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COVID-19 and the case of the missing patient


COVID-19 turned the world upside down. Since March 2020, we’ve lost more than 550,000 family members, friends, and colleagues, with millions more facing long-term health consequences as a direct result of the virus. Unfortunately, those massive numbers still don’t paint a complete picture including the indirect impact this pandemic has had on people’s health.

When the world shut down, people stayed home over fears of contracting the virus. To further prevent the spread of the virus and free up capacity to care for the surge of COVID-19 patients, healthcare organizations also pushed out appointments for routine care and elective procedures.

As a result, millions delayed routine care due to COVID-19.

Patients delaying routine care during COVID-19

According to a recent Definitive Healthcare survey of more than 500 healthcare providers, nearly a quarter of respondents indicated that delayed care was their biggest concern for 2021.

To understand care delays, we focused on three chronic diseases that are among the leading causes of death in the U.S. - heart disease, cancer, and diabetes.

As we looked at the data in our Medical Claims Database, we identified three distinctly different groups of patients:

Three groups of patients 1. The Known Knowns: patients who received a diagnosis in 2019 and also received treatments for their condition 2. The Known Unknowns: patients who received a diagnosis between January - March 2020 but whose outcome is unknown and care is in limbo 3. The Unknow Unknowns: patients who did not receive a diagnosis or treatment but are still affected by a condition

The Known Knowns

We’ll use 2019 as our baseline for understanding the typical patient behavior of the Known Knowns. In 2019, U.S. physicians diagnosed 2.4 million new patients with hyperlipidemia and peripheral artery disease, 2.4 million new patients with cancer, and 2.3 million new patients with diabetes. On average, 80% of patients who received a diagnosis continued on for treatment in 2019. However, as this group entered the pandemic, there was a steep drop-off as only half continued their treatments in 2020.

The Known Unknowns

The next group, the Known Unknowns, is a worrying one. Nearly half of the patients who received a diagnosis in the first three months of 2020 did not continue on to receive treatment once the pandemic hit.

COVID-19 pushed the Known Unknowns into limbo during a critical point in their care journey. For healthcare providers, this group is especially concerning. Providers know these patients exist and are delaying care, meaning that they’ll be sicker when they show up in a doctor’s office, placing added strain on healthcare resources.

The Unknown Unknowns

Finally, we have the true wild card of the bunch - the Unknown Unknowns. There is no way to have an exact number of how many patients fall into this bucket since they were never diagnosed. But by comparing the total number of new patients diagnosed in 2020 to 2019, we know we missed more than 2.5 million new screenings in 2020. We also saw a 38% drop in new diagnoses directly after the pandemic started, showing just how many people were pushing off routine care in the early months of COVID-19.

So what do patient care delays mean for outcomes?

Now that we know patients were postponing care, you’re probably wondering what that means for outcomes.

As patients slowly began to return to doctor’s offices and healthcare screenings increased in the later months of 2020, some troubling trends have started to emerge.

By comparing healthcare screenings and outcomes from June - September 2020 to the same period in 2019 in our Medical Claims Database, we found:

  • 21% increase of heart disease patients being diagnosed with type II diabetes with complications
  • 6.5% increase in severe kidney disease/failure for heart disease patients and a 7% increase for diabetes patients
  • 33% increase in positivity during cancer screening and a 9% increase in a metastatic diagnosis for cancer patients

By examining these numbers, it’s clear patients are coming in with more severe complications and additional comorbidities than in 2019. And the more worrying thing is that the increases are happening in a smaller patient population since we know more than 2.5 million new diagnoses were missing in 2020.

This data also represents only a tiny portion of the impact delayed care has on healthcare since we focused on only three disease areas. Contact Definitive Healthcare today if you’d like to find out how COVID-19 delayed care and impacted outcomes in other specialties.

The impact of these delayed screenings on the health of our population will, unfortunately, outlast the pandemic itself. There is, however, a light at the end of this tunnel. Check back as we’ll explore more about vaccination trends and what providers can do to mitigate COVID-19’s collateral damage in part two.

Definitive Healthcare

About the Author

Definitive Healthcare

This blog was written by a former contributor at Definitive Healthcare. At Definitive Healthcare, our passion is to transform data, analytics and expertise into healthcare…

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