Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

Huguet, Nathalie; Angier, Heather; Hoopes, Megan; Heintzman, John; Schmidt, Teresa; DeVoe, Jennifer E.

doi:10.3122/jabfm.2019.06.190087

Cited by 17 publications

(25 citation statements)

References 17 publications

(8 reference statements)

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“…24 Huguet et al found a large increase in the prevalence of pre-existing conditions from pre-to post-ACA among CHC patients residing in Medicaid expansion states who were uninsured in the pre-period. 25,26 These findings suggest that a large proportion of conditions were underdiagnosed and undertreated pre-ACA Medicaid expansion due to limited access. Underdiagnosis of chronic conditions has significant health implications: the detection of chronic conditions at the earliest stage possible is critically important to ensure appropriate treatment, decrease risk of complications, and reduce associated costs.…”

Section: Pre-existing Health Conditions Were Diagnosedmentioning

confidence: 96%

“…1 Huguet et al assessed the prevalence of pre-existing conditions post-ACA Medicaid expansion among patients who had no insurance coverage in the pre-ACA period, and demonstrated a high prevalence of mental health diagnoses among CHC patients in both states that expanded Medicaid and those that chose not to. 26,28 Mental health disorders were shown to be the most common conditions among CHC patients who gained Medicaid or private insurance following the ACA Medicaid expansion. 26,28 Specifically, the diagnosis with the highest percent increase from pre-to post-ACA Medicaid expansion was a substance use disorder.…”

Section: Mental Health Parity Mattersmentioning

confidence: 99%

“…26,28 Mental health disorders were shown to be the most common conditions among CHC patients who gained Medicaid or private insurance following the ACA Medicaid expansion. 26,28 Specifically, the diagnosis with the highest percent increase from pre-to post-ACA Medicaid expansion was a substance use disorder. 26 The data also showed that non-Hispanic Black and Hispanic patients experienced greater increases in these diagnoses pre-to post-ACA Medicaid expansion.…”

Section: Mental Health Parity Mattersmentioning

confidence: 99%

“…26,28 Specifically, the diagnosis with the highest percent increase from pre-to post-ACA Medicaid expansion was a substance use disorder. 26 The data also showed that non-Hispanic Black and Hispanic patients experienced greater increases in these diagnoses pre-to post-ACA Medicaid expansion. In these groups, diagnosis of substance use disorders more than doubled.…”

Section: Mental Health Parity Mattersmentioning

confidence: 99%

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The Affordable Care Act Medicaid Expansion Positively Impacted Community Health Centers and Their Patients

et al. 2020

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Community health centers (CHCs) provide primary care for underserved children and adults. The Patient Protection and Affordable Care Act (ACA) aimed to strengthen the CHC network by increasing federal funds and expanding Medicaid eligibility. The ACA also aimed to boost preventive and mental health services and to reduce health and healthcare disparities. Here, we summarize our results to-date as experts in investigating the impact of ACA Medicaid expansion on CHCs and the patients they serve. We found the ACA Medicaid expansion increased access to care and preventive services, primarily in Medicaid expansion states. Rates of physical and mental health conditions rose substantially from pre-to post-ACA in expansion states, suggesting underdiagnosis pre-ACA. Disparities in health insurance coverage by race/ethnicity decreased at CHCs, yet some remain. These findings indicate that the ACA Medicaid expansion significantly helped CHCs and patients. Insurance expansion buoyed CHCs' financial viability by increasing reimbursement. Therefore, the ACA Medicaid expansion enhanced the health of underserved patients and repeal would jeopardize these advances for CHCs and their patients.

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Section: Pre-existing Health Conditions Were Diagnosedmentioning

confidence: 96%

Section: Mental Health Parity Mattersmentioning

confidence: 99%

Section: Mental Health Parity Mattersmentioning

confidence: 99%

Section: Mental Health Parity Mattersmentioning

confidence: 99%

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The Affordable Care Act Medicaid Expansion Positively Impacted Community Health Centers and Their Patients

et al. 2020

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“…Electronic health record data from over 78,000 uninsured patients aged 19 to 64 years in 386 Community Health Centers in 19 states contain a high level of pre-existing conditions. Huguet et al 20 compared the prevalence and types of preexisting conditions before the Affordable Care Act (ACA) in 2012 to 2013 and post-ACA (2014 to 2015) by insurance status and race/ethnicity. This study emphasizes the high prevalence of pre-existing conditions among Community Health Center patients and the large increase in the proportion of patients with at least one pre-existing condition post-ACA.…”

Section: Social Determinants Of Health-challenges To Best Medical Carmentioning

confidence: 99%

New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine

Bowman¹,

Neale²,

Seehusen

2019

J Am Board Fam Med

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From the United States and Netherlands, we have 2 articles on back pain, with findings that indicate significant treatment differences between the countries, and a high likelihood of persistence. The Inflammatory Diet is now shown to be related to diabetes. Multiple perspectives on palliative care for the homeless. Could pharmacists assist in preventing suicide? There are changes in the practice of family medicine. Social determinants of health substantially influence health and medical care. Moreover, care for patients from deprived communities is under-reimbursed. Patient pre-existing conditions increased after the Affordable Care Act, suggesting that repealing pre-existing condition protections would likely exacerbate disparities in health and health care. (J Am Board Fam Med 2019;32:759-762.) Interventions and Long-Term Outcomes of Back Pain in Older Patients Early imaging of patients with low back pain is discouraged unless certain "red flags" are present; older age is 1 of the recognized red flags. Powell et al 1 examined the long-term implications of early imaging in more than 57,000 patients in Medicare Advantage Plans. Patients seeing primary care or chiropractors for the initial visit had less imaging and fewer interventions. Imaging was associated with increased narcotic use and surgical intervention. Some of the findings are troubling in light of the ongoing "opioid epidemic." Unfortunately, van der Gaag et al 2 found that back pain in Dutch adults over age 55 years is quite persistent over the next 5 years. Of note, the imaging rate was substantially higher in the United States than in the Netherlands. The use of physical therapy or chiropractic therapy was higher in the Netherlands. Perhaps, we should also think, "Yoga anyone?" Penrod et al 3 found that back pain is one of the most common associations with mentions of yoga in the medical records of a large health system. In addition, over 10 years, the percentage of charts with mention of yoga increased 10-fold.

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Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

et al. 2020

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IMPORTANCE Understanding opioid prescribing patterns in community health centers (CHCs) that disproportionately serve low-income patients may help to guide strategies to reduce opioidrelated harms. OBJECTIVE To assess opioid prescribing patterns between January 1, 2009, and December 31, 2018, in a network of safety-net clinics serving high-risk patients. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 3 227 459 opioid prescriptions abstracted from the electronic health records of 2 129 097 unique primary care patients treated from 2009 through 2018 at a network of CHCs that included 449 clinic sites in 17 states. All age groups were included in the analysis. MAIN OUTCOMES AND MEASURES The following measures were described at the population level for each study year: (1) percentage of patients with at least 1 prescription for an opioid by age and sex, (2) number of opioid prescriptions per 100 patients, (3) number of long-acting opioid prescriptions per 100 patients, (4) mean annual morphine milligram equivalents (MMEs) per patient, (5) mean MME per prescription, (6) number of chronic opioid users, and (7) mean of high-dose opioid users. RESULTS The study population included 2 129 097 patients (1 158 413 women [54.4%]) with a mean (SD) age of 32.2 (21.1) years and a total of 3 227 459 opioid prescriptions. The percentage of patients receiving at least 1 opioid prescription in a calendar year declined 67.4% from 15.9% in 2009 to 5.2% in 2018. Over the 10-year study period, a greater percentage of women received a prescription (13.1%) compared with men (10.9%), and a greater percentage of non-Hispanic White patients (18.1%) received an opioid prescription compared with non-Hispanic Black patients (9.5%), non-Hispanic patients who self-identified as other races (8.0%), and Hispanic patients (6.9%). The number of opioid prescriptions for every 100 patients decreased 73.7% from 110.8 in 2009 to 29.1 in 2018. The number of long-acting opioids for every 100 patients decreased 85.5% during the same period, from 22.0 to 3.2. The MMEs per patient decreased from 1682.7 in 2009 to 243.1 in 2018, a decline of 85.6%. CONCLUSIONS AND RELEVANCE In this cross-sectional study, the opioid prescribing rate in 2009 in the CHC network was higher than national population estimates but began to decline earlier and more precipitously. This finding likely reflects harm mitigation policies and efforts at federal, state, and clinic levels and strong clinical quality improvement strategies within the CHCs.

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Prevalence of Pre-existing Conditions Among Community Health Center Patients Before and After the Affordable Care Act

Cited by 17 publications

References 17 publications

The Affordable Care Act Medicaid Expansion Positively Impacted Community Health Centers and Their Patients

The Affordable Care Act Medicaid Expansion Positively Impacted Community Health Centers and Their Patients

New Research on Back Pain, Diet and Diabetes, Advanced Care Planning, and Other Issues Frequently Seen in Family Medicine

Assessment of Opioid Prescribing Patterns in a Large Network of US Community Health Centers, 2009 to 2018

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