PopHealthCare COO for Risk Adjustment Operations, Art Diaz, and Chief Medical Officer, Dr. Chris Dodd, discuss how the coronavirus pandemic has impacted both the financing of healthcare delivery and utilization of care for geriatric and vulnerable populations. For health plans, delayed care and fewer provider encounters will likely negatively impact subscriber risk scores which will in turn, reduce their risk adjusted revenue in 2021. In a recent publication by HHS, during the peak of the initial wave of the pandemic in early April, Part A and B claims fell more than 60% relative to the same time period in 2019; claims did not return to approximate 2019 levels for 3 months after this. The significantly reduced health care utilization by Medicare members underscores concerns related to lower subscriber risk scores, reduced preventative care, delayed chronic condition treatment, and indefinitely postponed elective procedures.
Dr. Dodd similarly observed, “What we’re going to experience is an increasing tsunami of people living with chronic conditions that are experiencing complications of those conditions not receiving the treatment they need.” In response to the massive contraction of primary care access across the United States caused by the pandemic, PopHealthCare continues to deliver advanced primary care to members in their homes.
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Bosworth A, Ruhter J, Sheingold S, and Zuckerman R. The Impact of the COVID-19 Pandemic on Medicare Beneficiary Use of Health Care Services and Payments to Providers: Early Data for the First 6 Months of 2020 (Issue Brief No. HP-2020-01). Washington, DC: Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services. September 28, 2020.