Pandemic drove less care, fewer medical bills for Minnesota patients in 2020

From outpatient surgeries and emergency room visits to lab tests and imaging procedures, Minnesotans in the midst of the pandemic last year used less health care overall and racked up fewer medical bills in the process.

Such declines have been widely noted over the past 18 months for helping fuel health insurer profits in 2020, but a new report released Tuesday offers the most detailed look yet at the changes in Minnesota.

The average total cost of care for a commercially insured patient in the state fell by 2.5% from $627 per month in 2019 to $611 per month last year, according to the report from Minnesota Community Measurement. It was the first time in seven years of publication that the report charted a decline in per-person costs.

COVID-19 prompted a short-term shut down of non-emergency health care at hospitals during 2020 and shifted many outpatient visits to online formats. Some patients opted to stay away from health care, worried about potential exposure to the pandemic virus.

The new report documents the impact from those changes for cost and use of services last year, but the long-term consequences for people's health still aren't clear.

"We know at least anecdotally that there are reports of many more people who delayed care in 2020 showing up in 2021 with more advanced disease than they might have otherwise had if it had been caught earlier," said Julie Sonier, the president and chief executive of Minnesota Community Measurement, a Minneapolis-based nonprofit that publishes report cards on health care cost and quality. "That's why we don't know really the long-term implications for cost and utilization and, quite frankly, people's health."

The report released Tuesday found that per-person costs between 2019 and 2020 fell most for outpatient hospital services followed by inpatient care. Pharmacy costs, however, increased 11.1%, which was the fastest rate of increase since Minnesota Community Measurement started publishing annual reports on cost and utilization in 2014.

Total cost of care is a function of the prices paid for health care services and the frequency with which patients seek those medical interventions. In terms of utilization, the report tracked double-digits declines in several categories including outpatient surgery (-18.7%), emergency room visits (-14%), pathology and lab tests (-12.8%) and imaging (-12.3%).

The new report, which draws on health insurer data for 1.3 million enrollees primarily under the age of 65, included a few surprises.

While total spending declined in 2020, people with commercial health insurance were more likely to have at least one medical claim last year than they were in 2019. The expanded claims activity was particularly pronounced among men age 19 to 35 — a group that, in general, doesn't go to the doctor very often.

"Our best hypothesis there is that it has something to do with COVID testing, but that is speculation because we don't have the detailed claims to be able to answer that question," Sonier said.

Overall, the percentage of commercially-insured people who used any health care service in the year increased from 87.5% in 2019 to 88.2% last year. Beyond COVID-19 testing, easy access to virtual visits with health care providers was another potential contributor to the increase, Sonier said.

The report, which compares total cost of care results for 108 medical groups across Minnesota, returned to some familiar themes.

As in previous years, total cost of care was highest at Mayo Clinic, where primary care patients attributed to the Rochester-based medical center averaged $1,063 per person a month — significantly higher than at any other medical group in the state.

Prices in 2020 at Mayo Clinic in 2020 were 51% higher than the statewide average, the report found, while use of services was about 27% higher than the average for Minnesota medical groups.

In the past, Mayo Clinic has disagreed with Minnesota Community Measurement's method for calculating care costs. On Tuesday, a clinic spokesman said Mayo was reviewing the latest report, but could not comment.

Officials with Minnesota Community Measurement argue the information helps consumers shop for health care in ways that drive the system to improve cost and quality.

"This information is valuable because it helps health care providers know where they stand relative to their peers on health care cost and utilization," Dr. Mark Matthias, physician vice president of acute care at CentraCare and chair of the nonprofit group's board of directors, said in a statement.

"Lower utilization and cost in 2020, most likely the result of delaying care, is evident in trends that we're seeing this year with patients who are presenting with more advanced illness than in the past," Matthias said. "This is a challenge that all health care providers are experiencing."