Report finds preventive care visits in California decreased 20-41% in 2020

Preventive care visits in California decreased between 20% and 41% in 2020, according to a new report from Manifest MedEx.

Manifest MedEx is the state’s largest nonprofit health information exchange and collects claims and clinical data for over 26 million Californians. The organization’s analysis of 4 million Californians’ 2020 health data reveals a notable decrease in non-COVID-19-related medical services and examines the potential consequences of this care gap.


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The report found a large decline in the use of preventive care among Californians in 2020, having fallen between 20% and 41% last year. These include colonoscopies, mammograms, and PET scans. Perhaps the biggest consequence of this, the report says, is delayed cancer diagnoses.

For instance, colonoscopy rates dropped by over 90% between April and May of 2020. They later rose to around 20% below pre-pandemic levels.

“There are large numbers of people who never received recommended colonoscopies in 2020. It will be important to close the gap in screening and monitor whether colorectal cancer, as well as other cancer types, will be diagnosed at later stages in California over the next few years.”


Image: Manifest MedEx


The report also found considerable decreases in ambulatory care at the onset of the pandemic, beginning with a 50% drop from March to April of 2020. The rate increased later in the year, but eventually stagnated at around 20% of pre-pandemic levels.


Image: Manifest MedEx


Children over 5 years old and adolescents saw a noticeably larger decline in ambulatory services than adults, at 25% and 36%, respectively. By comparison, visits from individuals aged 25 to 44 decreased by 17% and visits from individuals aged 45 to 64 decreased by 14%. 

While the report acknowledges this gap could be due to less respiratory infections among younger individuals, it says the disparity is nonetheless a cause for concern.

“As COVID-19 cases decline, it will be important to closely monitor the medical utilization patterns of Californian children.”

Ambulatory service decreases were relatively comparable across all payer types (commercial (19%), Medi-Cal (21%), and Medicare Advantage (19%)).

Using the input of state health leaders, Manifest MedEx offered multiple recommendations for addressing these gaps in care. Launching campaigns to increase preventive cancer screenings, making sure all children and adolescents have wellness visits, and reaching out to high-risk individuals and those experiencing care gaps to connect them to services are all potential solutions to the issue.

The report wasn’t able to collect sufficient race and ethnicity results due to limited or hard-to-use data. Manifest MedEx intends to work with its participating providers and health plans to improve race and ethnicity data collection in order to include health equity measures in its reporting.