Planning for Financial and Population Health Impacts of Deferred Care

With the onset of the global COVID-19 pandemic, health officials generally advised people to defer elective care to free up capacity in the healthcare system as well as to avoid the risk of infection. Although we are seeing an uptick in healthcare utilization, studies show that there is still a deficit in certain care categories compared to pre-COVID pandemic levels. We believe employers have a role in encouraging employees to return to healthcare, both to support employee well-being and to lessen the long-term impact of deferred care.

How big of a problem is this? An Urban Institute study showed that as of September 2020, 36% of adults reported delaying or forgoing health care due to concerns about COVID-19 exposure or provider services being limited. Additionally, we have observed significant decreases in diagnoses in the claims data collected in our Mercer FOCUS data warehouse. While new preventive health diagnoses were down 46% in April 2020, they were still almost 9% below pre-COVID conditions in February 2021. Gaps were also observed in new breast cancer diagnoses (down 4%), skin cancer diagnoses (down 17%) and all other cancers (down 13%). 

These statistics are worrying. A study from The BMJ found that every month delayed in treatment for certain cancers can raise risk of death by around 10%. Diagnosing cancer and other serious health conditions at later stages will impact financials, productivity and employee well-being. Now is the time to encourage employees to seek appropriate, high-value care.

Prepare for both financial and population health impacts

As you encourage employees to return to healthcare, there are steps you can take to prepare for both the unpredictable financial impact of care deferred over the course of the pandemic – and for the impact on population health.

  • Consider your margins. Ensure financial projections have adequate and appropriate margins so you have the flexibility to handle an unpredictable impact.
  • Understand your health trends. Monitor your utilization data to understand where your population is seeing deferral gaps and what financial implications those specific conditions may have. Lean on your carrier, vendor and consulting partners to assist. Understand how trends in certain categories of conditions impact your population, such as the growing burden of behavioral health disorders and the decline in the US birth rate.
  • Expect greater claims volatility. Since some types of delayed care increase the risk of large claims, consider communicating this risk to finance and other stakeholders.
  • Implement enhanced care management. Do you have clinical programs in place that can support complex conditions and patients who are diagnosed at later disease stages? Clinical oversight can help ensure care is being managed efficiently and that low-value services are not inappropriately recommended.
  • Consider targeted health solutions. Once you know what gaps in care have occurred, consider implementing targeted solutions to support or provide expert medical advice to those who have developed chronic conditions (e.g., diabetes) or advanced diseases (e.g., cancer) as a result of deferred care.
  • Focus on high-value care.  To ensure your employees are obtaining high-quality, cost-efficient care, consider strategies such as advanced primary care, centers of excellence and high-performance networks. Encourage your employees to receive care virtually or at home, as appropriate. The added convenience may encourage greater utilization of needed care, and relatively low-cost virtual services can help people stay healthier and prevent the need for more expensive services down the road.

Encourage employees to return to care and support their well-being

Communicate! Create a strategy to encourage employees to receive preventive care, utilizing your enterprise channels, health plan and well-being partners. Educate employees on the importance of preventive care and how they can access it. It’s important to meet employees where they are, physically or virtually, especially if you are transitioning to a hybrid or remote working model.

The COVID-19 pandemic will have a lasting and multifaceted impact on societies around the world. There is much that employers can do to positively impact the future of health in this changed environment. For now, the priority should be getting employees and their families back to health care. 

Sunit Patel
by Sunit Patel

Partner, Chief Actuary, Mercer

Partner and Chief Actuary, US Health & Benefits Actuarial Financial Group

Erin Milligan
by Erin Milligan

Senior Associate, Mercer Health & Benefits

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