DECREASED RATES OF HEALTH PLAN DISENROLLMENT FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Author(s)

Kern DM, Willey V, Quimbo R, Chung H, Deshpande G, Cochetti PT
HealthCore Inc., Wilmington, DE, USA

OBJECTIVES: To quantify the time to and rates of health plan disenrollment for patients with Chronic Obstructive Pulmonary Disease (COPD) compared with a matched group of patients without COPD. METHODS:  Patients ≥40 years old were identified from the HealthCore Integrated Research Environment (HIRE) as having COPD if they had ≥1 inpatient claim with primary diagnosis of COPD; or, ≥1 ED claim or ≥2 outpatient/SNF/inpatient claims with non-primary COPD diagnosis. The index date for COPD cases was the earliest date at which they met the criteria for COPD during 1/1/2007-12/31/2014. Non-COPD patients include those who did not meet the criteria for COPD. COPD patients were matched to non-COPD patients using exact 1-to-1 matching according to age, gender, health plan type, region, primary policy holder status, ACA plan, and length of pre-index enrollment. Non-COPD patients were assigned an index date equal to that of their matched COPD case. All patients were required to have 12 months of pre-index enrollment. RESULTS:  657,766 health plan enrollees were matched (328,883 per cohort). Median follow-up time was 2.5 years for COPD and 1.7 for non-COPD patients. During follow-up, 55% of COPD patients disenrolled compared with 63% of non-COPD patients (rate ratio=0.69; 95% CI=[0.69, 0.69]); within those who disenrolled, time to disenrollment was longer for COPD patients (median=688 vs 346 days). Accounting for censoring, Cox regression showed similar results (hazard ratio (HR)=0.71) and were consistent across sensitivity analyses: (1) including death as a disenrollment event (HR=0.77), (2) excluding patients who died during the first 30 days of follow-up (HR=0.77). CONCLUSIONS:  Presence of COPD was found to be associated with a longer duration of health plan enrollment and decreased risk of disenrollment. This may be due to job-lock, in which patients with chronic medical conditions do not leave their employer due to the threat of losing their health insurance.

Conference/Value in Health Info

2017-05, ISPOR 2017, Boston, MA, USA

Value in Health, Vol. 20, No. 5 (May 2017)

Code

PHS183

Topic

Health Service Delivery & Process of Care

Topic Subcategory

Health Care Research

Disease

Respiratory-Related Disorders

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