After the pandemic, patients have changed the way they get care

A little over five years after the arrival of COVID-19, Americans are viewing the healthcare industry much differently.

More Americans are getting care outside of clinics and hospitals, says Allison Oakes, executive director of research at Trilliant Health. And she says it’s clear that’s a trend that appears to be here to stay.

“I think now that we're five years removed from that initial public health emergency, we have a better idea of what has returned to what it was and what will really never be the same,” Oakes says. “And I do think it's important for decision-makers across the health economy to start realizing and understanding that some things aren't ever going to go back to the way that they were.”

Consumers' attitudes toward the healthcare industry have changed.

“There has been a huge decrease in public trust in the traditional healthcare system, and as a result of that, some people just don't want to engage with it, either the way they used to, or at all,” she says.

Some patients are opting for urgent care or non-traditional providers. But others are simply not getting any care, due to rising costs, even for those with insurance.

(See part of our conversation in this video. The story continues below.)

Changes for hospitals

Hospital volumes have rebounded in some areas, but some analysts have questioned if they’ll ever get back to pre-pandemic levels. Trilliant Health’s data suggests that may not happen.

“I think we have to move away from the assumption that hospital volume will return to what it previously was,” she says.

Since 2017, hospital inpatient admissions have declined by 8%, and inpatient surgeries have dropped by over 15%, according to Trilliant’s data.

“Those are the things that really drove hospital revenue, and it just doesn't seem like people are coming back,” she says.

Hospitals and health systems are offering more outpatient options, since patients increasingly want procedures outside the hospital setting. Oakes also pointed to the increasing popularity of GLP-1 drugs, which is coinciding with a decline in bariatric surgeries.

More patients are opting for urgent care centers, which is a trend that may continue. Urgent care volume rose by 42.3% between the first quarter of 2019 and the fourth quarter of 2023, according to Trilliant’s data.

“People have very much shifted where they're getting some of their healthcare use to the urgent care setting,” Oakes says.

Many patients are going to urgent care centers rather than emergency departments, and Oakes says that’s a positive in some respects. Patients aren’t going to emergency rooms unnecessarily, avoiding higher costs and freeing up space for those who truly need to be at the hospital.

Some health systems see urgent care centers as a key to growth. Ardent Health has acquired a host of urgent care clinics as part of its expansion strategy, and Oakes expects other hospital systems to take a similar approach.

“I think as we see hospitals shift their strategy to acquiring more urgent care centers, it will also likely become more common,” she says.

It may be good for patients to use urgent care more, and for hospitals to preserve emergency space for those who need it.

“If people are triaging themselves to an urgent care instead of going to the emergency room, that's a good outcome from a sort of public health value and spending point of view,” Oakes says.

While urgent care may be alleviating some challenges for hospitals, those patients aren’t getting the continuity of care or regular visits with doctors that could detect problems before they become more serious.

Health systems should examine how to get those urgent care patients into some type of primary care setting.

“There's also probably a lot of people who are going to urgent care for primary care needs that would be better served by a provider who they actually have an ongoing relationship with,” she says.

People are using primary care less, Oakes says. And many Americans who want to visit primary care physicians often face long waits to get appointments, due to a shortage of primary care providers.

Looking more broadly, Oakes sees a “disaggregation of traditional health care” over the past few years. More Americans are seeking point-of-service solutions for their health needs.

Direct-to-consumer companies offering healthcare services “really proliferated during the pandemic,” Oakes says.

Those companies are offering convenience, and patients know what they’re going to pay, which is appealing to consumers.

“One thing they do is they tell people how much the service is going to cost them,” Oakes says. “They have very clear pricing transparency for people. And I think sometimes people would rather go with the known thing, rather than working and walking into the urgent care or the emergency room and having no idea what it's going to cost.”

Costs of care

The rising costs of care, including high-deductible health plans, are spurring consumers to seek non-traditional services, or simply avoid getting care.

“We've only seen those deductibles continue to increase,” Oakes says. “And this idea of people having skin in the game related to their health care, I think, is another thing that has scared people away from getting necessary, high-value care that they need, and getting it at the right time.”

“The way that people are now on the hook for some of these healthcare costs on top of these huge insurance premiums that they're paying, I think, has further eroded trust in the healthcare system and the ways in which people are willing to engage with it,” she adds. “So patients are feeling it, hospitals are feeling it, and I think it's led to this disengagement with the healthcare system to a certain extent.”

Patients also face high costs and confusing billing from hospitals, and hospitals in the same market can charge far different prices, with some patients paying twice as much for similar services.

Prices can also vary depending on the patient’s insurance plan.

“The prices that we pay for things have unjustifiable amounts of variation,” Oakes says. “Within the same city, if you go down the street to two different hospitals, you could pay vastly different prices. Even within the same hospital, two different patients who see the same doctor for the same procedure but have different insurance, can pay wildly different amounts of money.”

Changes for telehealth

More Americans turned to telehealth during the COVID-19 pandemic, largely out of necessity.

During the height of the pandemic, about 60 million telehealth visits took place each quarter, but that number has dropped to 30 million.

While usage of telehealth is far higher than it was before 2020, Oakes says it may not rebound to the peaks seen during the pandemic.

“I think we're in the midst of figuring out what the plateau or new norm is in terms of telehealth utilization,” Oakes says.

But there is one area where telehealth is a very popular option with consumers, and that’s for those seeking behavioral health services. About 60% of all telehealth visits involve appointments for mental health needs.

“Behavioral health is one of those areas where we have seen that telehealth seems to be a clear substitute for in-person healthcare utilization,” Oakes says.