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    Patterns of Care Changes and The Effect on Risk Programs Comparing 2019 to 2020

    Covid-19 has brought a significant disruption in health care utilization, which caused 2020 to look very different from previous years. Changes include short and long term alterations to the way people interact with the health care system. Last summer we hypothesized that these changes could include:

    – Patterns of care changes that are short term, such as delaying of elective procedures and chronic care, and an overall decrease in utilization.

    -A shift in the places of services, that would continue with Telehealth utilization becoming more and more widespread.

    -A decrease in individuals that get attributed and shifts in the providers that they get attributed to.

    As part of our ongoing analysis of behaviors and underlying relationships in health care, we are now at a point where we can better understand and measure the extent of these changes. Some of what we are documenting is consistent with the findings published by others examining the impact of COVID. However, we believe that these specific results and our understanding of value based care will allow us to begin to quantify the implications of these changes on existing value based programs and identify options for moving forward.

    Our analyses confirm declines in utilization across multiple types and places of services, and cost avoidance that can be attributed to a significant decrease in IP utilization (10% decrease), including readmissions (18% decrease) and admissions associated with low quality care (15% decrease). We found a short-term substitution of Office Visits with Telehealth, however Telehealth claims peaked in April and then started declining, reaching a plateau around June 2020. Geography and access also play a major role on the extent of Covid related changes for a particular population.

    The implications are clear – as 2020 enters into the measurement and math of value based programs; as part of spending, utilization benchmarks and measurement frames, it will distort the results beyond useful meaning. Spending levels and “Savings” measured will not be correlated to provider performance but will reflect the pandemics impact. Gaps in care and quality measures -whether based on claims or EMRs will also be affected.

    2020 will have long term effects on many of the programs and measures that payers currently have in place.  Payment calculations, payment weights, and any measurement of costs (2020 RCCs will be rendered unusable) will suffer from their dependence on historical data. In addition existing patient attribution results will be compromised. Understanding the implications of these changes and charting a path forward, without undermining the trust of providers, will be a challenge for payers that requires careful consideration and planning.

    Our recommendation is that 2020 should not be used as a base or measurement year, as Covid fundamentally disrupted patterns of care and access. Programs would have a hard time realizing additional savings, and attribution will be compromised as patterns of care continue to change. We describe some of that disruption in more detail in the next section.

    We will continue to monitor these trends over the next few years, and continue to publish our findings here.

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