Over the course of the last year, at least 41 percent of adults decided to forgo care because of COVID-19 concerns, according to a study in JAMA. Naturally, some of the missed care services were elective procedures that hospitals and health systems put on hold, but other people were missing out on routine and emergency care.
In April of 2020, for the first time in 60 years, expenditures on health services were down from the previous year, Kaiser Family Foundation revealed in data that was recently published. Even months after the pandemic’s nadir, health services spending was down from the previous year. In particular, visits to physician offices and outpatient care centers were the hardest hit in terms of health services spending.
In total, utilization of the health care system fell 23 percent between March and August of 2020, according to a research report from Prealize. The Palo Alto, California-based predictive analytics company used its AI capabilities to parse through analysis of claims data from nearly 600,000 U.S. patients between March 2020 and August 2020. Here’s what the researchers found:
-50 percent decline in respiratory from March to June 2020 compared to the previous year
-33 percent decline in gastrointestinal diagnosis
-28 percent decline in cardiovascular diagnosis
-26 percent decline in cancer diagnosis
-26 percent decline in musculoskeletal diagnosis
There was also a decline in procedures:
-47 percent decline in podiatry procedures from March to June 2020 compared to the previous year
-47 percent decline in breast procedures
-40 percent decline in neurosurgical procedures
-30 percent in orthopedic procedures
-29 percent decline in cardiac procedures
From July to August of 2020, there were similar year-over-year declines in procedures and diagnoses of those same diseases, although less drastic than March to June. While utilization of the health care system has rebounded since those first few months of the pandemic, experts say the health deficit will be felt for years to come. Using the claims data, Prealize applied more than 50 machine-learning models built into its platform to project diagnostic and utilization trends for 2021.
-112 percent increase in fractures thanks to delayed orthopedic procedures and care
-23 percent increase in cancer diagnosis thanks to deferred screenings and care
-18 percent increase in ischemic heart disease thanks to deferred screenings and care
-14 percent increase in congestive heart failure thanks to deferred screenings and care
-8 percent increase in COPD thanks to deferred screenings and care.
Nigam Shah, PhD, Professor of Medicine and Biomedical Data Science at Stanford University and Cofounder of Prealize Health, says the cancer and heart disease predictions are far scarier to him than the one on fractures. “If you defer a cancer screening and catch cancer later, the cost to manage and the impact on the patient’s life rises exponentially. Even though 23 percent sounds less 112 percent, one is a shift. The deferral leads to morbidity and new expenses that you might not have thought about,” says Shah.
To Shah’s point, in April 2020, there were 40 percent fewer cardiac screenings performed than in April 2019. The number of colonoscopies dropped 93 percent in April 2020 compared to April 2019. The number of mammograms fell 90 percent. He says that impact that deferred cancer and heart disease screenings can have on a patient will end up costing more than that of a delay for a hip or knee procedure.
As the uncertainty of the impact of COVID-19 continues, this kind of data can help payers and providers get in front of high-risk patients and optimize resources. Providers can understand which of their patients can use virtual care and which need in-person care. Payers can get in front of future high-cost members and better understand clinical utilization.
“Health care is capacity constrained. You have 10 case managers, 50 doctors, 100 nurses. Whatever your ratio is there are only a certain number of finite actions you can take. The big opportunity is to use predictions to prioritize. If you view it that way, it becomes a resource allocation and optimization exercise,” Shah says.
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