The Early Effects Of The ACA

By Megan Williams, contributing writer

athenahealth’s non-partisan look at the impact of the Affordable Care Act provides detailed insight into patient behavior and market response.

Much has been said about the Affordable Care Act, but a recent report – made possible by a partnership between the Robert Wood Johnson Foundation and athenaResearch (a department of athenahealth) – provides additional and valuable insight.

The report, ACAView: Tracking The Impact Of Healthcare Reform, introduces approximately 35 metrics derived from data obtained from medical practices to provide near real-time visibility into patient characteristics, clinical activities, and practice economics. The reports are obtained from providers on a monthly basis and their first quarterly report covers data through May, 2014. The first report from the collaboration provides three key findings:

• Providers are so far not seeing an uptick of new patients.
• There is no evidence of greater health needs since coverage expansion.
• The Medicaid case-mix is increasing in Medicaid-expansion states, and decreasing in non-expansion states.

New Patients Holding Steady

The study found new patient numbers (defined as patients who had not visited a practice in the previous two calendar years) did not increase for specialty visits for the first five months of 2014 as compared to the same period in 2013. Pediatrics being the exception, most specialists saw a decrease.

The study notes this lack of change may be due to the fact that the newly insured are continuing to seek care in emergency departments, even for non-emergent needs. These new patients may alternatively still be in the process of shopping for physicians, scheduling appointments, and waiting to be seen. Severe weather in some parts of the country during this first quarter was also noted as a possible reason for the lack of movement in new patient visit numbers.

Health Needs Not Increasing

Perhaps the most notable statistic in this area was the fact that new patients demonstrated a lower rate of chronic disease than established patients. The rate of diabetes in 2013 among established patients was 9.4 percent compared with 5.3 percent for new patients. The rates for high blood pressure and high cholesterol among new patients showed similar trends.

The exception was small medical practices in the South which saw an increase of the diagnosis of diabetes of 12 percent in relative terms from 2013 to 2014. For high blood pressure, an increase of 7 percent was recorded, and cholesterol saw a slight increase of 2 percent.

Medicaid Case Mixes Changing As Expected

In short, ACA coverage appears to be exacerbating the pre-existing gap between states that elected to pursue Medicaid expansion and those that did not. The ACA originally would have extended Medicaid coverage to everyone below 138 percent of the federal poverty level, with federal funds covering almost all of the expansion.

After the Supreme Court ruling of 2012 that some of the provisions of the act were too coercive, states split along party lines regarding their Medicaid expansion. The increase in Medicaid coverage, while covering an additional six million citizens overall, has amounted to a 15.3 percent increase in expansion states, compared to a 3.3 percent increase in non-expansion states.

To read more on the Affordable Care Act’s impact on IT in the healthcare industry, please visit our library of articles on the topic.