As the Covid-19 threat spread in early 2020, some state licensing requirements were eased by the federal government to allow telemedicine providers to work across state lines. A CDC report said virtual health services could “facilitate access to care, reduce risk for transmission of SARS-CoV-2, conserve scarce medical supplies and reduce strain on health-care capacity and facilities while supporting continuity of care.”
As a result, the policy shift “literally opened up access in the mental-health [and physical health-care] services,” said Mark Cunningham-Hill, medical director of the Northeast Business Group on Health, a nonprofit group of employers and health-care providers based in New York City. “Before the pandemic, utilization was relatively low.”
Convenience was a big attraction for workers, but employers’ fears that it would be overused — and increase benefit costs — were unfounded. In fact, Cunningham-Hill notes that telehealth can help patients get the care they needed early on before a condition becomes more complicated and costly.
“Maybe we’ll move to a hybrid model going forward where we’ll see people once and make that physical and personal connection, and then we’ll transition to video telehealth,” said Cunningham-Hill, who is based in Paoli, Pa. “It might be a steppingstone to make it more ingrained in how things work.”
According to National Alliance for Caregiving and AARP, Caregiving In The U.S. Report (2015), more than 1 in 6 Americans are caring for an elderly family member, disabled relative or friend. The same report states that 39% have to leave their jobs to care for the patient, due to inflexibility in work schedules. 10 Million caregivers, age 50+, lose $3 trillion dollars in wages, retirement, and benefits.
Northeast Business Group on Health Survey (2019-2020), finds that 91% of employers say their employees caring for elderly patients will abandon self-care. The companies surveyed believe that 51% of caregivers would not report their status to employers. The Caregiver Health Effects Study (1999), claims that, "Elderly spousal caregivers (aged 66-96) who experience caregiving-related stress have a 63% higher mortality rate than non-caregivers of the same age."
The WELL Health-Safety Rating covers quite a number of areas, said Mark Cunningham-Hill, MD, medical director at the Northeast Business Group on Health. The nonprofit, employer-led coalition focuses on helping its members achieve quality and value when it comes to healthcare benefits and services.
One consideration when it comes to achieving COVID-19 safety is that it's not just about the building itself, but the number of people in it and what they're doing, Cunningham-Hill said. For instance, ventilation considerations would be different between a building in which a group of opera singers convened and one in which office workers sat typing at their desks.
In principle, a business having a WELL Health-Safety Rating or a similar credential probably means its building is better than ones that couldn't meet those levels, he said. And for employers, "it certainly might help with attraction and retention."
To help consumers, clinicians and other stakeholders make informed choices, a team of researchers launched a searchable online database, called MIND (M-Health Index and Navigation Database), that evaluates apps based on cost, features, privacy policies and scientific evidence. That database draws on an evaluation framework that has been endorsed by the American Psychiatric Association.
Another app evaluation site called One Mind PsyberGuide reviews apps against rating criteria developed by experts in the field. The organization also offers a guide to digital mental health apps for employers, which it developed in collaboration with the Northeast Business Group on Health.
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."
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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.