The Impact of Natural Disasters on Healthcare Quality and Performance

A study by RAND Corporation found that short-term, localized disasters have minimal impact on Medicare Advantage healthcare quality scores, indicating the system’s resilience. Policymakers may not need major adjustments, though long-term disasters like pandemics require different considerations.

A study conducted by researchers from the RAND Corporation and published in The American Journal of Managed Care examines the impact of geographically limited disasters on healthcare quality performance scores, particularly for Medicare Advantage (MA) contracts. With climate change driving an increase in natural disasters, concerns have risen over the potential disruptions to healthcare access and service quality. Disasters can overwhelm healthcare infrastructure, force patient displacement, and disrupt the supply of essential medications. However, the extent to which these disruptions affect performance accountability programs like Medicare Advantage Star Ratings has been unclear. This study seeks to fill that gap by determining whether localized disasters significantly impact healthcare quality metrics and whether policy adjustments are necessary.

Understanding Medicare Advantage Quality Measures

Medicare Advantage (MA) contracts are evaluated through the Star Ratings system, which the Centers use for Medicare & Medicaid Services (CMS) to assess provider performance. These ratings measure patient experience, clinical outcomes, and preventive care efforts. Since healthcare providers worry that disasters might unfairly lower their performance scores, the study examines whether these evaluation frameworks remain accurate during disaster periods. Using data from 2016 to 2018, the researchers analyzed healthcare performance before and after disasters such as hurricanes, wildfires, and earthquakes.

To assess disaster impact, the researchers used CMS data to determine the proportion of Medicare beneficiaries residing in disaster-affected areas. They applied linear mixed models to analyze performance changes across 11 key healthcare measures, including flu vaccination rates, diabetes care, timely access to care, and hospital readmission rates. Contracts were classified as "disaster-affected" if at least 25% of enrollees lived in a FEMA-designated disaster area. The study then compared performance scores before and after the disasters, accounting for factors like contract size and type.

Minimal Impact of Disasters on Healthcare Performance

The study’s findings reveal that geographically limited disasters have little to no meaningful impact on Medicare Advantage quality performance scores. While minor statistical differences appeared in a few measures—such as flu vaccination rates and timely access to care—their effect sizes were small. For example, in 2017, flu vaccination rates dropped by only 1.3 percentage points in disaster-affected contracts, while timely care access decreased by 0.6 percentage points. These minor fluctuations suggest that the healthcare system effectively absorbs the impact of short-term, localized disruptions.

The study examined two years of disasters, including hurricanes Harvey, Irma, and Maria, the California wildfires, and the Alaska earthquake. In 2017, 20% of Medicare Advantage contracts were affected by disasters, while in 2018, only 9% were impacted. Despite these disruptions, none of the 11 healthcare quality measures showed significant or long-lasting deterioration. The researchers propose that large healthcare networks may have mitigated the impact by shifting patient care to alternative locations, utilizing telehealth services, and delaying non-urgent medical procedures until after the disaster subsided.

Implications for Healthcare Policy and Disaster Preparedness

These findings hold critical policy implications for healthcare administrators and policymakers. Since localized disasters do not substantially impact performance scores, the Medicare Advantage Star Ratings system appears robust and fair. CMS has already implemented a "hold-harmless" rule, which ensures that MA contracts affected by major disasters receive the higher of their prior or current year’s performance scores. However, given the study’s findings, this policy may not need to be extended to short-term, geographically limited disasters. Policymakers may instead focus on refining disaster-related adjustments for prolonged, large-scale disasters that pose a more significant threat to healthcare access and quality.

The study also raises questions about healthcare resilience and whether different types of providers experience varying levels of disruption. While large health systems may successfully redirect patients and resources, small clinics or independent providers could face greater challenges in disaster-affected areas. Future research may help policymakers determine whether certain provider types require additional disaster-related policy protections.

Healthcare Resilience: Lessons from Past Disasters

Despite these largely reassuring findings, the study acknowledges limitations. It only analyzed short-term disasters and did not account for long-duration crises like Hurricane Katrina or the COVID-19 pandemic, which likely had a more significant and lasting impact on healthcare quality. Additionally, since the study focused exclusively on Medicare Advantage contracts, its findings may not apply to other healthcare models, such as Medicaid or commercial insurance plans.

However, past research aligns with the study’s conclusions. After Hurricane Katrina, hospitalization rates spiked within six days but returned to pre-disaster levels within two months. Similarly, studies of multiple hurricanes between 2005 and 2016 found that emergency department visits did not significantly increase in affected counties beyond the immediate post-disaster period.

In contrast, the COVID-19 pandemic presented a unique scenario, leading to prolonged disruptions in healthcare delivery. Many non-urgent medical services were suspended, and providers struggled to maintain continuity of care for an extended period. Unlike localized disasters, which allow patients to return to normal care relatively quickly, the pandemic caused long-term systemic disruptions. These differences suggest that while short-term disasters may not affect healthcare quality scores, extreme long-term crises like pandemics may require a different policy approach.

A Stable Future for Healthcare Performance Measurement

The study offers reassurance that Medicare Advantage quality assessments remain stable, even in the face of localized disasters. The findings suggest that existing performance measurement frameworks can continue uninterrupted, ensuring fair and reliable provider assessments. While disaster-related policy adjustments may still be necessary for long-term or severe crises, the results indicate that routine environmental disruptions do not significantly impact healthcare quality scores.

By highlighting the resilience of the U.S. healthcare system, this study supports the continued use of value-based care models, even as natural disasters become more frequent. The ability of healthcare providers to adapt, utilize technology, and shift resources ensures that patients continue to receive essential care, even during temporary disruptions. This resilience provides confidence that Medicare Advantage and other quality assessment programs remain effective and fair, regardless of localized environmental challenges.