Health care costs have been a concern in this country for many decades. It has been well-documented that the United States spends substantially more on health care services than other developed countries for similar, if not worse, outcomes. Additionally, high health care costs represent major challenges to government budgets, employer competitiveness, and household finances. During the COVID-19 pandemic, many parts of the country are reporting dramatically reduced utilization of medical services—setting up one of the most profound natural experiments in health care value since perhaps the establishment of Medicare and Medicaid. The results of this experiment may require providers (particularly hospitals and health systems) to answer tough questions about their value.
Currently, the medium and long-term consequences of the COVID-19 pandemic is one of substantial uncertainty. While many health care services are currently not occurring, there is a question of how much care is being delayed versus forgone and the long-term consequences of this decreased utilization. One scenario (among many) is that non-COVID-19 health care spending goes down substantially, and it appears nothing of consequence happened. Such a result could lead purchasers to ask if substantial amounts of health care are “worth it” and what they should be paying for it.
There will certainly be many high-quality research papers that will tackle this issue. However, given data source availability, study timelines, and peer review, such studies may not be available for years—not helpful for the next round of high-stakes purchaser-provider negotiations. Plans, providers, and employers all have timelier (and more relevant) information that they can collect and analyze to hone their value points.
The following are some initial recommendations on analyses that could be prepared now and in the coming months. This information could be available from a business’ own employees, community surveys, or available administrative sources. Together these analyses could provide a clear picture and useful proof points of forgone or delayed utilization:
- Substitutes: When medical care was unavailable, did potential patients go without, or did they seek substitutes? What were those substitutes and were they safe and effective?
- Productivity: For essential workers in areas with low COVID-19 case rates, were there increased sick days or longer sickness leaves that could be associated with avoiding care?
- Primary and Secondary Prevention: Has there been any change in the stage of cancers at initial diagnosis? Have more diabetics become insulin dependent? Are fewer individuals with hypertension under control? Etc.
- Nature of Decreased Utilization: What was the composition of services that did not occur? Do they represent one-time choices (e.g. missing one check-up) or could they be replicable over time (e.g. watchful waiting for back pain)?
Please reach out to ZAHealth if you would like to discuss your organization’s strategy to understand and shape the post-COVID-19 health care value debate.