Health Care Utilization During Recent Shocks to the US Provider Delivery System - Recent years have created numerous shocks to the U.S. health care system and to care delivery for patients. These sudden and dramatic changes to the US health care system, include a rapid escalation in use of telehealth services, an abrupt decline in in-person services, and a large volume of deferred services. It is unclear how these care patterns will evolve in subsequent years. The persistence of delayed care, and differences among complex patient populations, is not understood. Physician organizations (POs) face differing burdens in rapidly adopting telemedicine, and the PO barriers to telemedicine adoption may be reflected in the outcomes of patients treated by these POs. Likewise, the reduction in in-person care has placed financial stress on many POs, leading to concerns that many POs may go out of business or consolidate. The impacts of care reductions, the adoption of telemedicine as a new care delivery modality, and access to POs are likely to have larger effects among vulnerable patient populations, including lower-income, rural, and minority populations, and patients with multiple chronic conditions or Alzheimer’s/dementia. Understanding patient and provider responses to these changes and the care patients receive, particularly those who are medically and socially complex, is essential to inform immediate-term and longer-term policymaking intended to help the health system and health care professionals respond to these changes to the delivery system. We propose to conduct a set of analyses to 1) Estimate how health services have changed during recent years, the factors associated with changes in health service use, if health delayed care remains unmet, and how these patterns differ for medically and socially complex patient populations; 2) Asses PO barriers to adopting telemedicine and assess if PO adoption of telemedicine lessens adverse health outcomes, particularly among complex patient populations; and 3) Examine if PO closure or consolidation in recent years leads to gaps in patient care continuity or access barriers among complex patient populations. To do so, we will leverage the existing data assets and expertise of the RAND U19 Center of Excellence that the research team has built over the past 5 years. We will use 100% Medicare fee-for-service claims data. Findings from this study will help inform an array of immediate-term and longer-term legislative actions, policies, and regulatory changes being considered, including changes to payment policies, use of technology, financial assistance to providers to ensure their survival, and improving the ability of health systems to respond to withstand significant shocks.
