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

Area of Science:

• Health Services Research
• Public Health Policy
• Disability Studies

Background:

• Individuals with disabilities frequently encounter fragmented healthcare services and recurrent out-of-pocket expenses.
• The Patient Protection and Affordable Care Act (ACA) was enacted with the objective of reducing financial barriers to preventive care, such as eliminating copays for annual wellness visits (AWVs).

Purpose of the Study:

• To assess the utilization patterns of annual wellness visits (AWVs) among adults with physical disabilities during the implementation phase of the ACA.
• To identify factors influencing AWV uptake in this population.

Main Methods:

• An interrupted time series analysis was conducted using administrative claims data from Medicare Advantage (MA) and commercial (COM) payers between 2008 and 2016.
• The study identified unique wellness visits for adults with physical disabilities, comparing AWV use across insurance types, sex, disability type, and race over time.

Main Results:

• AWV utilization varied significantly, peaking at 47.6% in 2016 among COM-insured White women with congenital disabilities.
• Conversely, AWV use was lowest in 2016 among COM-insured Hispanic men with acquired disabilities (21.6%) and similarly low for MA-insured Black and Hispanic men with acquired disabilities.
• Insurance type and sex were significant predictors of AWV use, followed by disability type and race.

Conclusions:

• The ACA's mandate for zero copays for preventive services like AWVs offers a crucial opportunity for persons with disabilities to access healthcare without cost.
• Despite this provision, significant disparities in AWV utilization persist, influenced by insurance type, sex, disability type, and race.
• These findings highlight persistent gaps in healthcare access for individuals with disabilities compared to the general population.