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Radar On Market Access: Though Care Utilization Rebounds, Insurers Still Face Uncertainty in 2021

Posted by Peter Johnson on Jan 28, 2021


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, AIS Health reported.

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.

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Topics: Industry Trends, Data & Analytics, Payer