Employers have long sought programs and practices that can help workers be proactive in managing their health. But a pandemic disrupted that work in many ways.
COVID-19’s spread — a health risk by itself — coincided with a decline in healthcare participation. In one study conducted by healthcare navigation company Castlight Health, researchers found “dramatic reductions” in the use of healthcare during the first two months of the pandemic. Musculoskeletal surgery, for example, declined about 47% compared to the same time frame in 2019, while MRIs declined 45%.
Some of the biggest plummets came at the expense of preventative care, a broad category that can include check-ups, immunizations, screenings, and other procedures undertaken for disease prevention purposes. According to data from the nonprofit Health Care Cost Institute (HCCI), submitted health claims for mammograms and pap smears were down nearly 80% in April 2020 year-over-year, and those for colonoscopies were down “almost 90%” in mid-April 2020 year-over-year.
Percentage change of selected preventative care procedures during COVID-19 pandemic
|Preventative care type||YOY trend (as of April 14, 2020)||YOY trend (as of Oct 1. 2020)|
|Childhood vaccinations (aggregate)||-57%||-8%|
SOURCE: Health Care Cost Institute
Those declines reversed by fall, HCCI data show, but preventative care procedures generally have not returned to pre-pandemic levels, said Daniel Kurowski, a senior researcher at HCCI. While Kurowski noted that there are limitations to the type of claim-based analysis used by HCCI in its study, he confirmed that the organization’s data suggest the U.S. healthcare system has not made up for the loss of services that occurred since the pandemic’s onset.
What can employers derive from these findings? Healthcare industry sources who spoke to HR Dive expressed some concern that deferred care could have an impact on disease prevention down the line, but the complete picture is far from clear. What’s more, the scramble to respond to such challenges could yield some positive lessons.
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.”
An executive at insurer Aetna shared a similar view. “We have seen declines in every aspect of care within our populations, specifically within preventative services,” said Julie Bietsch, the company’s senior vice president, clinical operations. But by August, Aetna began to see preventative care utilization trends rebound to the point that, by October 2020, those trends were close to 2019 levels, Bietsch noted.
Virtual care has helped to fill in some of the gaps caused by COVID-19 and may even have helped to offset some declines in care utilization, said Magda Rusinowski, vice president of Business Group on Health. While such care was initially delivered via providers that specifically focus on virtual care, the format “has emerged as a way to see your brick-and-mortar provider” as well, Rusinowski said.
Cunningham-Hill said telehealth and similar technologies can allow care providers to review patients’ health and direct them to book appointments for in-person procedures, such as a mammogram, when available. For other specialties, such as mental healthcare, telehealth “possibly works better” than it did even before the pandemic, he added.
Even for procedures such as colonoscopies that typically require an in-person visit, alternatives are available. The pandemic has caused providers and other members of the healthcare system to “think outside the box” when it comes to preventative care, Bietsch said. Examples include HbA1c test kits that can evaluate blood glucose levels and Cologuard, a Food and Drug Administration-approved, an at-home testing kit that helps screen for colon cancer.
‘A matter of enormous concern’
Still, the impact of deferred care may be a puzzling development for employers, one with potentially devastating consequences for some patients.
Early detection of serious conditions is a primary concern. In a June 2020 article published in Science Magazine, Norman E. Sharpless, director of the U.S. National Cancer Institute, described a statistical model for excess deaths from colorectal and breast cancers between 2020 to 2030. Due to delayed diagnosis and care issues caused by COVID-19, Sharpless said the model suggests almost 10,000 excess deaths from both types of cancer over the next decade, or about a 1% increase.
“This analysis is conservative,” Sharpless wrote, “as it does not consider other cancer types, it does not account for the additional nonlethal morbidity from upstaging, and it assumes a moderate disruption in care that completely resolves after 6 months. It also does not account for regional variations in the response to the pandemic, and these effects may be less severe in parts of the country with shorter or less severe lockdowns.”