The Effects of Payer-Mix on Utilization during the COVID-19 Pandemic, in Urgent and Primary Care

Author(s): Luis W Dominguez, Brandon Beattie, Alexander Poulose

Background: Healthcare utilization has changed dramatically during the COVID-19 crisis with the most dramatic drops in April 2020. While a lot of research has focused on utilization among Medicare and the privately insured, comparatively less has been published on the effect of payer-mix, particularly Medicaid, on utilization.

Methods: Monthly patient volume was gathered across 3 ambulatory primary and urgent care clinics. The timeframe included appointments, walk-ins and virtual visits from January through June 2020, including the nadir in April. Patient volume was then compared to average payer mix over that same time, at each clinic. A simple linear regression was then run, comparing changes in patient volume and percent Medicaid. The limited data points allowed for a qualitative analysis.

Results: Two clinics had similar payer mixes, and saw similar decreases in utilization. A third clinic with twice as many Medicaid patients, saw only half the reduction in patient volume, during the nadir in April 2020.

Conclusion: Given the limited number of data points, only a qualitative analysis was possible. A simple regression line indicated a correlation between the proportion of Medicaid patients and demand resilience for healthcare resources. At scale, the Medicaid population may be less vulnerable to variations in utilization, exhibiting less elastic demand, despite a pandemic, for a myriad of reasons.