Research ArticleOriginal Research

Annual Wellness Visits for Persons With Physical Disabilities Before and After ACA Implementation

Tanima Basu, Neil Kamdar, Patrick Brady, Cristin M. Cole, Jaque King, Robyn Rontal and Diane M. Harper
The Annals of Family Medicine November 2021, 19 (6) 484-491; DOI: https://doi.org/10.1370/afm.2712

Article Figures & Data

Figures

  • Figure 1.
    Figure 1.

    Establishment of ACA intervals by proportion of annual wellness visits with zero copay.

    ACA = Affordable Care Act of 2010; COM = commercial; MA = Medicare Advantage.

    Note: The Pre-ACA period is from 2008 to 2010. The ACA implementation period is from 2011 to 2013. The Post-ACA period is from 2014 to 2016. The dotted lines represent the proportion of zero copay by insurance type. The solid lines represent the proportion of the population receiving an annual wellness visit. Black lines represent MA claims. Gray lines represent COM claims.

  • Figure 2.
    Figure 2.
    Figure 2.
    Figure 2.
    Figure 2.

    Proportion of zero copay and annual wellness visits by insurance, disability, and sex.

    A. Annual wellness visits among MA insured, with congenital disability, by sex.

    B. Annual wellness visits among MA insured, with acquired disability, by sex.

    C. Annual wellness visits among COM insured, with congenital disability, by sex.

    D. Annual wellness visits among COM insured, with acquired disability, by sex.

    ACA = Affordable Care Act of 2010; COM = commercial; MA = Medicare Advantage.

    Note: The Pre-ACA period is from 2008 to 2010. The ACA implementation period is from 2011 to 2013. The Post-ACA period is from 2014 to 2016. The solid lines represent the proportion of individuals with zero copay. The dotted lines represent utilization rate. Gray lines represent female. Black lines represent male.

Tables

  • Table 1.

    Population Description by Physical Disability Type

    Congenital DisabilitiesAcquired Disabilities
    Spina BifidaCerebral PalsyMultiple SclerosisSpinal Cord InjuryParaplegiaQuadriplegiaHemiplegiaTotalP Value
    No.11,33919,31985,92546,34016,2537,862130,096317,134
    Age, y, mean (SD)44.4 (16.5)48.0 (18.8)51.5 (14.4)62.1 (18.8)64.4 (15.7)65.8 (16.4)69.0 (14.1)60.8 (17.7)
    Age group, y, No. (%)<.001
       18-659,851 (86.9)15,314 (79.3)70,831 (82.4)22,976 (49.6)7,624 (46.9)3,308 (42.1)42,990 (33.0)172,927 (54.5)
       >651,488 (13.1)4,005 (20.7)15,094 (17.6)23,364 (50.4)8,629 (53.1)4,554 (57.9)87,106 (67.0)144,240 (45.5)
    Sex, No. (%)<.001
       Female7,664 (67.6)9,481 (49.1)63,753 (74.2)25,063 (54.1)7,244(44.6)3,902 (49.6)69,059 (53.1)186,166(58.7)
       Male3,675 (32.4)9,838 (50.9)22,172 (25.8)21,277 (45.9)9,009 (55.4)3,960 (50.4)61,037 (46.9)130,968 (41.3)
    Race, No. (%)<.001
       Asian238 (2.4)408 (2.4)1,259 (1.7)1,166 (2.9)367 (2.6)184 (2.7)3,627 (3.2)7,250 (2.6)
       Black1,120 (11.3)2,090 (12.4)7,546 (10.1)4,115 (10.2)2,046 (14.5)1,072 (15.8)17,657 (15.7)35,654 (13.0)
       Hispanic989 (10.0)1,526 (9.1)5,354 (7.6)3,672 (9.1)1,604 (11.4)928 (13.6)11,573 (10.3)25,646 (9.3)
       White7,536 (76.3)12,764 (76.0)60,030 (80.6)31,302 (77.8)10,109 (71.6)4,622 (67.9)79,781 (70.8)206,144 (75.0)
    Insurance, No. (%)<.001
       Medicare Advantage2,777 (24.5)9,431 (48.8)28,135 (32.7)25,249 (54.5)11,096 (68.3)5,098 (64.8)93,883 (72.2)175,669 (55.4)
       Commercial8,562 (75.5)9,888 (51.2)57,790 (67.3)21,091 (45.5)5,157 (31.7)2,764 (35.2)36,213 (27.8)141,465 (44.6)

Additional Files

  • Supplemental materials

    PDF file

    • Harper.pdf -

      Supplemental Tables 1-6; Supplemental Figures 1-3

  • In Brief

    Annual Wellness Visits for Persons With Physical Disabilities Before and After ACA Implementation

    Diane M. Harper and colleagues

    Background Researchers documented the use of Annual Wellness Visits (AWV) by persons with physical disabilities during the Affordable Care Act rollout. They extracted data from an administrative claims database including both Medicare Advantage and commercial insurance payers from 2008-2016, and looked specifically at unique yearly wellness visits for adults with physical disabilities. They used interrupted time series analysis to compare AWV use by insurance type, gender, disability type and race over time.

    What This Study Found Results showed that by 2016, AWV reached 47.6% (44.7, 50.8) among commercial insurance–covered white women with congenital disabilities (spina bifida and cerebral palsy). In contrast, the rate among commercially insured Hispanic men with acquired disabilities (spinal cord injuries, hemi-, para- and quadriplegia) was lower at 21.6% (18.4, 25.2). Medicare Advantage-insured Black and Hispanic men with acquired disabilities had a similarly low level of AWV use. The ACA mandated zero copays, allowing persons with physical disabilities the option for screening without cost. Insurance and gender significantly influenced AWV use, followed by disability type and race. Overall, the highest AWV use for persons with disabilities is nearly 15% less than the 62% AWV use threshold seen in the general population.

    Implications

    • Addressing use gaps and increasing AWV use may be one way to increase overall improved health of persons with disabilities.
         
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