS026122.
Citation: Jazowski SA, Wilson L, Dusetzina SB .
Association of high-deductible health plan enrollment with spending on and use of lenalidomide therapy among commercially insured patients with multiple myeloma.
JAMA Netw Open 2022 Jun;5(6):e2215720. doi: 10.1001/jamanetworkopen.2022.15720..
Keywords: Health Insurance, Healthcare Costs, Cancer
Levine DM, Chalasani R, Linder JA
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
The national impact of the Patient Protection and Affordable Care Act (ACA) continues to be debated. The purpose of this cross-sectional study was to determine the relationship between the ACA and ambulatory quality, patient experience, utilization, and cost by comparing outcomes before (2011-2013) and after (2014-2016) ACA implementation. The study focused on United States adults between 18 and 64 years of age with income less than and greater than or equal to 400% of the federal poverty level (FPL), who had responded to the annual Medical Expenditure Panel Survey. Researchers conducted analysis of data from a sample of 123,171 individuals between January 2021 and March 2022. The study found that after the implementation of ACA, adults with income levels less than 400% of the FPL received increased high value care such as diagnostic and preventive testing when compared with adults with income 400% or higher of the FPL, and there were no differences in the other quality measures. Individuals with income less than 400% of the FPL had greater improvements in access, experience, and communication measures compared with those who had income greater than or equal to 400% of the FPL. Receipt of primary care services increased for individuals with lower income compared to individuals with higher income and for those with lower income compared to those with higher income, total out-of-pocket expenditures decreased. There were no other differences in utilization or cost between those groups. The researchers concluded that in this study, the ACA was not associated with changes in utilization, quality, or cost, but was related to decreased out-of-pocket expenditures and improved patient access, communication, and experience.
AHRQ-funded; 233201500020I; HS026506; HS028127.
Citation: Levine DM, Chalasani R, Linder JA .
Association of the Patient Protection and Affordable Care Act with ambulatory quality, patient experience, utilization, and cost, 2014-2016.
JAMA Netw Open 2022 Jun 1;5(6):e2218167. doi: 10.1001/jamanetworkopen.2022.18167..
Keywords: Medical Expenditure Panel Survey (MEPS), Healthcare Costs, Healthcare Utilization, Ambulatory Care and Surgery, Health Insurance, Access to Care