Return to expected rates of ambulatory care services after COVID-19 differ by insurance coverage, study finds

As the COVID-19 pandemic progressed through early 2021, significant differences remained in the use of ambulatory care services depending on the type of insurance coverage individuals had, a new NIA-supported study found. Published Jan. 18, 2022, in JAMA, the study showed that the return to expected rates for ambulatory care services was significantly lower among patients with Medicaid or those dually eligible for coverage from both Medicare and Medicaid, compared to those with commercial, Medicare Advantage, or Medicare-fee-for-service insurance.

Multiple studies reported that ambulatory care visits sharply declined early in the pandemic, including emergency visits, office and urgent care visits, behavioral health services, and preventive screenings. Yet research shows that delays or gaps in preventive care and behavioral health services may result in the development of more advanced or terminal diseases.

To assess the trends in ambulatory care services during the pandemic, researchers conducted a retrospective cohort study using a national database (Milliman MedInsight) of claims data from multiple health care payers. Researchers analyzed data from more than 14.5 million patients 18 years or older across all 50 states from Jan. 1, 2019, through Feb. 28, 2021. The database includes claims data from patients with Medicaid and Medicare-Medicaid dual eligibility and commercial, Medicare Advantage, and Medicare fee-for-service insurance.

The ambulatory use rates were categorized for six major service types: emergency department, office and urgent care visits, behavioral health services, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Researchers found that between May-June 2020 and November-December 2020, the combined use of the six ambulatory care services significantly increased – returning to near expected rates – following the decrease in utilization seen at the beginning of the COVID-19 pandemic. However, these expected rates of utilization decreased again following the second wave of the pandemic.

Throughout most of the period during which utilization returned to expected levels (May-December 2020) and the following decline associated with the second wave of the pandemic (January-February 2021), the rate of recovery was significantly less for patients with Medicaid or Medicare-Medicaid dual-eligibility compared with those with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. These findings suggested potentially worsening access to care during the pandemic among patients who are socioeconomically disadvantaged.

According to the researchers, the precise reasons for lower rates of return to ambulatory care services for patients with Medicaid or Medicare-Medicaid dual eligibility are unclear. The researchers suggest that additional research is needed to confirm the findings and provide additional insight for the discrepancy among people with different types of coverage. Identifying specific reasons for the lower rates of return to ambulatory care use among patients with Medicaid and Medicare-Medicaid dual eligibility is vital to help reduce future inequities in other health conditions.

This research was supported by NIA Career Development Award grant K76AG064392.

References: Mafi JN, et al. Trends in US Ambulatory Care Patterns During the COVID-19 Pandemic, 2019-2021. JAMA. 2022;327(3):237-247. doi: 10.1001/jama.2021.24294.