4 trends crucial to optimizing health care plans emerge from pandemic-driven data

Here’s how benefits leaders can implement more effective strategies.

One potential silver lining of the pandemic? A continued reduction of non-emergent and low-acuity emergency room visits. (Photo: Shutterstock)

Measurements are taken to quantify, compare, and put events and data into context. In the case of COVID-19, the pandemic’s impact can be measured in tangible losses and gains. Without question, we mourn the loss of more than a half-million fellow citizens and are mindful of the continued health issues that could linger. But through the pain, we can learn from the gains made in the aftermath, assess what we learned, and create strategies to better prepare for future disruptions.

As vaccines become more available and the numbers of hospitalizations and fatalities decrease, benefits leaders can step back and measure the impact of the pandemic from a health care perspective. For this, we turn to data. Trends in employee health are crucial in designing and optimizing the most effective health care plans and programs going forward.

Related: Did COVID undo years of health plan cost-containment gains?

How can resources be aligned to deal with the considerable shifts in employee access in this new world of employee health and health care? Where are the priorities and what strategies can be deployed?

A 2021 report from Springbuk provides an analysis of data sampled from over 4,000 employers on four important employee health trends identified over the past year:

1. Greater reliance on telehealth

The new digital world is causing behaviors to evolve on many levels, but the pandemic certainly accelerated telehealth usage for employees and their covered families. We were having Zoom meetings and the kids were learning via remote access. We could also stay home and still seek treatment for non-emergent issues. Telehealth provided more efficient and cost-effective access — decreasing expensive emergency room and urgent care visits.

As the pandemic gained momentum in spring 2020, many health care providers upscaled their telehealth options. This helped providers respond to lockdowns and shelter-in-place mandates, reduced medical services, and public anxiety about visiting medical facilities.

The number of telehealth visits for employees and their dependents was nearly 12 times greater in 2020 than in 2019. Springbuk data showed a 2,166% increase for telemedicine in newborns to 17-year-olds and a 2,004% increase for individuals over 65. That is more than 20 times the normal rate. In a COVID-19 context, older patients were among the most vulnerable populations. Telehealth became a more viable option to access health care for at-risk populations, including older patients.

Mental health accounted for the most encounters for telehealth usage. In 2020, mental health visits made up 44.3% of all telemedicine encounters, compared with 16.1% for the year before. The data also showed an increase in telemedicine cost per encounter and per member per month (PMPM) in 2020. That can be attributed to changes in federal and state laws and regulations that affect telehealth, including allowing telehealth reimbursement to be on par with in-office doctor visits.

Throughout 2020, many patients were wary of in-person visits and accessed safer options at a very high rate. Surveys indicate that some individuals have realized they prefer the telehealth method rather than leaving home for care. These unintended consequences of the pandemic could create a longer-term behavioral shift in patients — one that can be a more cost-effective approach to health care delivery, especially avoiding unnecessary ER visits.

2. Lower demand for emergency care

As ERs made room for COVID-19 patients and followed health protocols in 2020, we witnessed a significant decline in year-over-year rates for low-acuity (67%) and non-emergent visits (57%). Also, telemedicine visits for conditions considered low-acuity increased by more than 186% in 2020 compared with 2019.

The potential silver lining in the pandemic would be a continued reduction of non-emergent and low-acuity emergency room visits. Low-acuity services treat common conditions that include ear infections, sinusitis, or urinary tract infections.

The 2021 findings also revealed that low-acuity ER visits cost about $520 more than an office visit for the same condition. From a benefits standpoint, encouraging patients to use non-emergency sources of health care for low-acuity issues means an opportunity for cost savings. Springbuk’s forecast: If the decrease in ER visits can be attributed to better access to and acceptance of telehealth, we’re likely to see a continued reduction in low-acuity ER visits; however, if the decrease is because of social distancing, working from home, etc., we might see a return to former rates in the future.

3. Decrease in elective surgeries

In 2020, people who had scheduled elective procedures postponed them out of fear of contracting COVID-19 or because of government restrictions on those types of surgeries. The largest percentage decline in elective procedures were ear, nose, and throat procedures; gastrointestinal surgeries; and cardiac procedures. In addition, knee and hip replacements made up 9% of elective procedures. Many of those procedures moved to outpatient settings, which on average resulted in savings of more than $10,000 each.

Given the decline, what’s the forecast for procedure volumes in 2021?

It could take years to determine the full impact of delaying or forgoing elective procedures.

4. Mental health and substance abuse

Employees seeking mental health and substance abuse (MHSA) help dropped slightly at the onset of the pandemic, followed by an upward trend starting in May 2020. By year’s end, MHSA benefits returned to 2019 levels at a macro-level. However, key cohorts behaved differently. The pandemic has amplified the growing concerns around mental health strains and the risks of substance abuse. The factors driving these concerns include isolation, the stress of a global pandemic, struggling economy, political upheaval, racial strife, working from home, child-care shortages, and overall fear and anxiety.

Anxiety, depression, adjustment disorders, and alcohol- and substance-related treatment drive a significant portion of MHSA treatment among adults. Springbuk data showed a pronounced upward trend in 2020 among several key categories, with women ages 18 to 25 experiencing anxiety disorder being the most impacted. Other highlights include:

MHSA treatment among those under 18 dropped off significantly in 2020 and has not returned to its former rate. Also, mental health prescription drug use was not significantly affected by the pandemic other than a brief spike in March 2020. This was attributed to people likely filling prescriptions in advance of the impending lockdown.

What’s the takeaway?

Obviously, 2020 was an uncommon barometer for health care strategies. But while much was lost, much was gained in terms of health benefits planning. Clearly, we’re in the digital age, with telehealth usage stepping forward and becoming a large factor in employees’ health plans. ER visits appear to be evolving into increased use of telehealth in the past year.

Similarly, there is postponement or movement of elective surgeries to the outpatient setting. The growing demand for mental health benefits makes it evident that employees believe that part of an employer’s role is to support their ongoing mental health. And evidence suggests that employers are uniquely positioned to positively impact the employee experience through these benefits.

How benefits leaders heed this data will play a role in improving employee health and containing costs, the main ingredients in creating a healthy environment for an employer’s greatest assets — its employees.

Anne Fischer is senior director of data science and methods for Springbuk. With more than 20 years of experience, Fischer has held multiple leadership roles in the health care Information Technology industry and garnered extensive experience in health care analytics, with a focus on complex algorithms such as episode groupers and risk models. 

Jennifer Jones, MSM, RD, is senior director of health strategy and experienced health care professional with a background in clinical dietetics, wellness programming, and employer health. With over 20 years of experience, she has worked in various settings, including health care systems, occupational health organizations, and health and welfare benefits advisory firms.

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