Lack of health insurance and high costs have long been major factors limiting access to healthcare in the United States. In 2019, a record 25 percent of Americans reported that they or a family member put off treatment for a serious medical condition because of the cost. Nearly one in three people for whom screening is recommended were not up-to-date with those tests, and that was before the COVID-19 pandemic.
Even 18 months into the pandemic, many patients are still delaying treatment and medical care, including preventive services such as cancer screenings and well visits. Nearly 1 in 5 American households has delayed care for serious illnesses in the past few months, and an estimated 41 percent of adults in the U.S. either delayed or avoided medical care in 2020. Payers have seen an overall reduction in claim volume, including drops in emergency department, inpatient and office visit claims across all plan types.
Some of those delaying care include patients with chronic health conditions and young Americans with mental health issues. One survey found that 57 percent of respondents with a chronic condition reported that they delayed receiving healthcare due to the pandemic. Even 24 percent of people with cancer and 29 percent with diabetes said they had put off at least one in-person visit. Among young people with major depression, 60 percent didn’t receive treatment during the height of the COVID-19 outbreak.
Other than concerns about exposure to COVID-19, some individuals reported delayed care for serious problems during the ongoing pandemic for reasons such as being unable to get an appointment, finding a physician who would see them or accessing the care location. Avoidance of urgent or emergency care was more prevalent among unpaid caregivers for adults, persons with underlying medical conditions, persons with disabilities and Black, Hispanic and young adults.
Consequences of Delaying Treatment
Some ramifications of delayed treatment due to the COVID-19 pandemic are increasing hospital admission rates, gaps in care and delayed diagnoses. Delayed or avoided medical care might increase morbidity and mortality associated with both chronic and acute health conditions and cause the need for more invasive treatment in the future.
Among those reporting delayed care, roughly 55 percent reported experiencing negative health consequences as a result. One-third of the adults who reported delaying or forgoing care said one or more of their health conditions worsened as a result, or their ability to work or perform other daily activities was limited. Mortality data suggest the COVID-19 pandemic has caused a surge in excess deaths from conditions such as diabetes, dementia, hypertension, heart disease and stroke.
Delays in treatment also have affected clinicians. A survey conducted by the American College of Surgeons found that 76 percent of surgeons say staffing shortages caused by the pandemic have made an impact on surgical practices’ ability to provide top-quality care.
A Decrease in Elective Medical Care
Elective procedures and other non-essential treatment weren’t the only types of healthcare delayed due to the COVID-19 pandemic. Many Americans either deferred screenings or skipped them altogether, as evidenced by these numbers:
- Slightly more than 15 percent delayed or went without some form of preventive care.
- Preventive cancer screenings dropped 94 percent over the first four months of 2020.
- Two-thirds of Americans delayed or skipped scheduled cancer screenings — such as mammogram, colonoscopy, skin check or Pap/HPV test — because of the coronavirus pandemic.
- Cervical cancer screenings declined by 94 percent in 2020.
- Colorectal cancer screenings were down 86 percent in 2020.
- In April 2020, the total number of breast and cervical cancer screening tests funded by the US Centers for Disease Control and Prevention’s National Breast and Cervical Cancer Early Detection Program declined by 87 percent and 84 percent, respectively.
- Declines in breast cancer screening in April 2020 varied from 84 percent among Hispanic women to 98 percent among American Indian/Alaskan Native women. White, Black and Asian women saw declines of 87 percent, 90 percent and 97 percent, respectively.
- By June 2020, the volume of breast and cervical cancer screening tests was 39 percent and 40 percent below the five-year average for that month, respectively.
Part of the reason for these delayed screenings might be due to CDC guidance in March 2020, in which the agency urged providers to postpone non-urgent outpatient visits and preventive care if it was not able to be performed via telehealth. In June 2020, the Centers for Medicare and Medicaid Services (CMS) recommended that patients not further delay preventive care such as cancer screenings and vaccinations.
Preventive Screenings Covered by Health Insurance
Depending on an individual’s risk factors and personal medical history, his or her doctor may recommend one or more of the following types of healthcare screenings:
- A mammogram to screen for breast cancer
- A colonoscopy or stool test to screen for colon cancer
- A prostate-specific antigen blood test (PSA) to screen for prostate cancer
- A PAP test or HPV test to screen for cervical cancer
- A low-dose CT scan or computed tomography to screen for lung cancer
Screenings are a crucial component of preventive care and an effective prevention mechanism that could substantially reduce cancer incidence and mortality rates in patients. As noted by the National Cancer Institute, screenings have the potential to detect precancerous lesions and cancers in their earliest stages when they might be most treatable and before symptoms appear.
Tragically, The National Cancer Institute expects to see 10,000 preventable deaths over the next decade because of pandemic-related delays in diagnosis and treatment of breast and colorectal cancer. Doctors also worry that these delays in screening and care can have larger impacts on communities of color, exacerbating healthcare disparities that existed before the COVID-19 pandemic.
As we mentioned in a previous blog, the gaps in care resulting from these delays in scheduling of healthcare screening and services have the potential to challenge both providers and payers, especially those responsible for managing high-risk populations. These entities not only face uncertain revenue levels but underutilization of healthcare, resulting in undertreatment of chronic disease and a negative impact on long-term mental health outcomes.
Recommendations for Hospitals, Health Care Systems and Other Providers
Population health management is an essential part of ensuring that information about the importance of preventive screening and timely medical care is directed at the most at-risk populations and addressing social determinants of health (SDOH) to do so. As clinical medicine becomes more personalized, targeting these higher-risk individuals will help enhance population health and economic efficiency.
Similarly, automated platforms can systematically detect patients who are at risk based on their medical or family history. Driven by robust analytics, medical practices can target personalized messages to defined populations using automated outreach. Patients can receive reminders about critical screenings, vaccinations and other preventative care, and providers can reduce their patient no-show rates. Addressing gaps in care also impacts providers financially because patient outcomes and performance are increasingly tied to financial incentives by private payers and the CMS.
Providertech’s CareX solution can help you engage your patients and members in preventative care, resulting in lower costs, improved communication and understanding of recommended care and minimized emergency department visits. The platform can automatically pull records from your EMR based on your appointment types, providers and clinics or digest existing internal patient registries. Schedule a demo with us to learn more! Also, check out our blog on using population health management to promote lung cancer screening guidelines.