Lincoln Absence Advisor

The delayed care dilemma

March 11, 2021 Lincoln Financial Group Season 2 Episode 34
Lincoln Absence Advisor
The delayed care dilemma
Show Notes Transcript

In the past year, did you miss a routine checkup, dentist appointment, etc.? If you did, you weren’t alone. In fact, by June of 2020 41% of all American had delayed or avoided some type of health care.  On this episode I’m joined by Dr. Glenn Pransky and we talk about the action of deferred, delayed, or avoided care. We take a deep dive into why so many Americans chose this action, the potential for it being problematic in the future, and how employers can provide a potential solution.  
 
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Chris Takesian:

Hello, again, listeners. I'm excited to be back for season two! To kick us off, raise your hand if you heard one or all of these phrases in relation to medical care over the past year; deferred, delayed or avoided...anyone? Yeah, me too. On today's episode, we're going to talk about just that-deferred, delayed or avoided care. I sit down with Dr. Glenn Pransky to discuss why so many Americans took this action, why it may be problematic and how employers can ultimately help provide a solution. Well, Dr. Pransky thank you for joining me for this episode. It is a pleasure.

Dr. Glenn Pransky:

Chris, good to be with you. And this is a great topic to talk about deferred or delayed care.

Chris Takesian:

Absolutely. So to level set with the audience, can you elaborate on what we mean when we say defered, delayed? Um, sometimes people will hear avoided care. What do we mean by that?

Dr. Glenn Pransky:

Chris, by this, we mean either not going to, or delaying a scheduled healthcare appointment or not going to a doctor or other healthcare provider when you're sick. When we look at the types of care that people avoided or delayed in this way in 2020, dental care was number one. About a quarter of all Americans delayed or skipped dental visits in the first quarter of 2020. Routine visits to doctors of all types was close behind about 23% of Americans deferred or delayed a regular doctor's visit in the first part of last year.

Chris Takesian:

I'll admit I am actually guilty of this. I delayed my dentist appointment a little bit with concerns over COVID, but, but there's research out there that is saying that COVID concerns really are no longer the only motivating factor when people are thinking about deferring or delaying their care, right?

Dr. Glenn Pransky:

Yes. Right. So you weren't alone, you know, by June 41% of all Americans had delayed or avoided healthcare. Again, seeing the dentist was number one. Unfortunately the rate of avoidance was a lot higher with people who had chronic illness. It was 56% for them. And those are the people who most need regular health care to manage their conditions. Yes, Chris' fear of contracting COVID was the number one reason people gave, but 60% of those who delayed or avoided care also said that they weren't able to make an appointment with their provider or their usual place of care was closed or their doctor or provider moved to a location that was difficult for them to access.

Chris Takesian:

And data out there really shows that this burden is magnified for the unemployed population?

Dr. Glenn Pransky:

Oh yeah. About, um, 40% of the people who avoided care mentioned financial strain as part of the reason. And this was even higher in people who are unemployed or said their family was in financial distress. And the economic impact, isn't just avoiding care. A survey last year showed up to a quarter of people with diabetes are rationing supplies like insulin or test strips. And this is related to levels of unemployment and loss of income. But again, COVID infection concerns appear to be the most important thing driving avoiding care, right now.

Chris Takesian:

So as we're going through what this really boils down to, and the really the problem we're discussing here is the idea that deferring or delaying care can have consequences. Can you elaborate on what those consequences may be?

Dr. Glenn Pransky:

Yeah, so those of us who are health services, researchers are following this closely. And we're worried about what we see so far. There was a recent survey of patients showed that of those who delayed care. A third of them actually experienced a significant worsening of their problem because of this delay. And a survey of primary care doctors came up with a similar result. 37% of them said that their patients with chronic illness are clearly in worse health as a result of avoided care because of missed opportunities to adjust medications or maybe improve care early on, more people with chronic problems are going to end up with more serious issues that are going to require hospitalizations. And for those who are employed longer work absence. So we know from pre COVID research that care avoidance is strongly associated with up to four times higher levels of anxiety and mental health problems. So another dimension of this is preventive care. This has taken a huge hit because of COVID concerns. So some research has shown up to a 60% drop in vaccination rates, for example, and the rates of colon and breast cancer screening are down 30 to 50%. By one estimate, this trend will result in delayed diagnoses for an estimated 36,000 breast cancers and 19,000 colorectal cancers in the U.S. And because of diagnosing these cancers at a later and more advanced stage, this could translate to over 10,000 excess cancer deaths just due to these two conditions because of this effect. Finally, I should touch on the specific problem of people avoiding going to an emergency room because of fears about contracting COVID. In a survey done in late spring of last year, 28% of Americans said that if they had a heart attack or a stroke, they preferred to stay at home and try to manage it rather than risk going to an emergency room in getting COVID in a hospital. And in fact, that's what they did. The center for disease control found that emergency room visits for heart attack and stroke were down 20 to 23% in the first half of last year, despite indications that the rates of these two conditions didn't change at all. So most experts think that this directly contributed to the increase in death rates from these two conditions s een across the U.S. And it's important to note that this affected people of all ages.

Chris Takesian:

Some of those statistics really are eye opening when we look at this, this issue of deferred and delayed care and with the potential for sicker patients in 2021. Wrapping this back to our audience, what could this mean for the downstream impact on employers?

Dr. Glenn Pransky:

Chris, it's hard to tell now because the specific data isn't there, but if you look at the studies done before the COVID pandemic, they clearly showed that when employees delay care and miss doctor's visits, that leads to worse health and in a working population that in turn leads to more absenteeism, lower productivity and loss of valued workers. So yeah, I think there's good evidence that this will have a negative downstream impact on employers, more absenteeism, lower productivity and higher healthcare costs. And the reason I'm saying that is that when you defer or delay care for these conditions like cancer or heart disease, when people come in later on, they're tougher to treat and it costs a lot more to treat them.

Chris Takesian:

Absolutely. Something that employers definitely should be keeping an eye on as we move throughout the year. But Dr. Pransky, this is a pretty bleak picture we're painting here. Uh, is there any good news, you know, how can we solve these problems? How can we, how can we give some good suggestions?

Dr. Glenn Pransky:

Sure. Chris, it's not all terrible. There's some good news out there. So first the impact of the drop in economic activity and this huge shift to working at home and less travel has had a profound impact in reducing air pollution. And that led to lowering rates of asthma exacerbations. And that also has reduced traffic accidents by as much as 50%. But this has only led to a small reduction, just 5% in traffic fatalities. And the problem there is that, although there are far fewer miles being driven and many fewer people on the road, there's actually more reckless driving and speeding. But again, back to the positive side, some people have used the time that they gain from not commuting, since they're working at home, to be more active and exercise more and stay healthy. Sales of bicycles and fitness equipment; these are at all time highs. And for those who took COVID prevention, seriously, a social distancing wearing masks, they had fewer respiratory infections over the winter, and these measures really were effective. So far, we've seen a 98% decrease in hospitalization for influenza in the current winter compared to the 2019-2020 winter.

Chris Takesian:

And that's a huge difference maker in your field specifically, because I think the original concern was that you were going to have the flu and you were going to have, COVID kind of interacting with each other, which would increase hospitalizations. But if we're seeing that, um, those practices being put in the 90%, 98% statistic, that that's a really positive sign. So I appreciate you commenting on that.

Dr. Glenn Pransky:

Yes, Chris, we, a lot of us were predicting a twindemic and it just didn't happen. Fortunately, it just didn't happen. Yeah. In one solution that comes to mind here is tele-health, uh, I found this to be a really great way to consult my own doctor without having to take a half day or go for an in-person visit. Is this a viable solution for both physical and mental health visits in your opinion? Yes, Chris I too, was really thrilled to be able to take just an hour out of my schedule to see my doctor for my annual checkup instead of a half day. And the other great thing is I had his full attention. So we know that tele-health rapidly expanded early on during the pandemic. And it continues to grow. Now nearly 95% of all U.S. employers cover telehealth, and that's a 40% increase compared to a year ago. And the coverage has expanded to both mental and physical health. And, you know, doctors are also getting on board by November of 2020, about 56% of primary care practices were fully on board offering extensive tele-health access to almost all of their primary care physicians. So there's good research out there over the last 25 years that shows that telehealth can be as effective as in-person visits for a wide variety of medical problems. And in some instances can be even more effective for mental health issues. So the example here is when a patient can get to see a psychiatrist or a therapist who's really skilled at treating their problem and is a good fit for them instead of having to take the only person available. So employers need to make sure that their insurer offers adequate coverage for telehealth, pays the doctors fairly and local healthcare providers are encouraged and motivated to provide this service. You k now, for ongoing care, it's much better for people to see their own doctor via telehealth with full access to their medical records and the possibility of continuity of care instead of seeing somebody who doesn't know h im. Again, employers really benefit from their employees, that's you and I, not having to take a day off to see the doctor in person. So employers can have a potential role here helping employees learn how to access it and use it. I've seen that many people who haven't ever used telehealth they're intimidated by it, or they don't think it's going to work for them. They're skeptical. And so showing them how to use it and how it works and how to get the most out of your telehealth visit can really break down this barrier. But as said, it's not for everything. And if you really need to see a doctor in person, the risk of contracting COVID in a doctor's office or in a hospital is very low, especially now that there are procedures in place that are well-established, there's enough protective equipment and almost all healthcare workers have been, or soon will be vaccinated. This is another area where education by employers and examples from leadership and peers can be really helpful to reduce this concern. Um, Chris, do you think it makes sense to talk to employees about some of the serious problems that occur because of avoided care and help reduce their concerns?

Chris Takesian:

You know, I, I absolutely do. And especially with so many companies working within these virtual environments, if you're not seeing your employees on a daily basis, I do think it's okay to be checking in on them, both their mental and physical health in a respectful manner, of course, but really we're, we're seeing this done in other ways. So for example, a lot of companies offer incentive programs through their health insurance provider to ensure that employees are accomplishing their yearly checkups, getting blood work, done those types of activities. Of course, all this is simply to offer helpful information, not really asking about personal habits or medical data, but the goal is just to have happier and healthier employees. So yeah, I do think it's important. And on top of telehealth. If someone does not need to miss work due to an illness or injury, we're also seeing disability insurance as a valuable tool that employers can offer. Can you comment on, on this use of disability insurance?

Dr. Glenn Pransky:

Yes. I think it's more important now than ever. For example, if someone has an injury and needs a somewhat elective surgery, a scheduling might be delayed because hospitals are not fully up to capacity in many areas, thus, they might have a longer work absence or they may have to stay home to care for somebody when there isn't home health care available. So leave is also very important. So with so much economic uncertainty, the opportunities to ensure that income continues during a period of sickness or caregiving, those are especially important.

Chris Takesian:

Absolutely. And going back to the idea of telehealth, do you see this as more of a trend or do you see this becoming a long-term practice that we rely on going forward?

Dr. Glenn Pransky:

So Chris at first we thought that the emergency shift to allow more access and reimbursement for telehealth was going to be reversed after the pandemic ended, but consumers, employees, and employers, I should add immediately saw the benefits of easy access, much less lost work time for doctor's visit, and getting the doctor's full attention, the ability to quickly resolve a minor issue. So there's lots of demand to keep this available. I'm especially excited about the ability of tele mental health to address the significant shortage we have in the U.S. of psychiatrists and psychologists, especially in rural areas.

Chris Takesian:

Yeah, that was actually my favorite part about what you said as well. It really opens up your network to be able to meet with specialists, um, who you might click with a little bit better than just who's in your immediate area. So I do appreciate that and see why it could develop into a full blown trend. But, but what about the distribution of the COVID vaccine? Does that add to the solution?

Dr. Glenn Pransky:

I think it does help to significantly reduce fears of going to a doctor's office or hospital, knowing that most of the medical staff are getting vaccinated and that the vaccine may help employees be protected against getting any form of serious disease. It's still early to know what the impact is, but I think it's going to be at the very least reassuring.

Chris Takesian:

Yeah. I agree with you there and we can see the solutions right throughout this episode. We've, we've gone through several solutions, but, but how can employers use this information? How can they ensure their employees are taken care of themselves?

Dr. Glenn Pransky:

Communication is really important. Recently we did a podcast on maintaining employee mental health. During these trying times, the title is back to the workplace anxieties. I mentioned this because one of the topics we covered was the importance of open regular conversations with employees during the COVID pandemic. This is a time when consistent fact-based information is so important, as well as leadership with empathy, leadership by example. These principles have been studied in other crises, and they're really key to successful leadership during a time like this. So in that podcast, we were focused on safety at work and employees keeping themselves and their coworkers and their families safe and reassurance about jobs. There's so much disinformation out there these days that it's important to keep redirecting ourselves back to trusted sources of information and allaying people's fears. The points we've talked about today can be folded right into these conversations. Using these facts we've discussed here and personal examples is the most effective way to help convince people about the hazards of avoiding care. And that the risks of avoiding care are a lot higher than trying to avoid COVID by staying away from the doctor. But all of this makes sense only if everything is in place so that people can actually get the care they need. So employers need to look into insurance coverage for telehealth, local provider availability, both online and in-person and the documented safety practices in hospitals and offices. Your employees may need some help navigating the healthcare system too, as it's changed.

Chris Takesian:

Absolutely. And Dr. Pransky, every time we talk, I feel like it's a very informative discussion, but to summarize it for our listeners, what would you identify as the three key takeaways from today's conversation?

Dr. Glenn Pransky:

Well, the three key points, let me think. So first there's a lot of people who are avoiding care and it's having negative consequences on both their mental and physical health. The second point is that there are solutions like tele-health, but people have to be educated about realistically, what are the risks of avoiding care and the consequences and how low the risks are of going to a doctor's office and fear of COVID isn't the only thing that can lead to avoided care. And so these problems have to be solved as well.

Chris Takesian:

So any closing thoughts that you'd like to leave our audience with?

Dr. Glenn Pransky:

Take care of yourself, not only your physical health, but also your mental health during this trying time,

Chris Takesian:

We appreciate it. Dr. Pransky always a pleasure having you on, and we look forward to talking to I'm sure again soon.

Dr. Glenn Pransky:

Thank you, Chris.

Chris Takesian:

To everyone who was able to join us. Thank you for listening. We do appreciate it. To stay up to date with the most recent episode, be sure to subscribe to Lincoln Absence Advisor on Apple, Spotify, or wherever you listen to your podcasts.

Disclosures:

The information contained in this podcast is for general use and is not a substitute for the advice of an attorney or your human resource professional. Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates. Affiliates are separately responsible for their own financial and contractual obligations.