Increased spending on low-value care during the COVID-19 pandemic in Virginia

Abstract

Characterizing the value and equity of care delivered during the COVID-19 pandemic is crucial to uncovering health system vulnerabilities and informing post-pandemic recovery. We used insurance claims to evaluate low-value (no clinical benefit, potentially harmful) and clinically-indicated utilization of a subset of 11 ambulatory services within a cohort of ∼2 million Virginia adults during the first two years of the pandemic (3/1/2020-12/31/21). In 2020, low-value and clinically-indicated utilization decreased similarly, while in 2021, low-value and clinically-indicated utilization were 7% higher and 4% lower than pre-pandemic rates, respectively. Extrapolated to Virginia’s population of insured adults, ∼$1.3 billion in spending was associated with low-value utilization of a subset of ambulatory services, reflecting 6% higher spending than pre-pandemic rates in 2021. Compared with pre-pandemic rates, low-value and clinically-indicated utilization of the 11 services were 15% and 16% lower, respectively, during 3/1/2020-12/31/21 among patients with the greatest socioeconomic deprivation. Meanwhile, low-value and clinically-indicated utilization remained closer to pre-pandemic rates among patients with the least socioeconomic deprivation during the same timeframe. These results highlight widening healthcare disparities and underscore the need for policy-level efforts to address the complex drivers of low-value care and equitably redistribute expenditures to services that enhance health.