Cost and Number of Deaths Varied Based on Cause of Death and Demographics
The Center for Improving Value in Health Care (CIVHC) recently released information related to the number of Coloradans who died with a primary cause of death from COVID-19 versus those who died of other causes. The findings, based on 2020-2021 claims data in the Colorado All Payer Claims Database (CO APCD) and death registry information from the Colorado Department of Public Health and Environment (CDPHE) will be presented at the 2024 Academy Health Annual Research Meeting.
The full abstract is available below as well as a link to the infographic highlighting the findings.
Abstract
Effects of COVID-19 on Health Care Costs at End-of-Life in Colorado, 2020-2021
Investigators: Martha Meyer, Kimi Landry, Megha Jha, Darcy Holladay Ford
Center for Improving Value in Health Care
Research Objective:
The study examined end-of-life (EOL) health care utilization medical and pharmacy costs among Coloradans who died during the COVID-19 pandemic years 2020-2021.
Study Design:
Amidst the pandemic, managing EOL care posed significant challenges, with disparities in care intensity and hospice utilization across insurance types. This research aimed to highlight these disparities and assess the impact of COVID-19 on EOL care, considering demographic variables.
The CIVHC research team retrospectively analyzed deceased members’ medical and pharmacy claims from the Colorado All Payer Claims Database (CO APCD). Based on death record determination from the Colorado Department of Public Health and Environment (CDPHE), researchers then categorized the primary cause of death as COVID-19 or non-COVID-19. EOL utilization and costs were assessed across insurance types. We used Vertica SQL and SAS v 9.4 to explore demographic cost variations.
Principal Findings:
Among the studied population, 11.9% had COVID-19 listed as the primary cause of death. The proportion of COVID-19 deaths increased slightly from 11.5% in 2020 to 12.3% in 2021. Among Non-Hispanic Unknown race individuals, the proportion of COVID-19 deaths decreased from 22.5% in 2020 to 12.2% in 2021. Conversely, among Non-Hispanic Whites, the proportion increased from 50.3% to 62.9% during the same period. Age distribution analysis revealed significant fluctuations: in 2020, 33.9% of COVID-19 deaths occurred in individuals over 85 years old, dropping to 20.0% in 2021. Conversely, the percentage of COVID-19 deaths among individuals under 45 years old increased markedly, from just over 1.1% in 2020 to over 4.4% in 2021, indicating a 319.4% rise.
Overall, the PMPM increased from 2020 to 2021 ($5,948.60 v. $5,672.74), a 4.9% change. For COVID-19, PMPM increased by 11.8% ($6,206.97 v. $6,936.23) compared to non-COVID-19 PMPM, which increased by 3.9% ($5601.52 vs. 5818.93). In 2020, the COVID-19 PMPM was the largest for commercial payers at $16,597.19, which increased by 7% to $17,759.03 for 2021. Compared to COVID-19, Medicaid PMPM only increased by 4.6%, from $4,883.55 in 2020 to $5,107.08 in 2021. In contrast, COVID-19 PMPM increased 13.6% for Medicare FFS ($4624.69 to 6002.36) and 32.5% for Medicare Advantage ($3,217.00 to $4,263.58). For those dually eligible, COVID-19 PMPM increased 4.4% ($7,142.63 to $7,458.03).
The member month (MM) analysis revealed glaring differences in coverage duration. Commercially insured members were covered for an average of 2-4 months, whereas those with Medicaid, Medicare FFS, or Medicare Advantage were covered for 9-11 months before death.
Conclusions:
The study underscores significant variations in EOL health care costs during the pandemic, particularly among vulnerable populations. Understanding and addressing these disparities is crucial for informing policies and resource allocation.