Medicaid’s Impact on Chronic Disease Biomarkers: A Cohort Study of Community Health Center Patients

Background Understanding the impact of health insurance is critical, particularly in the era of Affordable Care Act Medicaid expansion. The electronic health record (EHR) provides new opportunities to quantify health outcomes. Objective To assess changes in biomarkers of chronic disease among commun...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 2017-08, Vol.32 (8), p.940-947
Main Authors: Hatch, Brigit, Marino, Miguel, Killerby, Marie, Angier, Heather, Hoopes, Megan, Bailey, Steffani R, Heintzman, John, O’Malley, Jean P, DeVoe, Jennifer E
Format: Article
Language:English
Subjects:
Adults
Biomarkers
Blood pressure
Chronic conditions
Chronic illnesses
Clinical trials
Cohort analysis
Diabetes
Diabetes mellitus
Electronic health records
Electronic medical records
Government programs
Health care
Health insurance
Health Policy
Hemoglobin
Hyperlipidemia
Hypertension
Indigent care
Insurance
Internal Medicine
Low density lipoprotein
Medicaid
Medical research
Medicine
Medicine & Public Health
Patients
Regression analysis
Regression models
Uninsured people
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Summary:Background Understanding the impact of health insurance is critical, particularly in the era of Affordable Care Act Medicaid expansion. The electronic health record (EHR) provides new opportunities to quantify health outcomes. Objective To assess changes in biomarkers of chronic disease among community health center (CHC) patients who gained Medicaid coverage with the Oregon Medicaid expansion (2008–2011). Design Prospective cohort. Patients were followed for 24 months, and rate of mean biomarker change was calculated. Time to a controlled follow-up measurement was compared using Cox regression models. Setting/Patients Using EHR data from OCHIN (a non-profit network of CHCs) linked to state Medicaid data, we identified three cohorts of patients with uncontrolled chronic conditions (diabetes, hypertension, and hyperlipidemia). Within these cohorts, we included patients who gained Medicaid coverage along with a propensity score-matched comparison group who remained uninsured (diabetes n  = 608; hypertension n  = 1244; hyperlipidemia n  = 546). Main Measures Hemoglobin A1c (HbA1c) for the diabetes cohort, systolic and diastolic blood pressure (SBP and DBP, respectively) for the hypertension cohort, and low-density lipoprotein (LDL) for the hyperlipidemia cohort. Key Results All cohorts improved over time. Compared to matched uninsured patients, adults in the diabetes and hypertension cohorts who gained Medicaid coverage were significantly more likely to have a follow-up controlled measurement (hazard ratio [HR] =1.26, p  = 0.020; HR = 1.35, p  
ISSN:0884-8734
1525-1497
DOI:10.1007/s11606-017-4051-9