Epic Research is not viewable using Internet Explorer. Please try accessing it with an alternate browser.
Contributors

Few Adult COVID-19 Patients Continue to Seek Medical Care One Year After Their Initial Diagnosis

May 31, 2022
June F. O’Leary, PhD | Glenn Melnick, PhD

Key Findings:  

  • COVID-related health care utilization drops significantly more than 30 days after initial diagnosis and continues to decline as patients approach one year post-initial infection across all age groups. 
  • COVID-19 patients aged 65 and older are 25 times more likely to seek medical care in the first 30 days after initial diagnosis than 301-360 days after their diagnosis.  

We previously reported that COVID-19 related health care utilization persists in a subset of insured adult patients for 180 days after their initial diagnosis.1 Specifically, depending on age group, 19-26% of 264,849 patients first diagnosed with COVID-19 from March 1 through July 31, 2020, had at least one COVID-19 related health care claim within 30 days, and these percentages dropped to 4-10% for the subsequent 31-90 days and to 3-6% by days 91-180.1   

To better understand utilization patterns further out from initial diagnosis, we analyzed claims data of a large national insurer covering over 21 million adult, commercial (18 to <65 years) and Medicare Advantage (≥65 years) members with at least one day of enrollment from March 1 through August 31, 2020.  We first identified a patient’s initial health care claim coded with a confirmed or probable COVID-19 diagnosis and further categorized patients by age group and coverage category (i.e., commercial or Medicare Advantage).2 We identified 331,137 individuals with a confirmed or probable COVID-19 diagnosis from March 1, 2020, through August 31, 2020, after excluding patients with reinfections (N=6,851) to focus on patients with only one COVID diagnosis documented.3-9  

Depending on age group, with utilization related to age as expected, claims for care are highest within the 30 days after an initial diagnosis (approximately 16-26% of patients) and continue to decline over the subsequent follow-up periods with approximately 1% of patients seeking care related to their initial COVID-19 diagnosis 301-360 days post diagnosis.   

Figure 1
Percentage of Patients with One or More COVID-19 Related Claims through 360 Days
Percentage of Patients with One or More COVID-19 Related Claims through 360 Days
Figure 1. Percentage of patients that had at least one COVID-19 related claim after their initial COVID-19 diagnosis (persons with reinfections excluded) by age group and time period between initial diagnosis and follow-up encounter. 

We conducted two sensitivity tests: 1) limiting the sample to only patients with continuous enrollment over the 360 period and 2) expanding the sample to include patients with reinfections. The findings with respect to utilization over time are robust and are insensitive to these changes in sample definition. 

The finding that the percentage of COVID-19 related health care claims continued to decline over the 181-360 days after initial diagnosis is consistent with emerging evidence.2 New patterns may become apparent as data become available on patients who received COVID-19 vaccines or were infected with other variants or both. Linking utilization measures to additional data such as comorbidities, specific symptoms (e.g., altered taste, cognitive difficulty, breathlessness) and disease severity can add to a greater understanding of PASC and the types of care patients receive.  Continued monitoring of COVID-19 patients’ health care utilization over time can inform frameworks guiding resource allocation and population health management programs.  

References

  1. “After Their Initial Diagnosis, Many Adult COVID-19 Patients Continue Seeking Medical Care for up to Six Months or More.” Epic Research.  (September 1, 2021).  Retrieved from:  https://epicresearch.org/articles/after-their-initial-diagnosis-many-adult-covid-19-patients-continue-seeking-medical-care-for-up-to-six-months-or-more. 
  1. Raman B., Bluemke D.A., Lüscher T.F. and S. Neubauer.  Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus.  European Heart Journal February 18, 2022.  https://doi.org/10.1093/eurheartj/ehac031.
  1. World Health Organization Emergency use ICD codes for COVID-19 disease outbreak (https://www.who.int/standards/classifications/classification-of-diseases/emergency-use-icdcodes-for-covid-19-disease-outbreak) and Centers for Medicare and Medicaid Services (CMS) New Waivers for Inpatient Prospective Payment System (IPPS) Hospitals, Long-Term Care Hospitals (LTCHs), and Inpatient Rehabilitation Facilities (IRFs) due to Provisions of Inpatient Rehabilitation Facilities (IRFs) due to Provisions of the CARES Act (https://www.cms.gov/outreach-andeducationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-15-mlnc-se).
  1. Centers for Disease Control and Prevention. New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), December 3, 2020 and New ICD-10-CM code for the 2019 Novel Coronavirus (COVID-19), April 1, 2020.  https://www.cdc.gov/nchs/icd/icd10cm.html.    
  1. FPM editors (American Academy of Family Physicians).  Six codes to remember as COVID-19 cases surges across the country.  October 31, 2020.  https://www.aafp.org/journals/fpm/blogs/inpractice/entry/key_covid_codes.html.  
  1. Billing guide from data provider.  
  1. American Hospital Association.  Frequently Asked Questions Regarding ICD-10-CM Coding for COVID-19.  August 27, 2021.  https://www.aha.org/fact-sheets/2020-03-30-frequently-asked-questions-regarding-icd-10-cm-coding-covid-19.  
  1. Centers for Disease Control and Prevention.  Requirement for Proof of Negative COVID-19 Test or Documentation of Recovery from COVID-19.  December 17, 2021.  https://www.cdc.gov/coronavirus/2019-ncov/travelers/testing-international-air-travelers.html. 
  1. Sheehan M.M., Reddy A.J. and Rothberg M.B.  Reinfection Rates Among Patients Who Previously Tested Positive for Coronavirus Disease 2019: A Retrospective Cohort Study.  Clin Infect Dis 2021 Nov 16;73(10):1882-1886.  doi: 10.1093/cid/ciab234.