In the South, Midwest and West, individuals aged 19 to 40 accounted for larger shares of COVID-19 claims than in the Northeast and the nation as a whole.
"We are in the most scarred chapter of our country in terms of a public health crisis," said Robin Gelburd, president of Fair Health. "What you are seeing is payers trying to determine what type of processes they should adopt with respect to cost sharing. All of this is happening in real time and we don't know where the end is."
The study mirrored Medicare claims data showing that chronic kidney disease and kidney failure were the most common comorbidities of hospitalized COVID-19 patients.
Those could be some of the underlying issues compounding COVID-19 for the older age group, leading to additional tests and procedures that account for the relatively higher charges, Gelburd noted. The charges were around twice as much as the negotiated rates between providers and insurers—including patients' out-of-pocket costs—which aligns with the standard practice, she said.
Many Medicare beneficiaries, which Fair Health's analysis excludes, end up under the Medicare severity-diagnosis related group of respiratory system diagnosis with ventilator support, which yields more than $42,000, said Glenn Melnick, a healthcare economist at the University of Southern California who has been studying COVID-19-related utilization and reimbursement trends. That may explain why the commercial claims for those 61 and older are relatively lower, he said, noting that it could also be related to claims lag since a lot of older patients are staying in the hospital longer. Still, the charges and payments for the upper age groups seem low, especially since commercial insurers typically pay more than Medicare, Melnick said.
The total charges to treat COVID-19 within hospital settings are projected to range from at least $362 billion to as high as $1.45 trillion, Fair Health estimates.
"The COVID-19 pandemic is scrambling norms we'd otherwise see in the data," Gelburd said.
The Fair Health analysis revealed that males were associated with a larger share (54%) of COVID-19 commercial claims, according to Fair Health data. The office setting was the most common venue for initial diagnoses, except for patients aged 61 and older, who were most commonly diagnosed initially in an inpatient setting.
Notably, the Northeast had the highest percentage of COVID-19 patients first diagnosed via telehealth, which was typically the least-common medium.
"Maintaining higher reimbursement rates for telehealth might steer visits away from the emergency room, which would be a win-win for both members and payers," Gelburd said.
Physicians and data experts at Santa Clara (Calif.) Valley Medical Center developed a COVID-19 risk score that aims to maximize resources and direct treatment.
If they are male, over the age of 60, have a body-mass index of at least 30 and have comorbidities like diabetes or heart conditions, they are more likely to get sick, Santa Clara Valley Medical Center experts' analysis of nearly 7,000 emergency department visits revealed.
Patients who have fewer than three of those characteristics are extremely unlikely to require hospitalization. And 1 in 8 patients who meet at least three of the criteria will likely get very sick.