Assessing a Medicaid Randomized Insurance Experiment Within Community Clinics
Condition: Cardiovascular Disease; Cancer
MeSH terms: Cardiovascular Diseases
Study type: Observational

Summary: 
      This study examines the impact of a randomized insurance experiment on preventive services
      receipt and healthcare utilization in safety net patients using linked public insurance
      claims and safety net clinics' electronic health record (EHR) data.
    

Detailed description: 
      In 2008, the Oregon Medicaid program used a "lottery" (Oregon Experiment) to allocate limited
      insurance resources to low income adults who did not categorically qualify for traditional
      Medicaid coverage. Thousands were randomly selected to apply for Medicaid; many others were
      not selected. This "natural policy experiment" is the first population-level randomization of
      insurance coverage since Rand's 1971-1982 experiment. We will use data from safety net
      clinics that share a common electronic health record (EHR) operated by OCHIN, a non-profit
      organization in Portland, Oregon. As one of the nation's largest linked community health
      center networks, the OCHIN EHR database records nearly all visits to safety net clinics in
      Oregon with one patient chart linked across >100 community health centers. We will link
      Medicaid claims data and the OCHIN database to determine patients that had applied to
      participate in the Oregon Experiment, as well as to determine those that gained insurance via
      this experiment. We will test the hypothesis that public insurance coverage is associated
      with higher rates of receiving preventive care services and increased healthcare utilization
      among persons with a usual source of primary care. To that end, we will analyze preventive
      care and utilization patterns among the OCHIN clinic patients affected by Oregon's Medicaid
      Experiment. This study capitalizes on two unique opportunities: an EHR database linking >100
      community health centers, and the quasi-experimental design of Oregon's randomized Medicaid
      experiment.

      The specific aims related to the Oregon Experiment are:

      1) To compare post-intervention rates of preventive services receipt among OCHIN patients
      randomized to the Oregon Experiment group (intervention group), compared to those not in the
      coverage group (comparison group); and 3) To compare post-intervention rates of ambulatory
      healthcare utilization among OCHIN patients randomized to the Oregon Experiment group
      (intervention group), compared to those not in the coverage group (comparison group).
    

Intervention name(s): Insurance Intervention
Intervention type(s): Other
Intervention description(s): Random selection to apply for Medicaid coverage through Oregon Experiment drawings held between March and October 2008
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Adult individuals on the Oregon Experiment 'reservation list' (applied for the Oregon
        Experiment) linked to individual patients in an Oregon safety net clinic that is part of
        the OCHIN, Inc network using Link Plus software and demographic variables common to both
        datasets.
      
Keywords: Medicaid; public insurance; cardiovascular disease; prevention; community health centers; electronic health records; cancer prevention