HR Benefits Strategy In The Time Of Covid-19

How 2020 utilization patterns inform health benefits strategy in 2021

Covid-19 has had an unprecedented effect on all aspects of day-to-day life in the past 12 months. Many of these impacts have been seen in the availability of healthcare services. Concerns about infection, as well as shelter-in-place policies, have meant that accessing healthcare is much more difficult and, as a result, employees are accessing healthcare services care much less frequently. As we enter into 2021 with a Covid-19 vaccine in place, how can the patterns of deferred healthcare utilization inform HR benefits strategy for the next 12-18 months?  

In partnership with RAND, USC, and the National Bureau of Economic Research, Castlight recently published a study in JAMA Network Open examining the impact of Covid-19 on healthcare utilization for commercially insured employee populations. We looked at the utilization of healthcare services, such as preventive and nonelective care, elective procedures, prescription drugs, in-person office visits, and telemedicine visits during March and April of the Covid-19 pandemic in 2020 and compared utilization of these services relative to existing trends in 2019 and 2018¹. While we found minimal to no change in the utilization of nonelective care and prescription drugs, there were significant reductions in preventive and elective care, up to 70% for mammograms and colonoscopies. 
 

Additionally, we found that the use of telemedicine increased dramatically (by over 4,000%) in the first two months of the pandemic. However, this increase in telemedicine use did not offset the declines in in-person office visits, suggesting many employees have not had their primary care needs met. For those residing in zip codes with lower-income or predominately racial/ethnic minority populations, we found lower utilization rates of telemedicine services.  

Proactive outreach and engagement of employees will be critical to ensure the use of elective and preventative care services. 
Healthcare utilization will likely increase in 2021 (over prior years) to compensate for the care that was missed during Covid-19. However, given continued concerns about Covid-19 and long-term economic impacts, the volume of preventative care and elective procedures is not likely to rebound completely. Although this is positive news for the overall 2021 medical spending, preventative care visits and elective procedures are critical for reducing the incidence of chronic disease. Failure to engage employees in accessing these services may result in significant increases in medical spend for future years. Implementing health navigation platforms from technology providers can offer a centralized hub to enable individualized personal outreach as well as engage employees with access to telehealth and other digital health solutions.
  
Benefit programs may need to increase virtual service offerings, especially telehealth and digital health solutions. 
A secondary effect of the Covid-19 shelter-in-place restrictions has been the economic stress placed on providers and health systems in the U.S. Many primary and specialty care practices, especially in rural areas, have reduced hours or have ceased to operate².  Practices that remain open are inundated with Covid-19 patients and often do not have the capacity to treat those with non-Covid-19 related conditions. The result is that access to brick-and-mortar healthcare services may be constrained, increasing the time to get an appointment and making travel to access healthcare more difficult. Virtual service offerings, such as virtual primary care, tele-behavioral health, and digital health platforms for managing chronic disease will become important to ensuring the long-term health of employees. 

Innovative strategies will be needed to assist employees with overcoming the social and economic barriers to accessing care. 
Covid-19 has amplified the social and economic disparities in accessing healthcare services. Successfully addressing the Social Determinants of Health driving these disparities will require innovative approaches to engage employee populations. Examples of potential strategies include health benefits plan designs that reduce out-of-pocket expenses, partnerships with community organizations to improve access to housing, aligning healthy food programs with employees living in food deserts, arranging transportation to employees seeking healthcare services outside of their local geographies, and providing access to health literacy and advocacy programs. 

The positive news is that every day we are learning more about battling the pandemic. Health providers are learning new techniques for stabilizing Covid-19 patients, several new vaccinations are expected to begin distribution, and technology advances are accelerating hope for a cure. As HR professionals continue to learn how to lead in the new normal, learning how to utilize and incorporate healthcare data into your health benefits strategy can be a game-changer in creating a healthy and resilient workforce.

Notes
¹ https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2772537
² https://www.nejm.org/doi/full/10.1056/nejmsb2021088

Heather Hagg, Ph.D., is Vice President of Analytics and Operations at Castlight Health. Heather has executive experience in private sector, federal government and startup healthcare organizations. She has co-authored over 30 papers in refereed journals and conference proceedings in the areas of integrated health, health services research, implementation science and health system improvement. Visit www.castlighthealth.com Connect Heather Hagg Follow @CastlightHealth