Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California

Satre, Derek D.; Parthasarathy, Sujaya; Altschuler, Andrea; Silverberg, Michael J.; Storholm, Erik D.; Campbell, Cynthia I.

doi:10.2105/ajph.2016.303126

Cited by 14 publications

(11 citation statements)

References 9 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, we expect this to have had a negligible impact on our results given the low prevalence of HIV infection (0.12%) among KP members. 52 Fifth, we did not have data on individual-level socioeconomic status, which may contribute to differences in life expectancy; however, disparities by socioeconomic status are likely to be explained by differences in access to care, which we accounted for in our analysis by comparing HIV-infected and HIV-uninfected individuals from within the same health care system. Sixth, we did not have sufficient sample size to estimate life expectancies in subgroups of optimally treated HIV patients defined by gender, race/ethnicity, or HIV-transmission risk group.…”

Section: Discussionmentioning

confidence: 99%

Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care

Marcus

Chao

Leyden

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

346

226

View full text Add to dashboard Cite

Background It is unknown if a survival gap remains between HIV-infected and HIV-uninfected individuals with access to care. Methods We conducted a cohort study within Kaiser Permanente California during 1996–2011, using abridged life tables to estimate the expected years of life remaining (“life expectancy”) at age 20. Results Among 24,768 HIV-infected and 257,600 HIV-uninfected individuals, there were 2229 and 4970 deaths, with mortality rates of 1827 and 326 per 100,000 person-years, respectively. In 1996–1997, life expectancies at age 20 for HIV-infected and HIV-uninfected individuals were 19.1 and 63.4 years, respectively, corresponding with a gap of 44.3 years (95% confidence interval: 38.4 to 50.2). Life expectancy at age 20 for HIV-infected individuals increased to 47.1 years in 2008 and 53.1 years by 2011, narrowing the gap to 11.8 years (8.9–14.8 years) in 2011. In 2008–2011, life expectancies at age 20 for HIV-infected individuals ranged from a low of 45.8 years for blacks and 46.0 years for those with a history of injection drug use to a high of 52.2 years for Hispanics. HIV-infected individuals who initiated antiretroviral therapy with CD4 ≥500 cells per microliter had a life expectancy at age 20 of 54.5 years in 2008–2011, narrowing the gap relative to HIV-uninfected individuals to 7.9 years (5.1–10.6 years). For these HIV-infected individuals, the gap narrowed further in subgroups with no history of hepatitis B or C infection, smoking, drug/alcohol abuse, or any of these risk factors. Conclusions Even with early treatment and access to care, an 8-year gap in life expectancy remains for HIV-infected compared with HIV-uninfected individuals.

show abstract

Section: Discussionmentioning

confidence: 99%

Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care

Marcus

Chao

Leyden

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

346

226

View full text Add to dashboard Cite

show abstract

“…Thus, PLWHA may need to depend on either community providers or wrap-around services from the Ryan White program to support continued engagement in care with the goal of viral suppression (Arns et al, 2004; Cahill et al, 2015; Gonzalez et al, 2011; Holtzman et al, 2015; Huynh et al, 2013; Lucas, 2011; Magidson et al, 2015; Turan et al, 2016). Indeed, a recent study found that post-ACA enrollees in Kaiser Permanente Northern California were more likely to be virally suppressed than a similar group enrolled prior to the ACA (Satre et al, 2016). Enhanced treatment would provide two major benefits: improving the health and functioning of individuals living with HIV and also contributing to National HIV/AIDS Strategy’s goal of reducing community viral load, and therefore, new HIV infections.…”

Section: Discussionmentioning

confidence: 99%

Transitioning From Medicaid Disability Coverage to Long-Term Medicare Coverage: The Case of People Living With HIV/AIDS in California

Comulada

Desmond²,

Gildner³

et al. 2017

AIDS Education and Prevention

View full text Add to dashboard Cite

Medicaid can serve as a bridge to Medicare coverage for the long-term disabled with sufficient covered work experience. We perform multinomial logistic regression on 2007–2010 Medicare and Medicaid claims data to examine transitions to Medicare for people living with HIV/AIDS (PLWHA) in California who had Medicaid coverage in 2007. We find only 16% had obtained Medicare coverage by 2010. African-Americans, women, individuals with schizophrenia diagnoses, alcohol or substance abuse disorders, and any physical comorbidity were significantly less likely than others to obtain Medicare (p < 0.001). This study contributes new information on the impact of eligibility requirements for Medicare long-term disability insurance for PLWHA. About one-third of PLWHA under age 65 are covered by Medicaid. Many PLWHA get stuck in Medicaid because their disability prevents them from obtaining the additional employment experience needed to qualify for Medicare.

show abstract

“…27 This result could be attributable to the widely adopted policy of starting antiretroviral treatment for all newly diagnosed patients regardless of CD4 cell counts and/or to care previously received in Ryan White facilities. Yet the post-ACA cohort also had a higher proportion with asthma and substance use disorders (and hypertension and depression were substantial in both cohorts).…”

Section: Discussionmentioning

confidence: 99%

“…Building on preliminary analysis of HIV-positive KPNC members enrolled in early 2014, 27 the current study examined a full year of enrollees using medical, psychiatric and substance use disorder diagnostic data; service utilization data; as well as qualitative interview data integrated into quantitative data interpretation. We anticipated that KPNC would devote considerable effort to planning in areas such as membership changes, new enrollment methods, and care delivery strategies, and that KPNC leaders would describe these aspects of ACA implementation.…”

Section: Introductionmentioning

confidence: 99%

“…We expected that HIV viral control for post-ACA enrollees would be at least as good as for pre-ACA enrollees in spite of growth in deductible plans. 27 We also hypothesized that the post-ACA new HIV-positive members might have more comorbid conditions and greater services utilization than the pre-ACA cohort due to pent-up demand for health care.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics

Satre

Altschuler

Parthasarathy

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

Self Cite

View full text Add to dashboard Cite

Objectives This study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure and health care utilization after key ACA provisions went into effect in 2014. Methods This mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation. Quantitative analyses compared newly enrolled HIV-positive patients in KPNC between January-December 2012 (“pre-ACA”, N=661) with newly enrolled HIV-positive patients between January-December 2014 (“post-ACA”, N=880) on demographics; medical, psychiatric and substance use disorder diagnoses; HIV clinical indicators; and type of health care utilization. Results Interviews found that ACA preparation focused on enrollment growth, staffing, competition among health plans, concern about cost sharing, and HIV pre-exposure prophylaxis (PrEP) services. Quantitative analyses found that post-ACA HIV-positive patient enrollment grew. New enrollees in 2014 were more likely than 2012 enrollees to be enrolled in high-deductible plans (p<.01) or through Medicaid (p<.01), and marginally more likely to have better HIV viral control (p<.10). They also were more likely to be diagnosed with asthma (p<.01) or substance use disorders (p<.05) and to have used primary care health services in the 6 months post-enrollment (p<.05) than the pre-ACA cohort. Conclusions As anticipated by KPNC interviewees, ACA implementation was followed by HIV-positive patient enrollment growth and changing benefit structures and patient characteristics. Although HIV viral control improved, comorbid diagnosis findings reinforced the importance of coordinated health care.

show abstract

Demographic, Insurance, and Health Characteristics of Newly Enrolled HIV-Positive Patients After Implementation of the Affordable Care Act in California

Cited by 14 publications

References 9 publications

Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care

Narrowing the Gap in Life Expectancy Between HIV-Infected and HIV-Uninfected Individuals With Access to Care

Transitioning From Medicaid Disability Coverage to Long-Term Medicare Coverage: The Case of People Living With HIV/AIDS in California

Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics

Contact Info

Product

Resources

About