Impact of the COVID-19 Pandemic on Healthcare Access and Outcomes: A Combined Insurance Claims and Survey Study of People with MS

Background: In the context of the COVID-19 pandemic, people with multiple sclerosis (pMS) have been particularly vulnerable to adverse outcomes due to disruption of care.

Objectives: The CopeMS study led by The University of Texas at Austin and the MS Association of America investigates the long-term impact of the COVID-19 pandemic on healthcare access and the outcomes of pMS.

Methods: This retrospective cohort analysis used OPTUM Clinformatics® de-identified data to identify pMS who were continuously enrolled from 01/01/2019-12/31/2020 and assess changes in utilization of healthcare services during the COVID-19 pandemic compared to the year prior. Additionally, a national survey of pMS was conducted to further understand the impact of the pandemic on healthcare access and the wellbeing of pMS.

Results: In the Optum database, we observed a decrease in the utilization of MS-related services in 2020 compared to 2019. Significantly fewer pMS had visits with their neurologist, primary care provider, physical or occupational therapist despite an increase utilization of telemedicine services. Fewer pMS had MRIs of the brain or spinal cord during the pandemic. Emergency department and inpatient utilization also significantly decreased. At the same time, we observed a significant increase in the number of pMS utilizing social work services, though utilization remained very limited in our cohort (<2%). In our national survey, pMS reported widespread disruption of the MS-related services during the pandemic: 78/140 (55.7%) were unable to continue physical therapy services, 16/109 (14.7%) were unable to continue counseling services, 20/31 (64.5%) were unable to continue occupational therapy, 4/22 (18.2%) were unable to continue case management services, and 13/18 (72.2%) were unable to continue speech therapy. Telemedicine became the main modality for neurology visits, counseling and case management but was seldomly used for other services. Out of 529 pMS in our national survey, 47% of respondents reported worsening of MS symptoms during the pandemic with increased anxiety, and inability to maintain exercise habits as leading causes for worsening.

Conclusions: Despite the expansion of telemedicine, we observed decreased access to healthcare services important to the comprehensive care of pMS. Additionally, our findings show that the COVID-19 pandemic was associated with perceived worsening of neurological symptoms in pMS due to worsened mental health and lack of physical activity.