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CloudView blog

Ideas and insights to help health care providers stay informed and profitable in today's challenging health care environment.

ACAView: Measuring the Impact of Health Care Reform on Day-to-Day Physician Practice

by Iyue Sung, PhD, Director of athenaResearch

With this post, we are pleased to introduce ACAView, a joint initiative between the Robert Wood Johnson Foundation (RWJF) and athenahealth. 2014 marks the launch of the Affordable Care Act’s (ACA) most important coverage expansion provisions, designed to dramatically reduce the number of uninsured Americans. Between now and the end of 2016, millions of individuals are expected to sign up for subsidized insurance coverage through newly established health care exchanges, or marketplaces. Other tracking initiatives are closely monitoring the number of individuals that sign up for this coverage as well as those that take advantage of expanding Medicaid coverage in some states.

With ACAView, we will take a different approach. We will focus on the provider perspective; more specifically, how the ACA affects the practice patterns and economics of physicians and other care team members around the country. This is also part of a wider effort, Reform by the Numbers, RWJF’s rich source of timely and unique data about the impact of health reform.

ACAView will monitor the impact of coverage expansion on a monthly basis, mining insights from athenahealth’s cloud-based network of more than 50,000 providers and 50 million patients. Our cloud-based, centrally hosted software platform provides us with near real-time visibility into practice patterns of physicians around the country.

Our goal is to inform, exchange ideas, and provide a timely, front-row view of how this landmark legislation affects a robust cross-section of providers across the nation. In subsequent reports, we will examine an evolving set of metrics that address a broad range of topics. We will also share our analyses on the extent to which our providers represent all providers in the US. For more about our data on practices and patients, as well as our preliminary list of metrics, please read our Methodology report.

No Meaningful Change to Date in New Patient Volumes
Among the many unknown questions surrounding coverage expansion is the number of new patients physicians will accommodate. This is a critical issue because one of the goals of health care reform is to allow individuals to form stable physician relationships, rather than seek care in high-acuity settings or forgo care altogether. If the ACA is working, we would expect physicians to see a higher percentage of new patients over the course of the year. Over the long term, this number should eventually return to historical levels as these new patients become established.

Figure 1 shows the percentage of provider visits accounted for by new patients, for the first two months of 2013 and 2014. These percentages are based on physician practices active on athenahealth’s network before 2011. In January through March of 2014, new patients accounted for 17% of visits to primary care practices, down slightly from the 17.9% for the same period in 2013. Other specialties, with the exception of pediatrics, also showed a slight decline in the proportion of new patient visits. In general, we view these differences as too small, or the timeframe too early, to indicate a meaningful change.

The absence of an increase in new patient visits in the first two months of the year does not surprise us. As of April 1, 7.1 million individuals had enrolled in private insurance plans, through either state or federal marketplaces. This represents approximately 2% of the population (estimates for Medicaid enrollment were not yet available at the time of this report). Of that 2%, an unknown proportion of these individuals had some form of previous coverage, so they are not necessarily “newly insured.” It will take some time for newly insured patients to locate new physicians, make appointments with them, and receive care. We look forward to monitoring this metric to identify meaningful changes when and if they occur.

Will there be Noticeable Differences in the Health Status of New Patients?
Another question is whether the new patients that physicians see are sicker than they were in the past. We will examine this issue in greater detail in our next blog post, but provide an early example here. Figure 2 shows the percentage of new patients with a diagnosis of diabetes from January through March 2014 compared to January through March 2013. The chart also shows the same statistics for established patients (patients who have visited in the last two years), who have a higher rate of diabetes. For both groups, we see no change to date, but will continue to monitor this and other chronic disease indicators.

The questions of whether the ACA will cause physicians to devote a higher share of their case mix to seeing new patients, or whether new patients will be more likely to have chronic disease (compared to new patients from previous years, or established patients) are just two issues we will consider over the course of the year.

Other questions we will examine include the following:

  • How much will new patients owe for their care?
  • How will reimbursement levels change for new patients relative to historical patterns?
  • How long will new patients have to wait for care from the time an appointment is made?

Our objective with this joint initiative is to answer a broad set of questions as the year progresses, and we welcome your commentary and suggestions along the way. For continued updates, follow Reform by the Numbers, as well as the ACAView tag on the athenahealth CloudView Blog.

You can connect with our researchers through email at We also invite you to follow Josh Gray, VP of athenaResearch, on Twitter @JoshGray_hit on Twitter.

Matt Nix and Chris Jones of athenahealth conducted the analysis used in this post.

As a statistician, Iyue is responsible for methodology, analytic infrastructure, and extracting data-driven insights from the athenahealth patient database. 

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