Utilizing external data to address the changing paradigm
in elective care
Tracy Milanette, Sr. Director, U.S. Healthcare Services
Information Assets & Offerings
Julianne Migely, Director, US Provider & Payer Solutionsar 16, 2021
When COVID-19 began, it took a huge toll on elective
procedures. Data from IQVIA shows
that when the pandemic began last spring in the U.S., virtually every category
of elective procedures saw initial dramatic decreases. Ophthalmic procedures
fell 94% compared with pre-pandemic figures, pain-related procedures dropped by
91%, and orthopedic procedures fell by almost half.
Despite slow recovery in procedure volume into the summer months,
and the accelerated recovery in the fall, this cumulative decrease of elective
surgeries has resulted in a significant revenue loss for providers who rely on
these types of procedures to drive profitability. On the other end of the
spectrum, payers initially recognized the financial benefit of avoiding the
cost of covering elective surgeries during the pandemic, but now face
uncertainty about how pent-up demand will affect utilization and their bottom
line in the coming years.
For both stakeholder groups, the impact COVID-19 has had on
elective surgeries and uncertainty about the future is creating significant
financial risk. Will payers cover as many elective procedures in the years to
come? Will providers respond by shifting resources and finding profitability in
other non-elective service lines? Both groups will need new, enhanced analytics
to better manage and mitigate these risks.
In the past, both stakeholder groups could rely on their own
historic data to predict future monthly and seasonal demand for elective
procedures and plan accordingly. However, the lack of experience with COVID-19
– or any global pandemic – means that they won’t have the information they need
to forecast future trends, revenue expectations, or related costs.
This lack of data complicates the strategic planning process for
both payers and providers and puts their financial viability and long-term
strategy at risk.
Another source of
knowledge
When payers and providers utilize broader market insights gained
from external datasets, like IQVIA’s Medical Claims Database, and combine it
with other internal and public sources, they can more accurately forecast
future trends and how COVID-related changes in elective care will impact their
operations.
The IQVIA Medical Claims Database contains 1.1B annual claims,
offering users vital information about what takes place during patient visits
with their physicians. The data covers patient-level diagnoses, procedures, and
in-office treatments for visits made across medical practices, hospitals,
ambulatory surgical centers, and other healthcare practices. It also includes
demographic, treatment, care and physician information, including patient
geography, as well as dates and types of locations where care was delivered.
One of the greatest benefits of IQVIA’s Medical Claims Database
for strategic planning and market assessment is its timeliness. Because it is
an open source database, users can see most medical claims within 7 to 21 days
of submission. This makes it ideal for anticipating demand, assessing market
opportunities, and monitoring procedure trends.
Payers and providers can use the data to monitor upticks in
elective procedures and to analyze trends across regions, patient populations,
procedure types, and other criteria.
Local and regional insights allow providers to proactively
position their services, staff, facilities, and marketing messages to make the
most of the variable return to normal volumes. Payers can use it to adapt their
offerings and support services to mitigate costs while continuing to ensure the
best care for their members.
Expert guidance
Payers and providers can gain further clarity by reviewing
the webinars,
whitepapers, and related content developed by IQVIA experts,
like those at the IQVIA Institute of Human Data Science. Our experts
proactively monitor these trends in order to get a national perspective on
which procedures are rebounding, and which ones will be slower to recover. It
is still unclear when elective procedures will return to normal and which
procedures will be first to recover given pent-up demand, but with diverse data
sets, it paints a clearer picture when forecasting future trends.
The loss of revenue from elective procedures has been a
considerable financial burden for providers during the pandemic in the
short-term but has assisted payers in reassessing truly elective procedures and
reducing healthcare spend. However, it also serves as a catalyst for both to
reconfigure the delivery of healthcare services based upon new market trends.
It may still be several months before we see exactly how the elective procedure
landscape will evolve, but if organizations leverage these data now, they will
be better prepared to capitalize on future opportunities and mitigate risk.
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