Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance

Hall, Jennifer; DeVoe, Jennifer E.; Gold, Rachel; Angier, Heather; Sumic, Aleksandra; Nelson, Christine A.; Likumahuwa-Ackman, Sonja; Cohen, Deborah J.

doi:10.14236/jhi.v24i2.900

Cited by 4 publications

(5 citation statements)

References 26 publications

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“…As over 26 million patients, many of whom belong to vulnerable populations, are seen at CHCs ( National Association of Community Health Centers, 2017 ), the use of EHR data for research may also be an important resource for population health planning and health equity initiatives moving forward. Correct insurance information in CHCs is also important as many CHCs offer insurance enrollment services to help their patients gain or maintain insurance ( https://www.hrsa.gov/about/news/press-releases/2015-11-13-outreach-enrollment.html, 2015 ; Hall et al, 2017 ; DeVoe, 2013 , DeVoe et al, 2014a ; Harding et al, 2017 ). We found that EHR and Medicaid data agreement varied with patient demographics, visit types, and clinic characteristics; agreement also varied by these characteristics depending on the time period.…”

Section: Discussionmentioning

confidence: 99%

“…Additional research is needed to understand whether these differences are due to workflow, insurer factors, or how coverage information is transmitted to clinics. Clinics could use these findings as the basis to explore other strategies for improving the accuracy of patient health insurance information in the EHR, such as building direct linkages with Medicaid and other payers to keep information accurate and even build reminder systems for patients whose coverage has lapsed or is nearing expiration ( Hall et al, 2017 ; DeVoe et al, 2014b ; Gold et al, 2015 ). Because of the established link between preventive care and health insurance status, such efforts could substantially bolster the receipt of preventive care of economically vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

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Medicaid coverage accuracy in electronic health records

Angier

Valenzuela

Hoopes

et al. 2018

Preventive Medicine Reports

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Health insurance coverage facilitates access to preventive screenings and other essential health care services, and is linked to improved health outcomes; therefore, it is critical to understand how well coverage information is documented in the electronic health record (EHR) and which characteristics are associated with accurate documentation. Our objective was to evaluate the validity of EHR data for monitoring longitudinal Medicaid coverage and assess variation by patient demographics, visit types, and clinic characteristics. We conducted a retrospective, observational study comparing Medicaid status agreement between Oregon community health center EHR data linked at the patient-level to Medicaid enrollment data (gold standard). We included adult patients with a Medicaid identification number and ≥1 clinic visit between 1/1/2013–12/31/2014 [>1 million visits (n = 135,514 patients)]. We estimated statistical correspondence between EHR and Medicaid data at each visit (visit-level) and for different insurance cohorts over time (patient-level). Data were collected in 2016 and analyzed 2017–2018. We observed excellent agreement between EHR and Medicaid data for health insurance information: kappa (>0.80), sensitivity (>0.80), and specificity (>0.85). Several characteristics were associated with agreement; at the visit-level, agreement was lower for patients who preferred a non-English language and for visits missing income information. At the patient-level, agreement was lower for black patients and higher for older patients seen in primary care community health centers. Community health center EHR data are a valid source of Medicaid coverage information. Agreement varied with several characteristics, something researchers and clinic staff should consider when using health insurance information from EHR data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Medicaid coverage accuracy in electronic health records

Angier

Valenzuela

Hoopes

et al. 2018

Preventive Medicine Reports

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“…Preliminary study results have informed the initial development of a suite of EHRbased tools to fill these needs. 18 Analyses are ongoing to assess the effectiveness of such tools and whether these resources will have a positive impact on insurance coverage rates and health outcomes. 20,25…”

Section: Discussionmentioning

confidence: 99%

“…Our team previously described the workflows, tasks, and documentation needs of CHC sitebased Enrollment Assistants. 18 Yet, despite calls for healthcare organizations like CHCs to play a larger role in helping patients enroll in public health insurance, 19 patient perceptions of the strategies employed by CHCs and their attitudes towards receiving such assistance is poorly described in existing literature. To address this gap, we present qualitative findings on patients' perceptions and receptivity to insurance application assistance provided by CHC site-based Enrollment Assistants.…”

Section: Introductionmentioning

confidence: 99%

Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured

Hall¹,

DeVoe²,

Angier³

et al. 2017

Patient Experience Journal

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Low-income families struggle to obtain and maintain public health insurance. We identified strategies used by Community Health Centers (CHCs) to assist patients with insurance applications, and assessed patients' receptivity to these efforts. Observational cross-case comparative study with four CHCs in Oregon. We observed insurance assistance processes, and interviewed 26 clinic staff and 18 patients/family members. Qualitative data were analyzed using a grounded theory approach. Patients' understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

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“…The prevalence of diabetes in patients seen at CHCs is also considerably higher than the national average (21% vs. 11% in 2016) (19). Additionally, because CHCs routinely assist patients with Medicaid insurance enrollment and retention, they have robust data available relevant to understanding the impact of Medicaid expansions (20,21).…”

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confidence: 99%

The Affordable Care Act: Effects of Insurance on Diabetes Biomarkers

et al. 2020

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We sought to understand how Affordable Care Act (ACA) Medicaid expansion insurance coverage gains are associated with changes in diabetes-related biomarkers. RESEARCH DESIGN AND METHODSThis was a retrospective observational cohort study using electronic health record data from 178 community health centers (CHCs) in the ADVANCE (Accelerating Data Value Across a National Community Health Center Network) network. We assessed changes in diabetes-related biomarkers among adult patients with diabetes in 10 Medicaid expansion states (n 5 25,279), comparing newly insured with continuously insured, discontinuously insured, and continuously uninsured patients pre-to post-ACA expansion. Primary outcomes included changes from 24 months pre-to 24 months post-ACA in glycosylated hemoglobin (HbA 1c ), systolic (SBP) and diastolic (DBP) blood pressure, and LDL cholesterol levels. RESULTSNewly insured patients exhibited a reduction in adjusted mean HbA 1c levels (8.24% [67 mmol/mol] to 8.17% [66 mmol/mol]), which was significantly different from continuously uninsured patients, whose HbA 1c levels increased (8.12% [65 mmol/ mol] to 8.29% [67 mmol/mol]; difference-in-differences [DID] 20.24%; P < 0.001). Newly insured patients showed greater reductions than continuously uninsured patients in adjusted mean SBP (DID 21.8 mmHg; P < 0.001), DBP (DID 21.0 mmHg; P < 0.001), and LDL (DID 23.3 mg/dL; P < 0.001). Among patients with elevated HbA 1c in the 3 months prior to expansion, newly insured patients were more likely than continuously uninsured patients to have a controlled HbA 1c measurement by 24 months post-ACA (hazard ratio 1.25; 95% CI 1.02-1.54]. CONCLUSIONSPost-ACA, newly insured patients had greater improvements in diabetes-related biomarkers than continuously uninsured, discontinuously insured, or continuously insured patients. Findings suggest that health insurance gain via ACA facilitates access to appropriate diabetes care, leading to improvements in diabetes-related biomarkers.Diabetes is a leading cause of morbidity and mortality in the U.S. (1,2). Secondary preventive services for patients with diabetes, such as screening for and addressing glycosylated hemoglobin (HbA 1c ) and lipid levels, limit complications and improve health outcomes (3-5). Uninsured patients have higher average HbA 1c levels than do those with health insurance ( 4) and yet are less likely to receive secondary prevention (6-8). Prior research showed that even when uninsured patients with diabetes visited community health centers (CHCs), "safety net" clinics that provide care regardless of patients' ability

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Designing Health Information Technology Tools to Prevent Gaps in Public Health Insurance

Cited by 4 publications

References 26 publications

Medicaid coverage accuracy in electronic health records

Medicaid coverage accuracy in electronic health records

Maintaining public health insurance benefits: How primary care clinics help keep low-income patients insured

The Affordable Care Act: Effects of Insurance on Diabetes Biomarkers

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