ArticleJournal of acquired immune deficiency syndromes (1999)2016
Implementation and Operational Research: Affordable Care Act Implementation in a California Health Care System Leads to Growth in HIV-Positive Patient Enrollment and Changes in Patient Characteristics.
Article in Journal of acquired immune deficiency syndromes (1999), 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 18 citations in OpenAlex.
- Sociodemographic and clinical factors associated with use of depression treatment among people with HIV in the United States: An electronic health records-based cohort study.Journal of affective disorders · 2025Article
- The relationship of smoking and unhealthy alcohol use to the HIV care continuum among people with HIV in an integrated health care system.Drug and alcohol dependence · 2021Article
- What the HIV Pandemic Experience Can Teach the United States About the COVID-19 Response.Journal of acquired immune deficiency syndromes (1999) · 2021Article
- Health care utilization and HIV clinical outcomes among newly enrolled patients following Affordable Care Act implementation in a California integrated health system: a longitudinal study.BMC health services research · 2020Article
- Smoking and cessation treatment among persons with and without HIV in a U.S. integrated health system.Drug and alcohol dependence · 2020Article
- Changes in Days of Unhealthy Alcohol Use and Antiretroviral Therapy Adherence, HIV RNA Levels, and Condomless Sex: A Secondary Analysis of Clinical Trial Data.AIDS and behavior · 2020Article
- Article
- Adverse childhood experiences, mental health, substance use, and HIV-related outcomes among persons with HIV.AIDS care · 2019Article
- Implementing electronic substance use disorder and depression and anxiety screening and behavioral interventions in primary care clinics serving people with HIV: Protocol for the Promoting Access to Care Engagement (PACE) trial.Contemporary clinical trials · 2019Article
- Characteristics of patients with substance use disorder before and after the Affordable Care Act.Drug and alcohol dependence · 2018Article
- Evaluating the Impact of Eliminating Copayments for Tobacco Cessation Pharmacotherapy.Medical care · 2018Article
- Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.Preventive medicine · 2018Article
- Association of the Affordable Care Act With Smoking and Tobacco Treatment Utilization Among Adults Newly Enrolled in Health Care.Medical care · 2017Article
- Mental and Physical Quality of Life by Age Groups in People Living With HIV.The Journal of the Association of Nurses in AIDS Care : JANACArticle
- Buprenorphine Treatment and Patient Use of Health Services after the Affordable Care Act in an Integrated Health Care System.Journal of psychoactive drugsArticle
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
Abstract
objectivesThis study examined implementation of the Affordable Care Act (ACA) in relation to HIV-positive patient enrollment in an integrated health care system; as well as changes in new enrollee characteristics, benefit structure, and health care utilization after key ACA provisions went into effect in 2014.
methodsThis mixed-methods study was set in Kaiser Permanente Northern California (KPNC). Qualitative interviews with 29 KPNC leaders explored planning for ACA implementation. Quantitative analyses compared newly enrolled HIV-positive patients in KPNC between January and December 2012 ("pre-ACA," N = 661) with newly enrolled HIV-positive patients between January and December 2014 ("post-ACA," N = 880) on demographics; medical, psychiatric, and substance use disorder diagnoses; HIV clinical indicators; and type of health care utilization.
resultsInterviews found that ACA preparation focused on enrollment growth, staffing, competition among health plans, concern about cost sharing, and HIV pre-exposure prophylaxis (PrEP) services. Quantitative analyses found that post-ACA HIV-positive patient enrollment grew. New enrollees in 2014 were more likely than 2012 enrollees to be enrolled in high-deductible plans (P < 0.01) or through Medicaid (P < 0.01), and marginally more likely to have better HIV viral control (P < 0.10). They also were more likely to be diagnosed with asthma (P < 0.01) or substance use disorders (P < 0.05) and to have used primary care health services in the 6 months postenrollment (P < 0.05) than the pre-ACA cohort.
conclusionsAs anticipated by KPNC interviewees, ACA implementation was followed by HIV-positive patient enrollment growth and changing benefit structures and patient characteristics. Although HIV viral control improved, comorbid diagnosis findings reinforced the importance of coordinated health care.
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