DECREASED RATES OF HEALTH PLAN DISENROLLMENT FOR PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

OBJECTIVES: To quantify the time to and rates of health plan disenrollment for patients with Chronic Obstructive Pulmonary Disease (COPD) compared with a matched group of patients without COPD. METHODS: Patients ≥40 years old were identified from the HealthCore Integrated Research Environment (HIRE) as having COPD if they had ≥1 inpatient claim with primary diagnosis of COPD; or, ≥1 ED claim or ≥2 outpatient/SNF/inpatient claims with non-primary COPD diagnosis. The index date for COPD cases was the earliest date at which they met the criteria for COPD during 1/1/2007-12/31/2014. Non-COPD patients include those who did not meet the criteria for COPD. COPD patients were matched to non-COPD patients using exact 1-to-l matching according to age, gender, health plan type, region, primary policy holder status, ACA plan, and length of pre-index enrollment. Non-COPD patients were assigned an index date equal to that of their matched COPD case. All patients were required to have 12 months of pre-index enrollment RESULTS: 657,766 health plan enrollees were matched (328,883 per cohort). Median follow-up time was 2.5 years for COPD and 1.7 for non-COPD patients. During follow-up, 55% of COPD patients disenrolled compared with 63% of non-COPD patients (rate ratio=0.69; 95% CI=[0.69, 0.69]); within those who disenrolled, time to disenrollment was longer for COPD patients (median=688 vs 346 days). Accounting for censoring, Cox regression showed similar results (hazard ratio (HR)=0.71) and were consistent across sensitivity analyses: (1) including death as a disenrollment event (HR=0.77), (2) excluding patients who died during the first 30 days of follow-up (HR=0.77). CONCLUSIONS: Presence of COPD was found to be associated with a longer duration of health plan enrollment and decreased risk of disenrollment. This may be due to job-lock, in which patients with chronic medical conditions do not leave their employer due to the threat of losing their health insurance.