Open Enrollment Timeline for 2016 Marketplace Coverage

Via:  https://goo.gl/Mqc0Yj

The Impact of Comprehensive Case Management on HIV Client Outcomes

In 1990, New York State instituted Comprehensive Medicaid Case Management, also known as Target Case Management (TCM), for people dealing with multiple comorbid conditions, including HIV. 

The goal of TCM is to assist clients in navigating the health care system to increase care engagement and treatment adherence for individuals with complex needs. HIV-positive individuals engaged in care are more likely to be virally suppressed, improving clinical outcomes and decreasing chances of HIV transmission. 

The purpose of this study was to understand the impact of TCM management on outcomes for people with HIV. Data were obtained from Amida Care, which operates not-for-profit managed care Medicaid and Medicare Special Needs Plans (SNPs) for HIV clients. Changes in clinical, cost, as well as medical and pharmacy utilization data among TCM clients were examined between January 2011 through September 2012 from the start of case management enrollment through the end of the study period (i.e., up to 6 months after disenrollment). Additionally, CD4 counts were compared between Amida Care TCM clients and non-TCM clients. 

Notable findings include increased CD4 counts for TCM clients over the one-year study period, achieving parity with non-TCM clients (i.e., Mean CD4 count > 500). When looking exclusively at TCM clients, there were increases in medication costs over time, which were concomitant with increased care engagement. Current findings demonstrate that TCM is able to achieve its goals of improving care engagement and treatment adherence. 

Subsequent policy changes resulting from the Affordable Care Act and the New York State Medicaid Redesign have made the Health Home the administrator of TCM services. Government entities charged with securing and managing TCM and care coordination for people with HIV should provide thoughtful and reasonable guidance and oversight in order to maintain optimal clinical outcomes for TCM clients and reduce the transmission of HIV.

Full article at:   http://goo.gl/Lz1c6Z

By:  Brennan-Ing M1,2, Seidel L1,3, Rodgers L4, Ernst J1,5, Wirth D5, Tietz D6, Morretti A7, Karpiak SE1,2.

• 1Center on HIV and Aging, ACRIA, New York, New York, United States of America.
• 2College of Nursing, New York University, New York, New York, United States of America.
• 3Graduate School of Social Service, Fordham University, New York, New York, United States of America.
• 4BOOM! Health, Bronx, New York, United States of America.
• 5Amida Care, Inc., New York, New York, United States of America.
• 6Human Resources Administration, City of New York, New York, New York, United States of America.
• 7Columbia University, New York, New York, United States of America. 
• PLoS One. 2016 Feb 5;11(2):e0148865. doi: 10.1371/journal.pone.0148865.

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Health Insurance Coverage among Women of Reproductive Age Before & After Implementation of the Affordable Care Act

OBJECTIVES:

The Affordable Care Act's expansions to Medicaid and private coverage are of particular importance for women of childbearing age, who have numerous preventive care and reproductive health care needs.

STUDY DESIGN:

We conducted two national surveys, one in 2012 and one in 2015, collecting information about health insurance coverage and access to care from 8000 women aged 18-39. We examine type of insurance and continuity of coverage between time periods, including by poverty status and whether or not women live in a state that expanded Medicaid coverage.

RESULTS:

The proportion of women who were uninsured declined by almost 40% (from 19% to 12%), though several groups, including U.S. born and foreign-born Latinas, experienced no significant declines. Among low-income women in states that expanded Medicaid, the proportion uninsured declined from 38% to 15%, largely due to an increase in Medicaid coverage (from 40% to 62%). Declines in uninsurance in non-expansion states were only marginally significant.

CONCLUSIONS:

Despite substantial improvements in health insurance coverage, significant gaps remain, particularly in states that have not expanded Medicaid and for Latinas.

IMPLICATIONS:

This analysis examines changes in insurance coverage that occurred after the Affordable Care Act was implemented. While coverage has improved for many populations, sizeable gaps in coverage remain for Latinas and women in states that did not expand Medicaid.

Full article at:   http://goo.gl/Zqz3r9

By:  Jones RK1, Sonfield A2.

• 1Guttmacher Institute, 125 Maiden Lane, 7(th) Floor, New York, NY 10038. Electronic address: rjones@guttmacher.org.
• 2Guttmacher Institute, 1301 Connecticut Avenue N.W., Suite 700, Washington, D.C. 20036. Electronic address: asonfield@guttmacher.org.
• Contraception. 2016 Jan 20. pii: S0010-7824(15)30093-7. doi: 10.1016/j.contraception.2016.01.003.  

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Changes in Out-Of-Pocket Costs for Hormonal IUDs After Implementation of the Affordable Care Act: An Analysis of Insurance Benefit Inquiries

BACKGROUND:

The Affordable Care Act (ACA) requires that privately insured women can obtain contraceptive services and supplies without cost sharing. This may substantially affect women who prefer an intrauterine device (IUD), a long-acting reversible contraceptive, because of high upfront costs that they would otherwise face. However, imperfect enforcement of and exceptions to this provision could limit its effect.

STUDY DESIGN:

We analyzed administrative data for 417,221 women whose physicians queried their insurance plans from January 2012 to March 2014 to determine whether each woman had insurance coverage for a hormonal IUD and the extent of that coverage.

RESULTS:

In January 2012, 58% of women would have incurred out-of-pocket costs for an IUD, compared to only 13% of women in March 2014. Differentials by age and region virtually dissolved over the period studied, which suggests that the ACA reduced inequality among insured women.

CONCLUSIONS:

Our findings suggest that the cost of hormonal IUDs fell to US$0 for most insured women following the implementation of the ACA.

IMPLICATIONS:

Financial barriers to one of the most effective methods of contraception fell substantially following the ACA. If more women interested in this method can access it, this may contribute to a decline in unintended pregnancies in the United States.

Below:  Percentage of women who would have had out-of-pocket costs for a hormonal IUD, by month. Note: The lighter line begins in January 2013 because the 2012 data do not contain insertion copayments and deductible applicability.

Below:  In each age group: percentage of women who would have had out-of-pocket costs for a hormonal IUD, by quarter

Below:  In each region: percentage of women would have had out-of-pocket costs for a hormonal IUD, by quarter

Full article at:   http://goo.gl/0ilVW4

By:  Bearak JM1, Finer LB2, Jerman J2, Kavanaugh ML2.

• 1Guttmacher Institute, New York, NY 10038, USA. Electronic address: jbearak@guttmacher.org.
• 2Guttmacher Institute, New York, NY 10038, USA. 
• Contraception. 2016 Feb;93(2):139-44. doi: 10.1016/j.contraception.2015.08.018. Epub 2015 Sep 16.

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The ACA and People with HIV: Video Profiles from the Field

Via:  http://goo.gl/8TE04z

Medicaid Expansion Did Not Result In Significant Employment Changes or Job Reductions in 2014

Medicaid expansion undertaken through the Affordable Care Act (ACA) is already producing major changes in insurance coverage and access to care, but its potential impacts on the labor market are also important policy considerations. 

Economic theory suggests that receipt of Medicaid might benefit workers who would no longer be tied to specific jobs to receive health insurance (known as job lock), giving them more flexibility in their choice of employment, or might encourage low-income workers to reduce their hours or stop working if they no longer need employment-based insurance. Evidence on labor changes after previous Medicaid expansions is mixed. 

To view the impact of the ACA on current labor market participation, we analyzed labor-market participation among adults with incomes below 138 percent of the federal poverty level, comparing Medicaid expansion and nonexpansion states and Medicaid-eligible and -ineligible groups, for the pre-ACA period (2005-13) and the first fifteen months of the expansion (January 2014-March 2015). Medicaid expansion did not result in significant changes in employment, job switching, or full- versus part-time status. 

While we cannot exclude the possibility of small changes in these outcomes, our findings rule out the large change found in one influential pre-ACA study; furthermore, they suggest that the Medicaid expansion has had limited impact on labor-market outcomes thus far.

Purchase full article at:   http://goo.gl/UViyzj

By:  Gooptu A1, Moriya AS2, Simon KI3, Sommers BD4.

• 1Angshuman Gooptu is a doctoral student in the School of Public and Environmental Affairs at Indiana University, in Bloomington.
• 2Asako S. Moriya (Asako.Moriya@ahrq.hhs.gov) is a service fellow economist in the Center for Financing, Access and Cost Trends at the Agency for Healthcare Research and Quality, in Rockville, Maryland.
• 3Kosali I. Simon is a professor in the School of Public and Environmental Affairs at Indiana University and a research associate at the National Bureau of Economic Research in Cambridge, Massachusetts.
• 4Benjamin D. Sommers is an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health and in the Department of Medicine at Brigham and Women's Hospital, in Boston, Massachusetts.
• Health Aff (Millwood). 2016 Jan 1;35(1):111-8. doi: 10.1377/hlthaff.2015.0747. 

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Health-Related Outcomes among the Poor: Medicaid Expansion vs. Non-Expansion States

Introduction

States’ decisions not to expand Medicaid under the Affordable Care Act (ACA) could potentially affect access to care and health status among their low-income residents.

Methods

The 2010–2012 nationally representative Medical Expenditure Panel Survey data were analyzed in 2015 to compare 9755 low-income adults aged 18–64 years from Medicaid-expanding states with 7455 adults from nonexpanding states. Multivariate logistic regression models were fitted to evaluate the differences in access to care, receipt of preventive services, quality of care, attitudes about health and self-reported health status by Medicaid expansion status. The differences in care utilization and medical expenditures between the two groups were examined using a 2-part modeling approach.

Results

Compared to their counterparts in Medicaid expansion states, low income adults in the nonexpanding states were more likely to be black and reside in rural areas and were less likely to have a usual source of care (prevalence ratio[PR] 0.86, 95% confidence interval[CI] 0.82–0.91) and recommended preventive services such as dental checkups (PR = 0.86; CI = 0.79–0.94), routine checks (PR = 0.89; CI = 0.83–0.95), flu vaccinations (PR = 0.89; CI = 0.81–0.98), and blood pressure checks (PR = 0.96; CI = 0.94–0.99). They also had less care utilization, fewer prescriptions, and less medical expenditures, but more out-of-pocket expenditures (all p-value <0.05).

Conclusions

Low-income adults in Medicaid nonexpanding states, who are disproportionately represented by blacks and rural residents, were worse off for multiple health-related outcomes compared to their counterparts in Medicaid expanding states at the baseline of ACA implementation, suggesting that low income adults residing in nonexpanding states may benefit markedly from the expansion of Medicaid

Below:  Number of care utilization and expenditures by Medicaid expansion status among low income population aged 18–64 years

Full article at:   http://goo.gl/KCUJBx

By:   

Xuesong Han, Binh T. Nguyen, Jeffrey Drope, Ahmedin Jemal

Intramural Research, American Cancer Society, Atlanta, Georgia, United States of America

Xuesong Han, Ahmedin Jemal

Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America

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We Mapped the Uninsured, You'll Notice a Pattern

Via:  http://ht.ly/UZkKw  By: https://twitter.com/nytimes

Limited Patient Access to HIV Drugs in ACA Exchange Plans Is Limited Compared to Other Sources of Coverage

New analysis from Avalere finds that only 16 percent of silver exchange plans in 2015 cover all top HIV drug regimens with cost sharing less than $100 per month per regimen. While almost half of plans include all 10 of the most commonly used HIV regimens on their formularies, many plans charge higher out-of-pocket costs for these drugs...

Read more at:  http://ht.ly/Uykq4  By:  https://twitter.com/avalerehealth

Women’s Awareness of Their Contraceptive Benefits Under the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act mandates that there be no out-of-pocket cost for Food and Drug Administration–approved contraceptive methods. Among 987 privately insured reproductive aged Pennsylvania women, fewer than 5% were aware that their insurance covered tubal sterilization, and only 11% were aware that they had full coverage for an intrauterine device. For the Affordable Care Act contraceptive coverage mandate to affect effective contraception use and reduce unintended pregnancies, public awareness of the expanded benefits is essential.

Half of the pregnancies in the United States are unintended.1 Cost is a barrier to contraceptive use; in fact, when contraception is provided at no cost, women choose more effective and more expensive methods, such as long-acting reversible contraceptives (LARCs)—which include intrauterine devices (IUDs) and contraceptive implants—and have fewer unintended pregnancies.2,3 The Patient Protection and Affordable Care Act (ACA; Pub L No. 111–148) eliminates the cost barrier to contraception for most women with private health insurance by mandating coverage without patient cost sharing for Food and Drug Administration–approved contraceptive methods and tubal sterilization.4 Although this contraceptive coverage requirement went into effect in August 2012,5 whether privately insured women are aware of their newly expanded contraceptive benefits is unknown.

...Privately insured women are largely unaware of their contraceptive benefits under the ACA, and a substantial proportion would switch methods if there were no cost barrier. It is unclear whether the high proportion of women reporting “I don’t know” about coverage reflects a lack of method awareness or a lack of knowledge about coverage, which is a study limitation.

Before the ACA, studies suggested that full contraceptive coverage could increase use of LARCs and reduce unintended pregnancies and abortions. In 2002, the Kaiser Foundation Health Plan in California sent quarterly outreach publications to inform enrollees of their policy change to include 100% coverage of injectables and LARCs, resulting in a significant increase in the use of these methods.7 In the CHOICE project, women in the St. Louis, Missouri, region received dedicated counseling promoting LARCs and were provided no-cost contraception, resulting in a high uptake of LARCs and a reduction in unintended pregnancy.3 These demonstrations suggest that the ACA mandate may not lead to more effective contraceptive method use without efforts to inform both women and health care providers of the coverage mandate and to provide accurate information about method options. Furthermore, it is not clear whether insurers are complying with the mandate8 or if there is an adequate workforce to provide LARCs.9 Although system-level barriers to female sterilization under Medicaid regulations are well recognized, low awareness of coverage for sterilization may prove to be a barrier even among privately insured women.10

For the ACA contraceptive coverage mandate to affect the use of effective contraception, raising women’s awareness of the expanded benefit is an essential first step. Private insurers, health care providers, and policymakers must do a better job of communicating the benefit, or this could be a missed opportunity to reduce unintended pregnancies and abortions among US women.

Below:  Awareness of contraceptive coverage based on the question, “To the best of your knowledge, does your health insurance policy currently cover these birth control methods at no cost to you (no copay or deductible payment)?”: Pennsylvania, 2014. Note. IUD = intrauterine device. The sample size was n = 987.

Full article at:  http://goo.gl/QT25sl

By: Cynthia H. Chuang, MD, MSc, Julie L. Mitchell, DO, Diana L. Velott, MPA, MS, Richard S. Legro, MD, Erik B. Lehman, MS, Lindsay Confer, MPH, and Carol S. Weisman, PhD

Cynthia H. Chuang is with the Division of General Internal Medicine, Penn State College of Medicine, Hershey, PA. Julie L. Mitchell is with the Department of Medicine, Penn State College of Medicine. Diana L. Velott, Erik B. Lehman, Lindsay Confer, and Carol S. Weisman are with the Department of Public Health Sciences, Penn State College of Medicine. Richard S. Legro is with the Department of Obstetrics and Gynecology, Penn State College of Medicine.

Corresponding author.

Correspondence should be sent to Cynthia H. Chuang, MD, MSc, 500 University Drive, HO34, Division of General Internal Medicine, Penn State Hershey, Hershey, PA 17033 (e-mail: ude.usp.cmh@gnauhcc). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.

Contributors

C. H. Chuang was the principal investigator for the MyNewOptions study; she conceptualized the study and wrote the article. J. L. Mitchell, D. L. Velott, R. S. Legro, E. B. Lehman, L. Confer, and C. S. Weisman contributed to data interpretation and to writing the article. E. B. Lehman analyzed the data.

 

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Exploring Massachusetts Health Care Reform Impact on Fee-for-Service-Funded Substance Use Disorder Treatment Providers

The Affordable Care Act (ACA) is forecast to increase the demand for and utilization of substance use disorder (SUD) treatment. Massachusetts implemented health reforms similar to the ACA in 2006-2007 that included expanding coverage for SUD treatment. 

This study explored the impact of Massachusetts health reforms from 2007 to 2010 on SUD treatment providers in Massachusetts, who relied on fee-for-service billings for more than 50% of their revenue. The changes across treatment facilities located in Massachusetts were compared to changes in other similar fee-for-service-funded SUD treatment providers in Northeast states bordering Massachusetts and in all other states across the US. From 2007-2010, the percentage changes for Massachusetts based providers were significantly different from the changes among providers located in the rest of the US for admissions, outpatient census, average weeks of outpatient treatment, residential/in-patient census, detoxification census, length of average inpatient and outpatient stays, and provision of medication-assisted treatment. 

Contrary to previous studies of publicly funded treatment providers, the results of this exploratory study of providers dependent on fee-for-service revenues were consistent with some predictions for the overall effects of the ACA.

Purchase full article at: http://goo.gl/5ml3Xn

By: Fields D1, Pruett J2, Roman PM1.

• 1a Center for Research on Behavioral Health and Human Services Delivery, Institute for Behavioral Research , University of Georgia , Athens , GA .
• 2b School of Social Work , University of Georgia , Athens , GA .  

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Applying a PrEP Continuum of Care for Men Who Have Sex with Men in Atlanta, Georgia

Reductions in human immunodeficiency virus (HIV) incidence with pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) will require significant coverage of those at risk. We propose a simplified framework, similar to the HIV care continuum, to achieve protection with PrEP as follows: 1. At-risk MSM; 2. Awareness of and willingness to take PrEP; 3. Access to healthcare; 4. Receiving a prescription; and 5. Adhering to effective PrEP. We evaluated the PrEP care continuum on an Atlanta cohort of MSM and projected how many MSM might achieve protection from HIV. Even with optimistic estimates, few Atlanta MSM (15%) are projected to achieve protection from HIV with PrEP given the significant barriers described. Each continuum step represents an important point for intervention that could substantially increase the overall effectiveness of PrEP. In addition, novel strategies for PrEP delivery are needed to achieve the necessary effectiveness for Atlanta MSM at risk of HIV.

Below:  Theorectical model of the PrEP care continuum, factors relevant to uptake, and areas for intervention. Abbreviation: PrEP, pre-exposure prophylaxis

Below:  Distribution of health insurance status and Affordable Care Act (ACA) eligibility for (A) the total InvolveMENt cohort, (B) black MSM, (C) white MSM, and d) HIV seroconverters in the InvolveMENt cohort. *P < .001 for difference between white MSM, black MSM, and HIV serocoveters by chi-square test. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men.

Below:  The PrEP care continuum for (A) the total InvolveMENt cohort, (B) black MSM (C) white MSM and (D) HIV seroconverters in the InvolveMENt cohort. Abbreviations: HIV, human immunodeficiency virus; MSM, men who have sex with men; PrEP, pre-exposure prophylaxis.

Full article at: http://goo.gl/BvMLfn

By: Kelley CF1, Kahle E2, Siegler A2, Sanchez T2, Del Rio C3, Sullivan PS2, Rosenberg ES2.

• 1Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Department of Epidemiology.
• 2Department of Epidemiology.
• 3Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.  

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States’ Implementation of the Affordable Care Act & the Supply of Physicians Waivered to Prescribe Buprenorphine for Opioid Dependence

Highlights

• The impact of the Affordable Care Act (ACA) on the supply of buprenorphine-waivered physicians was examined.
• There was significant growth in physician supply from June 2013 to May 2015.
• States that were more supportive of ACA experienced greater growth in waivered physicians.
• Less growth was observed in states that were less supportive of ACA.

Although the Affordable Care Act (ACA) is anticipated to affect substance use disorder (SUD) treatment, its impact on the supply of physicians waivered to treat opioid dependence with buprenorphine has not been considered. This study examined whether states more supportive of ACA, meaning those that had opted to expand Medicaid and establish a state-based health insurance exchange, experienced greater growth in physician supply than less supportive states.

Buprenorphine physician supply, including total physician supply, supply of 30-patient physicians, and supply of 100-patient physicians per 100,000 state residents, was measured from June 2013 to May 2015. State characteristics were drawn from multiple secondary sources, with states categorized as ACA-supportive, ACA-hybrid (where states either expanded Medicaid or established a state-based exchange), or ACA-resistant (where states took neither action). Mixed effects regression was used to estimate state-level growth curves to test whether rates of growth varied by states’ approaches to implementing ACA.

The supply of waivered physicians grew significantly over the two-year period. Rates of growth were significantly lower in ACA-hybrid and ACA-resistant states relative to growth in ACA-supportive states. Average buprenorphine physician supply at baseline varied by region, the percentage of residents covered by Medicaid, and the supply of specialty SUD treatment programs.

This study found a positive impact of the ACA on growth in the supply of buprenorphine-waivered physicians in US states. Future research should address whether the ACA affects the number of patients receiving buprenorphine, Medicaid spending, and the quality of treatment services delivered.

Purchase full article at: http://goo.gl/AjKtj5

By: Hannah K. Knudsen, Michelle R. Lofwall, Jennifer R. Havens, Sharon L. Walsh

Department of Behavioral Science and Center on Drug and Alcohol Research, University of Kentucky, 845 Angliana Avenue, Room 204, Lexington, KY 40508, USA

  

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A Survey of Texas HIV, Sexually Transmitted Disease, Tuberculosis, and Viral Hepatitis Providers' Billing and Reimbursement Capabilities

The Affordable Care Act presents financial challenges and opportunities for publicly funded service providers. 

We assessed billing practices and anticipated barriers to third-party billing among organizations in Texas that provide publicly funded HIV, sexually transmitted diseases, tuberculosis, and viral hepatitis services. 

• One third to one half of the organizations did not bill for medical services. 
• The most common barrier to third-party billing was lack of staff knowledge about billing and coding. 

Future research must evaluate options for organizations and communities to maintain access to infectious disease services for vulnerable populations. 

Purchase full article at: http://goo.gl/W7b4OW

By: Flynn MB1, Atwood R1, Greenberg JB1, Ray T1, Kaye Harris K1.

• 1Matthew B. Flynn is with the Department of Sociology and Anthropology, Georgia Southern University. Robin Atwood, Jennifer B. Greenberg, Tara Ray, and Karol Kaye Harris are with the Department of Kinesiology and Health Education, The University of Texas at Austin.  

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