HEALTHCARE UTILIZATION POST-ACA: THE IMPACT OF MARKETPLACE INSURANCE ENROLLMENT GUIDES AND IMPLICATIONS FOR AN ACADEMIC HEALTH SYSTEM IN DELAWARE
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Date
2018-04-04
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Johns Hopkins University
Abstract
Purpose and Study Aim
The Patient Protection and Affordable Care Act expanded health insurance coverage, established Marketplace insurance exchanges, and required consumer enrollment assistance programs to facilitate sign-up. Christiana Care Health System, a leading provider of healthcare services to underserved individuals in Delaware, set up a MarketPlace Guide (MPG) program to provide enrollment assistance along with referrals to primary care and other services. This study identified the demographic and health characteristics of consumers assisted by the program and whether assistance impacted subsequent healthcare utilization.
Methods
We compared utilization in the emergency department (ED), outpatient, and inpatient settings between MPG-assisted and non-assisted groups with Poisson and negative binomial regression models and ran difference-in-difference analyses to compare changes in utilization between 2012 and 2014.
Key Results
The demographic characteristics of the MPG-assisted patients confirmed that the program was effective in reaching the socioeconomically disadvantaged. The majority of patients were low income and minority, with a higher proportion of males and younger individuals in the uninsured group than the Medicaid group. Chronic conditions were prevalent in both groups, although the Medicaid group had more chronic conditions.
Among Medicaid patients in 2014, utilization was 40% higher for MPG-assisted patients in the outpatient and ED regression models compared to unassisted patients. Findings were similar among the uninsured, with 1.4 times higher ED utilization and 4.2 times higher outpatient utilization for MPG-assisted patients. Comparing 2014 to 2012, outpatient and ED utilization increased among the Medicaid MPG group, while outpatient utilization decreased and ED utilization increased among the uninsured group, although the changes were not statistically significant between years or compared to the unassisted groups.
Implications
There was evidence, albeit not definitive, that the MPG program was associated with increased utilization and not solely in lower cost settings. This signifies a need to provide broader support to underserved communities who face barriers in accessing healthcare services and could be accomplished with “community health navigators” (CHN). Not-for-profit hospitals are well-positioned to administer CHN programs to address disparities and facilitate appropriate access to healthcare services, although more research is needed to determine cost-effectiveness and impact on health disparities.
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Keywords
Affordable Care Act, Community Health Workers