Randomized trial examines payer mix effects on clinical quality outcomes in health centers, suggesting dynamic nature of relationships.
Key Points
This research aims to investigate how payer mix patterns influence clinical outcomes in Federally Qualified Health Centers (FQHCs) before and after COVID-19.
Conducted a repeated cross-sectional analysis using Uniform Data System data from 1,190 FQHCs in 2019 and 1,150 FQHCs in 2022.
Examined eight clinical quality measures impacted by payer mix proportions, focusing on Medicaid, Medicare, and uninsured patients.
Utilized multiple linear regression models to assess quality performance while controlling for organizational characteristics.
In 2019, a 10 percentage point increase in Medicaid was linked to lower tobacco screening performance (-1.64 pp, p = .004).
By 2022, associations reversed, with Medicaid improving tobacco screening (+0.94 pp, p = .023) and uninsured better performing than the privately insured.
Higher proportions of Medicaid and uninsured patients were consistently tied to increased uncontrolled diabetes cases over both years.