PROJECT SUMMARY/ABSTRACT
The COVID-19 pandemic has created an unprecedented shock to the U.S. health care system and to care
delivery for patients. As documented by the study team, the COVID-19 pandemic suddenly and dramatically
changed health care utilization patterns, including 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 over the course of the pandemic (e.g., the degree to which deferred services will occur later, telehealth
will substitute for in-person services, and new levels of telehealth services will be sustained), much less in the
years following the COVID-19 pandemic, and how continuing care patterns will differ for socially and clinically
vulnerable patient populations. Physician organizations (POs) face differing burdens in rapidly adopting
telemedicine, and PO barriers to telemedicine adoption may be reflected in the outcomes of patients treated by
these POs. 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 racial/ethnic minority populations, and patients with multiple
chronic conditions. Understanding patient and provider responses to the COVID-19 public health crisis and the
care patients receive, particularly those who are medically and socially vulnerable, is essential to inform
immediate-term and longer-term policymaking intended to help the health delivery system respond to COVID-
19. We propose to conduct a set of analyses to 1) Estimate how health services have changed during the
COVID-19 pandemic, the factors associated with changes in health service use, if health delayed care remains
unmet once the COVID-19 pandemic subsides, how policy responses (social distancing policies and COVID-
19 vaccination) have impacted care delivery, and how these patterns differ for medically and socially
vulnerable patient populations; 2) Asses PO barriers to adopting telemedicine and assess if PO adoption of
telemedicine lessens adverse health outcomes, particularly among vulnerable patient populations; and 3)
Examine if PO closure or consolidation due to COVID-19 leads to gaps in patient care continuity or access
barriers among vulnerable 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 policies and regulatory changes, 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 how the COVID-19 pandemic has reshaped the US health care system.