At the height of the pandemic, employee health care claims dropped steeply when people avoided visiting doctors' offices. Now as coronavirus vaccinations are widely available, Americans are expected to seek long-delayed care. Health claims could reflect the consequences of letting risky health conditions go untreated for more than a year, exacerbated by stress, poor diets and suspended gym memberships.
A financially strong 2020 for self-funded health plans could turn into a challenging 2021.
A recent survey by the American Psychological Association, conducted in February with responses from more than 3,000 U.S. adults, found that:
Despite these warning signs, the pandemic's effect on health care usage may provide an opportunity to rethink how health benefits are designed, offered and used.
"My concern is that [health plan sponsors] may be focused on getting everyone back to the office and getting everyone vaccinated, and they won't take the time to review other opportunities that may be bigger in the long run and more sustainable," said Mark Cunningham-Hill, medical director for the Northeast Business Group on Health, one of several regional employer coalitions focused on improving employee health care. "This may be an opportunity to reboot things not as they were before but doing [health care] better."
Mark Cunningham-Hill, M.B., Ch.B., medical director of the Northeast Business Group on Health and a former Johnson & Johnson, Inc. and GlaxoSmithKline PLC executive, says that coverage losses have mainly been confined to the hospitality, retail and travel industries. Cunningham-Hill notes that membership of his organization is mainly composed of white-collar employers.
“Most of the major, blue chip players have probably kept most of their staff on,” Cunningham-Hill tells AIS Health. “I know some have had to furlough some staff for periods, certainly the ones that have retail operations, but generally I think they’ve tried to keep staff on and have as few layoffs as possible. So I’m not sure if there’s been a massive shift in our membership away from benefits.”
More than bringing people back on board, Cunningham-Hill says his membership is concerned about the looming wave of delayed care claims. The entire health insurance industry faces that challenge: Care utilization plummeted during the second quarter of 2020 and has still not entirely rebounded (HPW 1/22/21, p. 1). Experts expect that patients will schedule replacement appointments to receive some of that delayed care eventually, but are not sure when or to what extent.
The deferral also likely worsened chronic health problems or prevented early discovery of pre-acute conditions, which could introduce otherwise preventable cost to the system.
Cancer is soon to become the world’s leading killer. Despite significant advances in therapeutics and guideline-recommended tests that screen for 5 cancer types—a single cancer at a time—cancer kills nearly 1700 of our loved ones every day in the United States.1 The fact remains that even today, the majority of cancers still lack screening tests and are therefore detected too late and often not impacted by available therapies, leading to poor patient outcomes.
In developing novel therapeutics, these mortality numbers are simply unacceptable. As such, we believe the best chance at reducing cancer mortality is to increase focus on cancer prevention and early detection. Because age is an established risk factor for many malignancies, there may be a misperception that cancer is a disease of the elderly; however, cancer strikes all age groups.
Cancer is a disease that strikes great fear in many individuals, but it is also a disease of interest and concern for the self-insured and employers. Employers have a bigger stake in the health of their employees, employees’ families, and employee productivity than any other entity or institution in our society. As they balance strategies to optimize the health of their employees and beneficiaries while constraining growth in health care costs, employers find cancer represents a substantial challenge. This complexity relates to many factors, including a dearth of data on quality of care, as well as a lack of price transparency. These factors are magnified by the fact that the term “cancer” translates into hundreds of specific clinical scenarios, compared with hypertension or diabetes, with each having an extensive array of services needed to support employees and their families when faced with a cancer diagnosis.
An emergency preparedness guide released by the Northeast Business Group on Health recommends that employers invest in V-BID principles to strengthen their COVID-19 response and prepare for a future pandemic situation. The incorporation of value-based principles in plan designs, as demonstrated with the V-BID X health plan, can encourage employees to seek appropriate care and address emergent needs in a public health emergency.
Northeast Business Group on Health (NEBGH) recently released a guide for employers to manage the current COVID-19 pandemic and future pandemic situations.
The "Pandemic Response, Recovery, and Planning: Lessons Learned for Employers in 2020" guide offers resources, best practices, and action steps around pandemic planning and strategy for the employer community.
The beginning of the pandemic presented employers with many unknowns and a learn-on-the-fly mentality, so NEBGH wanted to compile those learnings and create a guide for future pandemic responses.
"We thought it was important to pull together all of the learnings and best practices from the last year, so that now, and in the future, folks have our resource that they can [utilize,"] Candice Sherman, CEO of NEBGH, told HealthLeaders.
Sherman added that due to the ongoing vaccination effort around the country, employers may start bringing employees back to the workplace if they haven't already.
She said this is an “opportune time” for employers of all types to “review and refresh what they have in place, [look into] what more they might need to do [to be prepared,] and what some of the new challenges will be."
While focused on the acute, short-term issues presented by COVID-19, NEBGH is also looking ahead to the next potential pandemic situation.
"Experts are certainly predicting that this will not be the last pandemic we have to face, and so it's important to be prepared for whatever lies ahead," Sherman said.
Dr. Mark Cunningham-Hill remembers the initial months of the pandemic well. As the medical director for the Northeast Business Group on Health, a regional coalition of employers and healthcare stakeholders, Cunningham-Hill observed closures on a wide scale. "Everything stopped for a month or two," he told HR Dive, "and gradually, telemedicine started coming online."
COVID-19 also may prompt healthcare providers, payers and even employers to re-examine what constitutes high-value or low-value care, Cunningham-Hill said. He referred specifically to procedures such as colonoscopies that are performed on patients over the age of 75, as well as false positives that lead to lengthy investigations that do not turn up problems. But there are also items proven to be valuable, such as asthma medications and diabetes management tools. "How do we come out of this doing more of the high-value stuff?," Cunningham-Hill said.
That points to another actionable item for employers: access. It is one thing to provide coverage for a given form of preventative care, but associated copays may discourage workers from actually taking part in that care. Even if the plan provides 80% coverage for a procedure with a $25 copay for the worker, "that copay is a fortune for someone earning $25,000 a year," Cunningham-Hill said. Such examples point to the need for greater healthcare equity, he added.
Employer benefits and human resources professionals should glean key lessons on emergency planning from the COVID-19 pandemic—and a new guide from the Northeast Business Group on Health aims to help set a baseline for those discussions.
The paper outlines seven key action steps employers should take to strengthen their COVID-19 response and prepare for a future pandemic situation that can be deployed now, the group said.
“The experts say it is not a question of if but when a future pandemic will occur. And while it’s impossible to be 100% prepared for future pandemics, employers can enhance their preparedness," said Candice Sherman, CEO of the Northeast Business Group on Health, in a statement.
Employers might face myriad challenges when reopening the workplace, but lessons learned during the pandemic suggest they also should consider preparing for a future crisis, according to a guide released today by the Northeast Business Group on Health.
The employer-led coalition of benefit leaders and health care stakeholders published its Pandemic Response, Recovery and Planning guide, which captures lessons learned by employers during the pandemic and outlines action plans for reopening the workplace, adapting benefits to address Covid-19 and preparing for a future pandemic.
"The pandemic is not over, and now is an opportune time for employers to see what more they might need to put in place to address health and safety," said Candice Sherman, CEO of the business group.
As the vaccines are being rolled out, employers will need to think about communicating and engaging with their workforce about vaccinations, she said. Many companies rolled out flu vaccine programs in the past, and some successful measures—such as offering incentives or time off for vaccination—can be employed for the Covid-19 vaccine as well, she said.
Employers will be key in communicating to workers the importance of receiving the vaccination.
"It is essential employers educate their workers that the vaccine is safe or the pandemic will never truly be over," Sherman said.
For example, workers who choose not to vaccinate might cause unease among their coworkers, throwing a wrench in reopening efforts. The guide suggests bringing in medical directors from health plans or doctors to hold forums about the vaccine.
Businesses also need to ensure health benefits are adaptable and accessible during a future crisis.
"We're not talking about health insurance coverage … but we're talking about wellness and mental health support, and those chip away at workers more than we realize," Sherman said.
Many organizations provided wellness and mental health support to employees before the pandemic, but access might have been disrupted as offices shuttered. The boom of telehealth tools has become fundamental to ensuring employees continue being able to reach those resources, Sherman said.
Lastly, even as companies build infrastructure—updating air filtration and testing protocols—to address this pandemic, they need to consider implementable plans for a future crisis.
"The experts are saying it's a matter of when, not if," Sherman said. It's never too early to think about what you need to have in place for the future, she added.
The Northeast Business Group on Health was founded in 1982, and its members are senior benefit leaders from about 180 large corporations, organizations and unions, including 1199SEIU, CityMD, Mount Sinai Health System and Pfizer. —S.S.
Members of the Northeast Business Group on Health (NEBGH), a regional coalition of employers and healthcare stakeholders, have asked questions about vaccine rollouts and about whether particular types of workers qualify as essential workers, NEBGH CEO Candice Sherman said. But with guidance changing on a day-to-day basis, there is still a "good deal of uncertainty," she added.
Sources who previously spoke to HR Dive described incentivizing vaccination as one potential avenue for employers worried about the impact of other policies, such as a vaccine mandate. While Sherman said NEBGH has not heard much from members with respect to incentives, "I frankly am in favor of incentivizing." She added that employers may want to work with health plans and pharmacy partners to ensure employees and their families have access to good information about vaccine availability.
Employers, in connection with their health plans, may be able to look into concepts such as drive-thru vaccination clinics once vaccines become more broadly available, Sherman said. Some states are already beginning to experiment with this specific idea. Florida announced plans this week to open a golf cart drive-thru vaccination clinic for seniors at one retirement community, reported ABC affiliate WFTV.
“The Haven health venture and the publicity surrounding it shone a light on the critical role employers play in funding the health care system and generating innovation that can benefit employees and the public at large. But health care delivery is primarily regional, so it’s not a surprise that these companies are pursuing projects tailored to their own populations.”
–Candice Sherman, CEO, Northeast Business Group on Health