Helping employees and managing elective surgery demand in uncertain times

With the latest COVID resurgence forcing hospitals to curtail and even cancel elective surgeries, employers are again concerned about the impact of delayed care on their employees and how to manage their needs.

As of early August, several hospital systems nationwide, notably in Florida, Louisiana and Texas, were reducing or suspending elective surgeries. This is unwelcome news for employees whose surgeries have been delayed, in some cases for over a year. For employers, it means continued uncertainty on two fronts: safeguarding the health—physical and mental—of employees and planning for cost increases once restrictions are lifted. While the uncertainty of today presents challenges, there are strategies benefit pros can put in place to do both.

Elective or essential?

Based on an analysis of national industry benchmarks, the average employer can expect 2.14% of its population to undergo elective surgeries each year. For an employer with 10,000 employees, this translates to slightly more than 200 workers. Although they are described as “elective,” operations to alleviate pain and improve the functionality of hips, knees and spines are essential contributors to employee workforce health.

The full impact of the widespread delays in elective surgeries and their influence on resources, outcomes and survival will not be apparent for some time. However, the adverse effects of the ongoing disruptions in care are significant. There are initial reports of increased depression and worsening of some conditions. However, there is anecdotal evidence of some conditions improving without surgeries and/or employees finding alternative care.

While there’s much we will uncover as research is conducted on the topic and employers analyze their data, there’s concrete evidence that delays in elective surgery increase employer costs. Beyond the costs related to delays in elective surgeries, there are broader costs related to the issue that should be examined.

Based on independent research conducted by our company with an actuarial firm in 2020, we found that 30% of elective surgeries were clinically unnecessary. The cost to payers for these surgeries was $30 billion. While an important figure to note, that still means that 70% of all elective surgeries are necessary. And employees and employers need help to address that reality, especially within today’s uncertain environment.

Take steps today to plan for tomorrow

To help their organizations and employees weather the current storm and prepare for calmer post-COVID waters, benefit and HR pros must have a plan to manage elective surgery demand. A growing number of large employers are deploying surgery decision support (SDS) programs to help their employees. Goals should include:

1. To provide education and information to employees so they can better determine if elective surgery is needed.
2. To provide employees with a range of clinically proven alternatives if surgery is required but the hospital postponing elective surgeries.
3. To ensure employers get the necessary help to maximize productivity and minimize costs.

There are a number of core components a successful SDS program will offer. Important features to consider are:

• Access to top specialists who can give second opinions about injuries or conditions, including virtual visits when possible.
• Insights into treatment alternatives, including physical and behavioral therapy and medications that may provide relief and help avoid surgery altogether.
• Tools and personalized support to combat stress, anxiety and depression and help employees cope.
• Benefit coordination information for employees, including how to access other resources offered through their health plan and partners.
• Emphasis on best practices. The New England Journal of Medicine reports that 30% of all conditions have a known best practice, but those are only followed 50% of the time.

Cost-saving potential

Personalized attention and concierge-level support from experienced nurses are essential to the success of an SDS program. With nearly 20,000 U.S.-based employees, one multinational manufacturing company calculated that having one nurse onsite to assist employees with elective surgeries and other health care needs saved over $2 million in the first year the program was in place. The company also reported dramatic improvements in employee outreach and engagement.

Other data is supporting the cost savings benefits of taking a more coordinated approach to elective surgeries. Our data, covering a number of large employers, shows that up to 40% of unnecessary surgeries can be avoided when employees participate in a SDS program. Using an average savings of approximately $26,125 per avoided surgery, this equates to significant total savings for employers. On average, a well-managed SDS program should offer significant ROI, often exceeding 4:1, depending on the engagement strategy and the benefit design in place.

Moving forward

While it is impossible to predict the future course of the pandemic, there are strategies benefit professionals can put in place to take care of workers and manage costs. Experienced partners can provide insights into the scope and timing of elective surgery demands that an employer may face, providing data on the estimated number and probable cost of the operations. For those employers who already have a medical decision support program in place, now is the ideal time to explore maximizing program engagement by deploying an innovative benefit design that strongly incentivizes – and even requires – program participation.

As vaccination rates increase and hospitals return to normal surgical routines, employers will still want to avoid unnecessary procedures and help employees obtain the best health care. Putting an elective surgery management program in place now is a big step toward creating a more informed and empowered employee population, optimizing benefit use, ensuring good outcomes and controlling future costs.

## Jessica Hennessey, DNP, RN, CPNP, CMPE is the senior vice president of Clinical Operations at ConsumerMedical, a clinical advocacy, decision support and expert second opinion company serving large employers and health plans nationally. In addition to leadership positions at several health care organizations, she has worked in pediatric and mental health nursing.