Instead of early, lower-cost intervention,employees are entering the system later and sicker. This is fueling morecatastrophic claims, higher utilization of emergency services and ultimatelyhigher costs for employer-sponsored plans.
Across the country, providers report more late-stagediagnoses and unmanaged chronic conditions. When symptoms become severe, theyoften require more intensive treatments that drive up costs, including:
· Hospitalization,
· Specialist care,
· Advanced imaging and Expensive drug regimens.
Delayed care domino effect
The reasons for this trend are well documented. A surveyby the Employee Benefit Research Institute found that four in 10 privatelyinsured adults report higher healthcare costs. At the same time, pollingby KFF found that 36% of adults say they have skipped or postponed needed caredue to cost, and about one in five have not filled a prescription for the samereason.
High-deductible health plans are a major factor. Whilethey can help control premiums, they also require employees to pay sometimesthousands of dollars out of pocket before coverage begins. That financialexposure can lead workers to put off care, particularly if they are unsurewhether a visit is necessary.
Medication non-adherence is another driver. Aboutone-third of adults report skipping doses or delaying prescriptions due tocosts, according to KFF. This can worsen chronic conditions and lead tohospitalizations that could have been avoided with consistent treatment.
What employers can do
· Lower financial barriers to preventive care —Waive or reduce cost-sharing for primary care visits, screenings and chroniccondition management.
· Promote and simplify primary care access —Offer telehealth, onsite or near-site clinics and easy scheduling to reducefriction.
· Educate employees on how their plans work —Many workers do not fully understand deductibles, health savings accounts orcovered services, which can lead to unnecessary delays.
· Encourage medication adherence —Consider programs that reduce or eliminate costs for essential medications tiedto chronic conditions.
· Use data to identify gaps in care —Analyze claims to find employees who are missing preventive services ormanaging chronic conditions poorly.
· Steer employees to high-value providers —Offer insurance from carriers that offer networks or incentives that guideworkers to high-quality, lower-cost settings for procedures and treatments.
· Leverage wellness and condition management programs —Programs that help employees manage diabetes, musculoskeletal issues orcardiovascular health can improve outcomes and reduce long-term costs.
Employershave more influence than they may realize in addressing delayed care. The goalis to reduce barriers and make it easier for employees to access care early.