Actuarial View of COVID-19: Payers, Providers, and Healthcare Reform

Web Exclusives —June 2, 2020



Burt Zweigenhaft, PhD, D.Litt, Founder, Association for Value-Based Cancer Care, moderated a panel session in which 3 experts from the independent actuarial firm, Milliman, discussed recent data showing the ways in which the COVID-19 pandemic may affect the future of healthcare.

Pamela Pelizzari, MPH, Principal and Healthcare Consultant, discussed the high-level impact of the crisis on utilization and costs; Gabriela Dieguez, FSA, MAAA, Principal and Consulting Actuary, explored the ways in which insurers are thinking about payer issues; and Bruce Pyenson, FSA, MAAA, Principal and Consulting Actuary, provided an analysis of provider consolidation and healthcare reform.

According to Ms Pelizzari, research over the past few months, drawing from a variety of data sources, shows that COVID-19 is having a huge impact on expected medical expenditures.

“Patients who previously had commercial insurance might be moving to Medicare if they are older, or to Medicaid,” if they lost their employment-based coverage, she noted.

The biggest driver of enrollment shifts, however, is the number of healthcare services that have been eliminated or deferred to 2021 or later.

Ms Dieguez added that the high unemployment rate that the United States is experiencing will contribute to this shift. “I think everyone is really bracing for impact from more cuts,” she said.

Mr Pyenson agreed that change should be anticipated, noting that there have been currents underway that are causing a lot of change. “They’ve been going on for several years now and are speeding up,” he said. He suggested that this is going to cause many organizations to “fall under a lot of scrutiny” moving forward.

Questions regarding deferred care and the extent to which patient visits and treatments will go back to pre–COVID-19 rates are among the greatest areas of uncertainty. “Perhaps deferred care is a move in the direction of more efficiency,” Mr Pyenson said. Healthcare consolidation in the interest of efficiency is “not going away. If anything, it’s accelerating,” he added.

“I think it’s time to really think about how we can bring US healthcare spending to a much lower level and more in line with other countries,” said Mr Pyenson. “It needs to be examined closely. This is an opportunity we should not lose to help the system become more efficient.”

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Last modified: August 10, 2023

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