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Showing content from https://pubmed.ncbi.nlm.nih.gov/31512184/ below:

Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study

Observational Study

. 2019 Nov;34(11):2549-2558. doi: 10.1007/s11606-019-05323-w. Epub 2019 Sep 11. Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study Edith C Kieffer^{3 4}, Renuka Tipirneni^{4 5}, Jeffrey T Kullgren^{4 5 6}, Matthias Kirch⁴, Emily K Arntson⁷, Sarah J Clark^{4 8}, Sunghee Lee^{4 9}, Erica Solway⁴, Erin Beathard⁵, John Z Ayanian^{4 5 7 10}, Susan D Goold^{4 5 7}

Affiliations

¹ Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. roslandam@pitt.edu.
² VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA. roslandam@pitt.edu.
³ University of Michigan School of Social Work, Ann Arbor, MI, USA.
⁴ Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI, USA.
⁵ Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
⁶ VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
⁷ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁸ Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
⁹ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA.

PMID: 31512184
PMCID: PMC6848397
DOI: 10.1007/s11606-019-05323-w

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Observational Study

Diagnosis and Care of Chronic Health Conditions Among Medicaid Expansion Enrollees: a Mixed-Methods Observational Study

Ann-Marie Rosland et al. J Gen Intern Med. 2019 Nov.

. 2019 Nov;34(11):2549-2558. doi: 10.1007/s11606-019-05323-w. Epub 2019 Sep 11. Authors Ann-Marie Rosland^{1 2}, Edith C Kieffer^{3 4}, Renuka Tipirneni^{4 5}, Jeffrey T Kullgren^{4 5 6}, Matthias Kirch⁴, Emily K Arntson⁷, Sarah J Clark^{4 8}, Sunghee Lee^{4 9}, Erica Solway⁴, Erin Beathard⁵, John Z Ayanian^{4 5 7 10}, Susan D Goold^{4 5 7} Affiliations

¹ Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. roslandam@pitt.edu.
² VA Pittsburgh Center for Health Equity Research and Promotion, Pittsburgh, PA, USA. roslandam@pitt.edu.
³ University of Michigan School of Social Work, Ann Arbor, MI, USA.
⁴ Institute for Healthcare Policy and Innovation (IHPI), University of Michigan, Ann Arbor, MI, USA.
⁵ Division of General Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.
⁶ VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
⁷ Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA.
⁸ Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA.
⁹ Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
¹⁰ Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, MI, USA.

PMID: 31512184
PMCID: PMC6848397
DOI: 10.1007/s11606-019-05323-w

Item in Clipboard

Abstract

Background: It is uncertain how Medicaid expansion under the Affordable Care Act influences the diagnosis of chronic health conditions, and the care and health of enrollees with chronic conditions.

Objective: Describe the prevalence of new and pre-existing chronic health conditions among Medicaid expansion enrollees. Examine whether perceived changes in specific types of access and self-rated health status differed between enrollees with chronic conditions and those without. Examine how gaining Medicaid coverage affected chronic disease management and well-being.

Design: Mixed-methods study including a telephone survey and semi-structured interviews.

Setting: Michigan's Medicaid expansion, the "Healthy Michigan Plan" (HMP).

Participants: 4090 survey respondents (response rate 54%) with ≥ 12 months HMP enrollment and 67 interviewees with ≥ 6 months enrollment.

Main measures: Self-reported chronic condition diagnoses, changes in physical/mental health, and healthcare access. Descriptive survey data were adjusted for survey design and nonresponse. Semi-structured interview questions about how gaining HMP coverage led to changes in health status.

Key results: Among enrollees, 68% had a self-reported diagnosis of a chronic health condition; 42% of those were newly diagnosed since HMP enrollment. In multivariable models, enrollees with chronic conditions were significantly more likely to report improved physical (adjusted odds ratio (aOR) 1.70, 95% CI (1.40, 2.07)) and mental health (aOR 1.75, (1.43, 2.15)) since HMP enrollment than enrollees without chronic conditions. Among enrollees with chronic conditions, the strongest predictors of improvements in health were having seen a primary care physician, improved mental health care access, and improved medication access. Interviewees with chronic conditions described how increased access to health care led to improvements in both physical and mental health.

Conclusions: Enrollees with expanded Medicaid coverage commonly reported detection of previously undiagnosed chronic conditions. Perceived health status and access improved more often among enrollees with chronic health conditions. Improved access was associated with improved physical and mental health among this vulnerable group.

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Conflict of interest statement

Dr. Kullgren has received consulting fees from See Change Health and Health Mine, and a speaking honorarium from AbilTo, Inc. All remaining authors declare that they do not have a conflict of interest.

Figures
Figure 1

Prevalence of chronic conditions—previously vs.…

Figure 1

Prevalence of chronic conditions—previously vs. newly diagnosed since Healthy Michigan Plan enrollment. COPD,…

Figure 1

Prevalence of chronic conditions—previously vs. newly diagnosed since Healthy Michigan Plan enrollment. COPD, chronic obstructive pulmonary disease. *Comparable Michigan Prevalence estimated using 2015 Michigan BRFSS results among respondents age 19–64 years old who did not report being pregnant or enrolled in Medicare, adjusted for BRFSS survey weights to more closely reflect the general Michigan population.^†Any chronic condition includes respondents who reported any of the following conditions: hypertension, heart disease, diabetes, mood disorders, stroke, asthma, COPD, or other. Write-in responses for “other” were verified and coded by two clinicians. Of all respondents with any chronic disease, 39.4% reported some “other” chronic disease, but only 8.9% of those with a chronic disease only selected “other.” Among all enrollees, a total of 6657 chronic diseases were indicated, including 1538 classified as “other” (23% of reported chronic conditions).