Since the start of the COVID-19 pandemic, the managed care
industry has wrestled with how to project utilization of normal care and assess
the risk of funding care related to the virus. While insurers generally seem to
be in good financial shape, experts say that plans face continuing uncertainty.
In the early days of 2021, the U.S. confronted a grim milestone when the tally
of Americans who died from COVID-19 reached 400,000.
"It's looking as if the numbers are going to be closer to the most severe
of the scenarios that we looked at [in September]," says Trevis Parson,
the chief actuary for health and benefits at Willis Towers Watson.
Meanwhile, care utilization went through wild swings over the course of 2020,
cratering in the second quarter before bouncing back. Evidence grew that, even
as utilization rebounded, many patients were forgoing preventive care such as
cancer screenings. It also seems that missed care has not, so far, been
replaced with procedures later in the year.
John Linnehan, the practice director for health economics and advanced
analytics at Avalere Health, has found that preventive care has dropped and not
rebounded, citing proprietary claims data collected by Avalere's parent
company, Inovalon Inc.
"We published some data at the end of last year specific to oncology…which
really showed that at the beginning of the pandemic, oncology-related
evaluation and management services were down over 70%," Linnehan said
during a Jan. 7 Avalere webinar. "And that's rebounded a little bit, but
still significantly down."
However, Linnehan said that the impact of care deferral has not been consistent
across all sectors of the health care industry. "From the provider revenue
and utilization perspective, it's a mixed story," he says. "Home
health has actually rebounded to pre-pandemic levels. But similar services that
are provided in skilled nursing facilities have not."
What this means going forward isn't clear, according to Parson. While all the
deferred care hasn't yet returned, it still could be coming — but Parson isn’t
sure when that might happen.
Meanwhile, many insurers have elected to waive COVID-19 cost sharing through at
least the first quarter of this year. Parson says the impact of those waivers
will mostly be retrospective, since carriers should have been able to account
for COVID-19 risk in setting their 2021 rates.
No comments:
Post a Comment