Analysis & Results
Pre-pandemic in 2019, the states with the highest utilization of outpatient medicine per patient were Maine (10.4 encounters per patient), Vermont (9.9 encounters per patient), North Dakota (9.3 encounters per patient), South Dakota (8.8 encounters per patient), and New Hampshire (8.5 encounters per patient). When compared to the national average of 6.3 encounters per patient, those five states have between 65% (Maine) and 35% (New Hampshire) higher utilization per patient. Each of these states are predominantly rural and have a higher-than-average amount of “Willful Endurer” psychographic profiles, or individuals who live in the “here and now”, in their Medicare population, making them more likely to seek care in outpatient settings compared to other patient profile types. Even so, additional research and analysis are needed to understand why utilization is higher in these states when compared to others.
Next, we wanted to understand the impact that COVID-19 had on these states in terms of utilization per patient. On average, the nation experienced a 6.1% reduction in encounters per patient from 2019 to 2020 (6.3 encounters in 2019 compared to 5.9 in 2020). For the some of the states with the highest utilization per patient, this decrease was significantly larger. The largest year-over-year decrease in utilization per patient occurred in Maine (14.6%), Vermont (12.9%), and New Hampshire (11.6%). North Dakota (6.5% decrease) and South Dakota (6.1%) experienced decreases much closer to the national average. One hypothesis for this disparity is proximity to substantial outbreaks. The New England states were impacted at the beginning of the pandemic with New York and Massachusetts, both bordering states, having significant COVID-19 spread and mortality. North and South Dakota had relatively benign spread and little interaction with the virus until the summer and fall of 2020.