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News Release

Bureau of Justice Assistance Enlists Altarum to Help Criminal Justice Organizations Across the United States Implement Peer Recovery Support Services to Address Opioid Crisis

Ann Arbor, Michigan | December 10, 2019—The Bureau of Justice Assistance, U.S. Department of Justice, has engaged Altarum to expand the reach of its Peer Recovery Support Services Training and Technical Assistance Center to increase access to peer recovery support services in the criminal justice system and associated community social services organizations across the nation.

Since 2017, Altarum has provided a wide variety of technical assistance through the Bureau of Justice Assistance Comprehensive Opioid Abuse Program (COAP) to organizations seeking to implement peer recovery programs to address opioid and other substance use disorders. Using evidence-supported approaches, Altarum teaches best practices through online webinars, virtual consultation, and in-person training that promotes peer-to-peer learning.

In this next phase of work with the Bureau of Justice Assistance, Altarum will continue to increase the capacity of criminal justice and child welfare organizations and their partners through the following services:

• Knowledge Building - Developing and disseminating publications to increase the knowledge and skills necessary for planning, starting up, or enhancing peer recovery support services.
• Capacity Building - Supporting ongoing cross-site coordination, peer-to-peer exchange, mentoring, and coaching to increase program capacity.
• Virtual & Distance Learning - Developing virtual training programs and producing webinars, podcasts, and other easy-to-access distance learning resources to improve recognition and understanding of core peer recovery support services concepts.
• Technical Assistance - Providing ongoing, tailored training and technical assistance related to best practices for peer recovery support services, including one-on-one virtual and on-site support to respond to developmental needs or concerns.
• Evaluation - Designing a comprehensive performance assessment plan and evaluation process to inform future directions and ensure effective training and technical assistance delivery.

The National Council for Behavioral Health, a nonprofit association of health care organizations that delivers behavioral health services, will contribute to this effort by developing educational publications and expanding the pool of expertise for participating organizations to draw upon.

Targeting Low-Value Care,
Addressing the Opioid Crisis

In this newsletter, we look at where low-value care is taking place, how much we are spending on it, and what we can do to reduce it. We also share a story of how we're helping providers in Central Texas reduce opioid misuse among new mothers.

Low-Value Care is Everywhere. What Is Driving It and How Can We Intervene?

Our analysis finds that low-value care—defined as care with little to no value to patients—is prevalent across the nation. Learn how your state measures up.

Our Low Value Care Visualizer Helps States Simplify Analytics for Action

Measuring low-value care can be challenging. Our new tool can help. 

How to Strengthen Provider Capacity to Serve Postpartum Women at Risk of Opioid Misuse

Jenn Rogers of Altarum explains how our work in Central Texas is helping providers reduce opioid misuse among new mothers

2020 AcademyHealth National Health Policy Conference
February 10–11 | Washington DC

Join our poster session “Integrating Medication-Assisted Treatment into Primary Care: Insights from the Provider Perspective” on Tuesday, February 11 at 8:00 AM. Altarum’s Lena Marceno will discuss the importance of MAT to help normalize and increase access to effective opioid use disorder treatment. Our research findings include:

• perceived provider barriers to implementing MAT;
• recommended policy changes from the provider community; and
• best practice guidance from providers who have navigated policy changes to improve opioid use disorder treatment.

Learn more about the AcademyHealth National Health Policy Conference and register for the event here.

News Release

Altarum Releases Policy Scorecard Report to Help States Strengthen Efforts to Address Affordability of Health Care

Washington, DC | January 7, 2020—Altarum’s Healthcare Value Hub today released a scorecard rating 42 states and the District of Columbia on their adoption of evidence-based policy actions to improve affordability of health care for residents.

The Healthcare Affordability State Policy Scorecard shows that many states are taking steps to increase access to coverage, but far fewer are taking other actions to address the affordability of health care for residents, even as polling data repeatedly shows affordability is an issue residents on both sides of the political aisle want their legislators and regulators to act on.

States have the power to make health care more affordable by implementing policies to produce better value for consumers, an increasingly important approach in the absence of federal legislation.

The scorecard shows that state residents struggle to afford healthcare, with 24 percent of adults facing affordability burdens in Maryland, the best performing state, and 57 percent in Mississippi, the worst performing state. This variation in burden appears to be tied to policies enacted at the state level, particularly those that extend coverage or reduce out-of-pocket costs. Approaches that address underlying cost drivers —such as reducing low-value care and curbing excess prices—are still in their infancy and may not be fully reflected in state outcomes at this early stage.

The four policy areas in which Altarum’s Healthcare Value Hub rated states include:

• extending coverage,
• lowering out-of-pocket costs,
• reducing low-value care, and
• curbing excess prices.

States were also rated on their outcomes in four areas:

• percent of population that is uninsured,
• percent of population that is forgoing needed care, delaying care or struggling with medical bills,
• rates of known low-value care services delivered by providers, and
• private payer prices relative to the national median.

Lawmakers, policymakers, government officials, consumer advocates, and the public can use this scorecard to understand how their state performs on addressing healthcare affordability relative to other states, and to craft a road map for specific evidence-based policy actions. Additionally, a few exemplar states in this scorecard provide proof-of-concept that other states can emulate.

“The Healthcare Affordability State Policy Scorecard provides a call-to-action and road map for people and policymakers to strengthen efforts to address health care affordability,” says Altarum Healthcare Value Hub Director Lynn Quincy. “The scorecard provides a clear guide on where to focus regulatory and reform efforts in 2020 and beyond.”

Even states that ranked at the top of the list, such as Massachusetts, can do more to improve affordability for the 26 percent of its residents who find health care costs burdensome, such as enacting stronger surprise medical billing protections and waging a multi-stakeholder campaign to reduce the use of low-value care services. Oregon also ranked high on many metrics but could do more toward measuring and reducing the provision of low-value care. Read the summary report, state scorecards, and methodology at healthcarevaluehub.org/affordability-scorecard.

About Altarum’s Healthcare Value Hub

The Healthcare Value Hub monitors, translates, and disseminates evidence-based policies and practices that improve value to health care consumers, particularly in the areas of cost and quality. The Hub also connects advocates, researchers, and policymakers to enhance understanding of issues and to spark action on the most promising policies and initiatives. The impact of the Hub is felt nationwide, from Connecticut where its survey of consumers helped pass a drug price transparency bill to a health care reform “bootcamp” for advocates, insurers, providers and other stakeholders in Utah. Learn more at HealthcareValueHub.org.

State Policy News

Experts Say States Should Focus on Controlling Prices, Reducing Low-Value Care to Make Health Care More Affordable

Policy experts gathering in Washington, D.C. yesterday urged states to make health care more affordable for residents by regulating prices through a variety of mechanisms and reducing the provision of low-value care.

The event was hosted by Altarum’s Healthcare Value Hub with support from the Robert Wood Johnson Foundation.

Roslyn Murray, a consultant for Catalyst for Payment Reform, said reducing prices should be a top priority of states, chiefly by addressing the anti-competitive actions of large, consolidated health systems; instituting price transparency regulations; empowering insurance commissioners to better address rate increases; and negotiating better prices for state employee and retiree health plans.

Speakers pointed to Colorado and Rhode Island for their success in giving more power to insurance commissioners to reject unaffordable rates; Oregon and Montana for imposing price ceilings in their state employee benefit contracts; and Colorado’s latest effort to offer a public option that places limits on hospital prices.

In addition to price-setting measures, Lynn Quincy of Altarum’s Healthcare Value Hub and Vicki Veltri of the Connecticut Office of Health Strategy emphasized that low-value care is a critical area for state action. "There are significant savings to be found in low-value care," said Veltri. The Healthcare Value Hub recently released a State Healthcare Affordability Scorecard that showed few states are taking action on low-value care even though it is prevalent across every state.

Jen Mishory of the Century Foundation, an expert in public insurance expansion proposals, said states should consider seeking waivers from the federal government to enact measures that can reduce premium costs, such as waivers that implement reinsurance.

The panelists discussed the importance of a common standard of affordability. "We need a standard to target to policies," said Liz Hagan of U.S. of Care. As an analogy, Janet Weiner of the Leonard Davis Institute of Health Economics noted the value of the federal poverty measure; while far too low, it provides a benchmark for policymakers.

Veltri discussed Connecticut’s effort to create an affordability standard that reflects the many factors that affect a family’s ability to afford healthcare—not only income but family size, other financial obligations, and health status. Veltri emphasized the importance of data in informing the standard.

Weiner noted that affordability can also be seen in simple terms, such as any obstacle someone faces in getting the care they need. "There are horrible inequities in our system," she said. “Far too many with less than $400 in their bank account have a $1,500 deductible."

Experts also touched on other important ways to reduce costs, from expanding Medicaid to cost-sharing strategies. The Healthcare Value Hub provides an affordability framework that captures all strategies that states should consider when addressing affordability, from extending coverage and making cost sharing affordable to reducing low-value care and curbing excess prices.

A recording and written summary of the event along with studies cited by the panel will be posted shortly on the event website.

We are grateful to Joanne Kenen of Politico for her excellent moderating of the event and Andrea Ducas of the Robert Wood Johnson Foundation for her insightful introductory and closing remarks.

Signaling Support Isn't Enough. We Must Take Action to Eliminate Racial Disparities

• $8 trillion in additional U.S. GDP, which is more than the current GDP of every country in the world except the U.S. and China.
• An additional $3.3 trillion in earnings by closing gaps in productivity and opportunity
• An additional $2.6 trillion in consumer spending, including $330 billion on food, $860 billion on housing, $440 billion on automobiles and transportation, and $90 billion on apparel and services.
• An additional $1.4 trillion in federal tax revenues and $325 billion in state and local tax revenues.
• Savings of $150 billion in excess health care spending and $50 billion in corrections spending
• An increase of 0.5 percent in the long-term annual growth rate of the U.S. economy.

New Analysis

Unprecedented Decline in Health Spending is Leading the Economic Downturn  

By George Miller and Paul Hughes-Cromwick

With yesterday's Gross Domestic Product Advance Estimate (GDP) release for the first quarter of 2020, we learned that health services contributed 47% of the stunning 4.8% decline in real economic activity. Yet those data pertained to the entire 3-month period, while the true economic devastation did not take hold until several days into March. In contrast, today's Personal Income and Outlays data concerns only March 2020. It shows that personal income fell 2% for March compared to February, and that personal consumption expenditures fell 7.5% for the month (both in nominal dollars). The report states, "Within services, the leading contributor to the decrease was spending on health care, including physician, dental, and paramedical services."

In this perspective, we use our Health Sector Economic Indicators^SM methodology, which emulates national health expenditure data, to analyze total health spending and selected components.

Preliminary data indicate that total health care spending in March 2020 was 5.5% lower than in March 2019 (Exhibit 1). This is the only occurrence in our historical time series of health spending (which goes back to 1989) that total spending has shown a monthly decline from the previous year. This decline was led by the two largest spending categories: hospital spending, which showed an 8.7% decline, and spending on physician and clinical services, which declined by a huge 19.3%, year over year. Spending declined in all major personal health care categories except nursing home care and prescription drugs (Exhibit 2).

In past recessions, health care has helped to provide relief by continuing to generate revenue during and immediately following the economic decline. As we enter what is surely a new recession, this situation is reversed, with health spending being a major contributor to the downturn. Almost overnight, we have gone from concerns generated by government projections that suggest higher prices will accelerate health care spending to concerns over the financial solvency of providers.

As the current crisis fades, some of this decline might be offset by a surge in spending resulting from the pent-up demand for health care that has been deferred. But some of that demand is for routine visits and elective procedures that might simply be forgone rather than delayed.

Some of this might be good news in the long run as we return to a concern for controlling health spending in part by reducing low-value care. But high-value services are also being foregone in the current environment. There is even evidence from declining emergency care volume that patients are forgoing essential services for serious problems such as heart attacks and strokes. A challenge in a post-COVID environment will be to continue to avoid the low-value services while resuming the high-value ones.

Further details about this unprecedented decline in health spending will be included in this month's Health Sector Economic Indicators, which we plan to release on Thursday, May 14.

Altarum's health sector tracking work is made possible by a grant from the Robert Wood Johnson Foundation. 

Pandemic Results in 1.5 Million Lost Health Jobs: Devastation Eclipsed by Non-Health Sector

By Ani Turner, Corwin Rhyan, Paul Hughes-Cromwick, and George Miller
May 8, 2020

Month-over-month change in health care employment, 1990 through April 2020 (Monthly losses shown in red)

Sector Components of the 21.4 Million Jobs Lost Since February 2020, in thousands

Health Care Sheds 43,000 Jobs in March, the Biggest Loss in at Least Three Decades

Health Sector Won't Be the Backstop in this Downturn

By Ani Turner 
Co-Director of Sustainable Health Spending Strategies

Today's jobs report begins to reveal the impact of the COVID-19 pandemic on employment. More than 700,000 jobs were lost since February. But the world has changed even in the three weeks since these data were collected (second week of March), and the end of this story is not yet in sight. As our chart illustrates, the loss of 43,000 health care jobs in the first month of the COVID-19 economic downturn is unlike anything we have seen at the start of a recession over the past three decades.

Health care has traditionally cushioned the blow of non-health sector job losses during and immediately following economic downturns. As we and others observed, job losses during the Great Recession would have been larger had health care employment not continued to grow. By 2010, there were 8.6 million fewer jobs than at the end of 2007 when the recession began; the loss would have been 9.2 million had health care not added nearly 600 thousand jobs. It took until November 2014 (fully 65 months into the economic expansion) for non-health jobs to return to their pre-recession level, at which point health care had grown by 1.7 million.
 
This time, health care looks to be contributing to instead of counterbalancing an accelerating economic calamity. Health care lost 43,000 jobs this month, by far the largest monthly drop in our data series going back to 1990. This may seem counterintuitive as we read daily of health care providers caring for COVID-19 patients stretched to capacity, but other types of health services have been shutting down like the rest of the service economy. This month's losses were concentrated in ambulatory care settings, including physician offices, dental offices, and offices of other practitioners. As non-essential visits were cancelled, and states began ordering social distancing, such offices were closed. Even telemedicine visits, directly linking providers to patients, reduce the use of support staff.
 
Once things "return to normal," demand for deferred health care may surge. But some routine care will never be made up and some conditions may resolve on their own. Indeed, care overall may be viewed differently as to what is required and what is discretionary. Like other service industries, health care providers are also suffering financial losses at a scale unlike in past recessions. The combination of intensive and costly COVID-19 care and the loss of high-margin discretionary procedures are devastating for hospital finances. While hospital jobs remained stable between February and March, even hospitals are beginning to furlough workers as revenues plummet and margins disappear.  
 
Health care job growth during a recession is not necessarily a good thing in the long run, as it reflects more and more of our societal resources going to health care spending. Baicker and Chandra have argued that  "employment in the health care sector should be neither a policy goal nor a metric of success." Nevertheless, today's jobs report gives us one more sign that this downturn is unique, and may be more painful than any in our lifetime. 

Altarum's health sector tracking work is made possible by a grant from the Robert Wood Johnson Foundation. This blog post, along with a chart showing month-over-month change in health care employment from 1990 through March 2020, is available here.

News Release

HRSA Selects Altarum to Lead Innovations in Newborn Screening Interoperability Resource Center

News Release

Men Lag Behind Women in Following Social Distancing Measures

Ann Arbor, Mich. - Men are less likely to follow social distancing guidelines and orders compared to women, according to survey data released Friday by Altarum. Over 16,000 Michigan residents have completed the tracking survey about COVID-19 perspectives, attitudes, and behaviors since Thursday, March 19.

Below are key social distancing findings:

• 9% of men reported they are "unlikely" or "extremely unlikely" to follow Michigan's shelter-in-place order, compared to just 4% of women in the state. On March 23, Michigan's governor announced a shelter-in-place order beginning at midnight that evening. Survey responses from two days after the order took effect show that women are much more likely to follow the order than men.
   
• Men are less likely to take appropriate public health precautions.
  • 90% of women reported avoiding public spaces a lot more or far more than usual, while only 76% of men reported doing so.
  • While 85% of women report maintaining a distance of 6 feet or more from others a lot more or far more than usual, only 77% of men reported doing so.

• In the last week of March, men in Michigan were twice as likely as women to have attended a gathering of 10 or more people (11% versus 5%).

• About half of men reported still working outside the home in the past week whereas just 41% of women reported working outside the home.

• Men are also reporting an overall lower level of concern about COVID-19. 33% of men rated their concern as less than 8 on a 0 to 10 scale, compared to only 18% of women.

"Data on COVID-19 cases in Italy and Spain indicate that men may be at greater risk of death from the coronavirus than women, underscoring the need for men to take social-distancing measures seriously," said Dan Armijo, chief operating officer of Altarum. "And while our survey focused on Michigan, we believe similar risk taking differences exist between men and women across the country."

Full survey results, including data visualizations and county-level data are available at altarum.org/COVID/results.

Altarum conducted the tracking survey to understand Michigan residents' risk factors, preventive behaviors, concerns, and sources of information about COVID-19. It is revealing how respondents' feelings and behaviors change over time, as well as how certain thoughts and behaviors might be related. All of this we hope will help inform the response to the outbreak in Michigan.

If you are a Michigan resident please take the survey at: https://altarum.org/COVID.

While these results have been weighted by age and gender to better represent the state's population, there is the potential for response bias because we are using an online survey instrument. In tandem, Altarum is also conducting a series of more traditional representative surveys and will make those results publicly available as we receive them.

Health Sector Economic Indicators Briefs

April 2020

Altarum''s monthly Health Sector Economic Indicators briefs analyze the most recent data available on health sector employment, spending, prices, and utilization-helping to fill gaps in the official government data. 

We''re watching closely the impact of the coronavirus on these key indicators. Below are highlights from this month''s briefs:

New Analysis

Impact of Covid-19 on Health Sector Begins to Take Shape

How might Covid-19 impact health care spending, utilization, employment, and prices in 2020 and beyond? In this early analysis in Health Affairs Blog, we share the most striking stories we see emerging from the data.

Cumulative Spending Growth since February 2020 for Major Categories

Sustainable Health Spending Strategies

New Analysis

Health Spending Rebound Continues into June Amidst Economic Devastation and New Covid-19 Fears

By Paul Hughes-Cromwick and Corey Rhyan

With yesterday's release of U.S. gross domestic product (GDP) data for the second quarter of 2020, dire economic anxieties were confirmed as we saw the worst reading in the series' history (which goes back to 1947): a drop of 32.9% at a seasonally adjusted annual rate. For the quarter, covering April thru June, health care services accounted for 9.5 percentage points of this total decline, or about 29%. This morning, the U.S. Bureau of Economic Analysis released data on Personal Income and Outlays, giving us a first look at June-specific data. It showed that the rebound we have been tracking in personal health care spending has continued: while April was down a whopping 29.0% and May 16.5%, June spending was down only 7.5% - all compared to the same month in 2019. In this perspective, we update our Health Sector Economic Indicators framework to analyze health spending and selected components, and consider various prospects over the short- and medium-term as Covid-19 continues to ravage the country.

June 2020 Health Care Spending Data

Exhibit 1: Year-Over-Year Growth Rates in Personal Health Care Spending

Exhibit 1 clearly shows the recovery, after February, of personal health care spending. Of note, June's year-over-year fall of 7.5% is slightly less bad than the March reading of -7.8%, and thus the smallest year-over-year decline since the pandemic struck.

Exhibit 2: Health Spending 12-Month Growth for Major Categories

Exhibit 2 decomposes total personal health care spending to illustrate 12-month changes for six categories, both for June 2020 and June 2019. Considering June 2019 annual growth as a baseline, it is interesting to see the range over which the categories have returned to the earlier growth rates. On one end of the continuum is physician & clinical services that have recovered to being down by only 1.9% compared to a year-earlier growth of 3.2%. On the other end of the continuum is dental services, still down 33.9% compared to the 2019 growth of 4.4%. In the middle is hospital care, down 13.1% compared to 5.0% growth in 2019. The prescription drugs category is the outlier, never going negative during the pandemic, although it has fluctuated from a high annual growth of 12.7% in March due to people stocking-up, to a much lower rate of 3.8% in May and now 5.6% in June.

Exhibit 3: Cumulative Spending Growth since Jan 2020, by Major Categories (Percent Difference for Jun 2020 shown in data labels)

Rather than "starting the clock" in June of 2019, Exhibit 3 pegs the baseline at the beginning of the year and traces spending recovery for five categories on a cumulative basis. Most of the major health spending categories follow the trend seen in hospital and physician & clinical spending, having bottomed out in April 2020 and then recovering in May and June, but still significantly below their February pre-pandemic levels. The long road back for dental services (down 35.4% cumulatively) is also seen in the cumulative data, having taken the most extreme hit from delayed care during the pandemic. Nursing home care spending avoided the initial severe drops in spending early in the pandemic; however, it is not recovering at all - its continued deterioration leaves its spending at -15.0% compared to January 2020. As mentioned above, prescription drug spending has only seen modest changes in 2020.

A Macro-Economic Update

While huge attention was appropriately directed to yesterday's historic GDP decline, lost in the commotion is the two-week string of deteriorating labor data as indicated by unemployment insurance weekly claims showing 1,434,000 initial claims for the most recent week. Worse, so-called continuing claims are back above 17 million, and total claims, counting the new special programs, exceed 30 million! A new Census Household Pulse Survey, for July 16 to 21 period, shows the number reporting not working is moving back down again but still below the recent "recovery" peak in mid-June. The number reporting not working because the company went out of business or they were laid off continues to rise. Official labor data from the Bureau of Labor Statistics for the month of July will be available August 7^th.

Today, the University of Michigan Consumer Sentiment Survey shows a decline of 25% from the same period in 2019. But most worrying of all the cross currents is the delay over new Federal stimulus legislation. The data clearly show that, despite massive declines in economic activity and consumer spending, incomes have been mostly stabilized and actually slightly up, because of previous legislation, especially the CARES Act. With no legislative compromise for continuing this help in sight, it creates a scary macroeconomic cliff if a deal is not found soon to renew extra unemployment insurance and other federal supports for those unable to work or otherwise missing incomes.

Looking Ahead

It is worth repeating that, like so many unprecedented current events, we have never had an economic downturn that was abetted by the health care sector. In all post-World War II recessions, health provided a stabilizing function, that is, it cushioned the blow from declines in the other sectors. Not this time. A few months ago, when health care spending dropped sharply but there was solid hope for quashing Covid-19 infections, we would have confidently predicted a continued recovery in health care spending and, perhaps, even an increase to account for pent-up demand. But with new cases steady at about 65,000 per day, the daily death count at nearly 1,200 and rising, plus a revised projection by IHME of 230,822 deaths by November 1 (up from 219,864 projected on July 22), it is likely that economic progress will stall. Health care activity can also be predicted to follow suit as fear of receiving care regains the upper hand. We are especially concerned about life and death care that is not received. Emergency room visits are down sharply (though they have recovered of late), and there has been a drastic decline in health screenings with models predicting "delayed diagnoses of an estimated 36,000 breast cancers and 19,000 colorectal cancers due to Covid-19's scrambling of medical care." Most amazingly, 1 in 4 survey respondents said they would rather stay home out of fear than go to a hospital when experiencing a heart attack or stroke!

We wish to highlight three related issues:

• While the data indicate a high plateau for many areas in the country, will ongoing Covid-19 infection spikes in other parts of the country naturally cause concern if other states may become the next Arizona, Texas, or Florida? Further, will opening schools have a major impact on community spread now that we are learning children may carry the virus at high levels?
• Will the reversion to normal health care spending be below or above trend? In some parts of the country, for example New York and Massachusetts, we've now seen suppressed Covid-19 spread for a couple of months. How quickly will care come back and is there truly pent-up demand that will result in "catch-up spending" this fall? Or, will health spending only return to trend, leaving a permanent hole in 2020 revenues from the spring?
• While we've emphasized macroeconomic factors, it is worth calling out the effects of this calamity on state budgets which are being decimated by evaporating revenues, yet are also faced with unique spending needs, especially Medicaid expenditures. There is the strong potential of a vicious cycle of state and local spending cuts, lost jobs and the impact on declining commercial health insurance, among other effects, especially if support for state and local budgets is not included in the next round of federal monies.

We will, of course, continue to closely monitor the spending, employment, price and utilization data. Specifically, we will analyze new total and health care employment data to be released on Friday, August 7th.

Altarum's health sector tracking work is made possible by a grant from the Robert Wood Johnson Foundation.

Covid-19 Is Changing Health Services-from WIC Programs to Pediatric Care 

Can We Make Nursing Homes Safer?

See more about our eldercare work at Altarum.org/eldercare and follow us on Twitter @Altarum and @SlocuMontgomery.

Health Care Regains Half of Jobs Lost This Spring

By Ani Turner and Paul Hughes-Cromwick

August 7, 2020-Based on today's Employment Situation-July 2020 release, the U.S. health sector is continuing to regain jobs, but at a slower pace than in May and June. Adding 125,000 jobs in July, the health sector has regained more than 780,000 jobs, or about half of the 1.58 million jobs lost in March and April of this year.

Month-over-month change in health care employment, seasonally adjusted

In ambulatory care settings, where most of the job losses occurred, two-thirds of jobs have returned. As we have noted in previous analyses, dental offices have experienced particularly dramatic swings in employment, losing more than half the jobs in this setting (549,000 jobs) in March and April, but rebounding quickly in May and June. Dental offices added another 45,000 in July and have now regained 483,000 jobs since April, or 94% of the jobs lost.

Hospitals were slower to lose jobs than ambulatory care settings, lost a smaller percentage of jobs, and have been slower to regain them. Hospitals lost 161,000 jobs in April and May and have gained back 30,000 jobs, or 18% of jobs lost, through July. At the current level of employment, the hospital workforce has shrunk by about 3%. Note that hospital employment includes inpatient care, including care of Covid-19 hospitalizations, and hospital-based outpatient clinics and ancillary services, as well as administrative and other non-health care service jobs.

Nursing and residential care employment continues to fall. Job losses in these settings have not been as dramatic as in ambulatory care but both nursing homes and other residential care have shed jobs for five straight months, for a total of 220,000 jobs lost.

The overall economy regained jobs in July, also at a slower pace than in May and June, adding 1.76 million jobs. Including health care, the economy has regained 42% of jobs lost. Comparing July 2020 to July 2019, health care jobs are down by 3.5%, while non-health jobs are down by 8.0%, for a total year-over-year decline of 7.5% in U.S employment.

What lies ahead for health jobs? Our crystal ball is as cloudy as anyone's, but it seems reasonable to project slower job recovery in the health sector (and overall) in the near-term. The surge in Covid-19 cases and deaths in July and August (with one highly respected model now projecting over 300,000 U.S. Covid-19 deaths by the end of the year) can be expected to put a damper on what had been a steady increase in health care utilization, especially for elective care. The large for-profit hospital companies reported better-than-expected earnings in the second quarter of 2020 because of government relief, aggressive cost cutting, but also a strong utilization recovery. The continuing spread of the virus will likely inhibit this elective care recovery especially in the most affected regions of the country.

Longer term, it is possible that health care in all settings may learn to manage with less staff as revenue is reduced and use of technology increases - good for efficiency, obviously not so for furloughed workers. Nonetheless, the health sector has not only been heroic in its care of Covid-19 patients, it has also been innovative in adapting to what may be the health care delivery environment for the long haul. This includes everything from instant temperature checks for arriving patients, to expedited Covid-19 testing protocols before outpatient procedures, to social distancing in waiting rooms, routine use of personal protective equipment, and a rapid ramp up in the use of telemedicine.

Altarum's health sector tracking work is made possible by a grant from the Robert Wood Johnson Foundation.

Sustainable Health Spending Strategies

News Release

Altarum Releases Policy Roadmap for Making Insulin Affordable

How Can Communities Address the Growing Number of Opioid Overdoses?

Webinar: How Do We Ensure Equity and Value in Telehealth?

December 11, 2020 | 2:00-3:00 p.m. EST

• Elaine Khoong, MD, MS, assistant professor of medicine and general internist at Zuckerberg San Francisco General Hospital
• Lee Taylor-Penn, MPA, MPH, senior policy analyst at Families USA
• Ian Hill, MPA, MSW, senior fellow in the Health Policy Center at the Urban Institute