Using the electronic health record for assessment of health insurance in community health centers

Abstract

Objective: To demonstrate use of the electronic health record (EHR) for health insurance surveillance and identify factors associated with lack of coverage.

Materials and methods: Using EHR data, we conducted a retrospective, longitudinal cohort study of adult patients (n = 279 654) within a national network of community health centers during a 2-year period (2012-2013).

Results: Factors associated with higher odds of being uninsured (vs Medicaid-insured) included: male gender, age >25 years, Hispanic ethnicity, income above the federal poverty level, and rural residence (P < .01 for all). Among patients with no insurance at their initial visit (n = 114 000), 50% remained uninsured for every subsequent visit.

Discussion: During the 2 years prior to 2014, many patients utilizing community health centers were unable to maintain stable health insurance coverage.

Conclusion: As patients gain access to health insurance under the Affordable Care Act, the EHR provides a novel approach to help track coverage and support vulnerable patients in gaining and maintaining coverage.

Trial registration: ClinicalTrials.gov NCT02355262.

Keywords: Patient Protection and Affordable Care Act; community health centers; electronic health records; health insurance; health services accessibility.

© The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Figures

Figure 1:

Distribution of OCHIN primary care clinic visits per person, 2012–2013 (total no. of visits = 1 189 933).

Figure 2

Longitudinal assessment of insurance status over 2 years, 2012–2013. a Gained Other: At least one subsequent visit with other insurance and none with Medicaid or commercial insurance b Gained Commercial: At least one subsequent visit with commercial insurance c Gained Medicaid: At least one subsequent visit with Medicaid and none with commercial insurance d Lost Insurance: At least one subsequent uninsured visit e Kept Insurance: Every subsequent visit with insurance