Health Care Reform: What Does It Mean for People Living With HIV Infection?

Sharts‐Hopko, Nancy C.

doi:10.1016/j.jana.2011.07.003

Cited by 2 publications

(2 citation statements)

References 2 publications

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“…It was posited that ACA mandates were likely to change the insured population’s composition (e.g., growth in Medicaid), 2 increase demand for primary and specialty care services, 3–6 and increase patient cost-sharing via deductible plans. 7,8 These changes are especially relevant to HIV-positive patients, who have high rates of comorbid medical, psychiatric and substance use disorders 9–12 that complicate their care.…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Section: Introductionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…The resulting impact on shifting clinical care needs and resource allocation (e.g., staffing and program development) could have significant implications for services use and health policy. 5,6 …”

mentioning

confidence: 99%

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

et al. 2016

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Objectives To examine changes in HIV-positive patient enrollment in a large health care delivery system before and after key Affordable Care Act (ACA) provisions went into effect in 2014. Methods Analyses compared HIV-positive patients newly enrolled in Kaiser Permanente Northern California between January and June 2012 (n = 339) to those newly enrolled between January and June 2014 through the California insurance exchange or via other mechanisms (n = 549). Results After the ACA, the HIV-positive patient enrollment increased. These new enrollees were more likely to be male (93.6% vs 89.1%; P = .01), to be enrolled in high-deductible benefit plans (≥ $1000; 18.8% vs 5.5%; P = .01), and to have better HIV viral control (HIV RNA levels below limits of quantification 79.5% vs 73.6%; P = .05) compared with pre-ACA new enrollees. Among post-ACA new enrollees, there were more patients in the lowest and highest age groups. Post-ACA exchange enrollees (22%) were more likely to be male and to have high-deductible plans than those enrolled through other mechanisms. Conclusions More men, higher deductibles, and better HIV viral control characterize newly enrolled HIV-positive patients after the ACA in California. Public health implications Evolving characteristics of HIV-positive enrollees may affect HIV policy, patient care needs, and service utilization.

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Health Care Reform: What Does It Mean for People Living With HIV Infection?

Cited by 2 publications

References 2 publications

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

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

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

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