Conclusion of Assessing a Medicaid Randomized Insurance Experiment within Community Clinics

By Heather Angier

Cardiovascular disease (CVD) risk can be reduced through early detection, yet disparities persist in receipt of these services. Oregon Health & Science University and OCHIN, Inc. (not an acronym) conducted a five-year study to better understand the impact gaining Medicaid had on CVD prevention. The study was funded by the National Heart, Lung, and Blood Institute (R01 HL107647 04); Principal Investigator: Jennifer E DeVoe.

We utilized the Oregon Experiment, a policy that offered uninsured adults a random chance to apply for Oregon Health Plan [(OHP); Oregon’s Medicaid) coverage, to conduct this research study. The Oregon Experiment included >90,000 names on the reservation list of those interested in gaining Medicaid. Of those approximately 30,000 people were randomly selected to apply and approximately 10,000 were enrolled in Medicaid in 2008.

We examined Oregon Medicaid enrollment and claims data plus the Oregon Experiment reservation list linked to electronic health record (EHR) data from OCHIN’s Oregon community health centers. OCHIN is a health information technology organization that provides a central, linked instance of the Epicare© EHR to its member clinics.

Our principal findings include the following:

  • Patients delay care when uninsured
  • EHRs are a promising source of data to improve quality reporting
  • Medicaid coverage is associated with receipt of several preventive services
  • Medicaid coverage is associated with increased utilization of primary care visits, labs, referrals, and imaging
  • After a short-term spike, demand among the newly Medicaid insured was sustained at a level similar to continuously insured patients
  • Even if patients have a healthcare visit, they may delay receipt of recommended preventive care during insurance coverage gaps

 

This study resulted in 12 published manuscripts, 3 additional manuscripts submitted and under peer-review, 1 forthcoming manuscript submission, and 21 presentations and is a national model of utilization of EHR datasets as tools to measure receipt of CVD preventive care. Findings can also be used to anticipate changes due to the Affordable Care Act.