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Article Title

Who Are the Users of Medicare’s New Preventive Visits Under the Affordable Care Act?

Publication Date

8-15-2016

Keywords

Affordable Care Act, preventive care

Abstract

Background/Aims: We found previously that under the Affordable Care Act’s new Medicare preventive visit coverage, called “Annual Wellness Visit,” preventive visits among Medicare fee-for-service (FFS) beneficiaries nearly doubled from 18% to 34%. The new coverage, however, may have differentially impacted subgroups of seniors. We hypothesized that preventive visit uptake would be greater for seniors who previously had frequent primary care visits, as they may have been “squeezing” preventive issues into office visits for acute and chronic care needs.

Methods: Medicare FFS beneficiaries aged 65–75 years who were primary care patients in a large, mixed-payer outpatient organization in northern California were studied. We examined patient characteristics associated with increased preventive visits between the period prior to (2007–2010) versus post (2011–2013) Medicare’s coverage expansion. The unit of analysis was patient-years (N = 112,888). Logistic regression was used with a dependent variable of “any preventive visit,” including both Medicare-covered and any privately paid preventive visits. Random effects model was used to account for multiple observations per patient. To identify subgroups of seniors who were more likely affected by the coverage expansion, we used interactions between “post period” and key patient characteristics: age 70–75 (vs. 65–69), frequency of nonpreventive primary care visits (1, 2, or 3+ vs. 0), and comorbidity by Charlson index (1 or 2+ vs. 0).

Results: Older seniors (odds ratio [OR]: 0.57 for age 70–75 vs. 65–69), males (OR: 0.92), and those who previously made frequent primary care visits (OR: 0.18 for 1 vs. 0; OR: 0.13 for 2 vs. 0; OR: 0.11 for 3+ vs. 0) and had more comorbidities (OR: 0.80 for 1 vs. 0; OR: 0.78 for 2 vs. 0; OR: 0.51 for 3+ vs. 0) were less likely to use annual preventive visits (P < 0.01 for each) during the study period (2007–2013). In contrast, after Medicare coverage expansion there was a significantly larger increase in the likelihood of using annual preventive visits among older seniors (OR: 1.5), males (OR: 1.1) and those who previously made frequent primary care visits (OR: 1.2 for 1 vs. 0; OR: 1.3 for 2 vs. 0; OR: 1.2 for 3+ vs. 0; P < 0.01 for each).

Conclusion: Seniors who were older and frequent users of primary care had been underutilizing preventive care. Medicare’s preventive service coverage expansion particularly benefited such seniors with needs for preventive care, but who may not have made separate preventive visits due to prior lack of coverage.

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