The physician gap: Why advisors and employers should care

After a couple of years of lower health care cost trends due to COVID, health care costs are expected to rise 8.5% on average next year. Understandably, most employers and their benefits advisors are focused on the downstream costs of cancer, musculoskeletal conditions, hospitalizations, ER visits and skyrocketing use of GLP-1 medications. But as clinicians who lead population health efforts at Accolade, our belief is that lack of timely access to physicians at pivotal moments – what we call the “physician gap” – is the major upstream issue.

The good news? There are multiple strategies benefits advisors and employers can deploy to address the physician gap and reduce downstream spend while delivering a better and more enjoyable employee experience.

The physician gap in primary care and mental health

Access to see a doctor was severely hampered during the pandemic. While many patients are resuming the care they previously delayed due to COVID, timely access to primary care providers (PCP) and specialists remains a problem today. The average wait time to see a PCP is around 26 days and is even more pronounced for individuals living in health professional shortage areas. 

Research tells us that individuals who have an ongoing relationship with a PCP experience better clinical outcomes, more equitable care and lower costs. Despite this knowledge, the Primary Care Collaborative’s 2023 Evidence Report shows a worsening ability to find and sustain a primary care relationship. One in four people in the United States has no such relationship, and those who do are increasingly naming a facility rather than a clinician as their usual source of care.

To help close this gap, we’ve emerged from the pandemic with higher adoption and confidence in the effectiveness and ease of telehealth. Patients are accessing virtual primary care in a timelier fashion; telehealth services routinely offer same-day and next-day appointments with a primary care doctor. 

We’ve also seen telehealth’s impressive traction with mental health, reaching unprecedented levels during the pandemic and maintaining high virtual visit rates thereafter. A recent survey by the Business Group on Health found that employers remain highly focused on access to mental health services. With the lack of mental health professionals in many communities, and concerns for travel time, privacy and potential stigma associated with seeking therapy, virtual care is an ideal use case for mental health.

The physician gap in hospital transitions

A second type of gap occurs at critical times for higher-risk patients during transitions of care, like those that occur after hospital discharge. One study of a large, urban tertiary care center found that higher-risk patients without timely PCP follow-up after hospitalization had a 10-fold increase in the likelihood of readmission. 

Leveraging admission, transfer, and discharge (ADT) data is foundational for early notification and activation of a transitions of care program. The first few days of discharge are essential to engaging with patients in scheduling PCP or specialist follow-up visits, confirming the right outpatient medications, making appropriate arrangements for home or facility transfer and addressing any patient or family concerns regarding upcoming clinical care, navigation of benefits and financial needs. 

The physician gap in cancer

A third area where we see the negative impacts of the physician gap is for new diagnoses, particularly when it comes to cancer. 

The return of cancer screening and care services likely caused a rebound in cancer incidence, with a delayed diagnosis of the cases that were missed during the acute phase of the pandemic. Multiple studies showed a drastic decrease in cancer screenings at the height of the pandemic, where breast cancer screening dropped by 16% and colorectal cancer by 25% from 2019 to 2020.

While some groups have rebounded with preventive screenings, it is important to note that this is not the case for everyone: Low-income individuals and those historically marginalized based on race/ethnicity were associated with both decreased pre-pandemic screening rates and impaired, incomplete recovery of screening rates.

Given these scenarios, it is reasonable to expect an increase in cancer incidence and possibly advanced-stage cancers. 

When patients have a cancer diagnosis, it’s paramount that they get an accurate diagnosis and treatment plan to ensure their highest chances of success. But cancer is highly specialized and complex, and there are wide variations in care even amongst cancer specialists. This makes expert medical opinions an important safeguard for all patients with advanced cancers and many other complex conditions. 

A study from the Mayo Clinic in 2021 found that getting a second opinion cuts the chances of misdiagnosis in half. It can also correct clinical errors in both diagnosis and treatment recommendations, improving the quality of care patients receive. Integrating a personalized approach to the benefits offerings will ensure employees are better supported with an uninterrupted healthcare journey, as providers will have full visibility of the patient’s needs and be able to share new perspectives of health management and reassurance that they are on the right path, where applicable.

The physician gap and the rise of GLP-1s

Closing the physician gap can also help employers address the ongoing surge in demand for GLP-1 medications. With obesity impacting nearly 40% of Americans, employers are facing a growing demand for more encompassing obesity care benefits, including coverage for GLP-1 medications. Accolade recently surveyed HR decision-makers and found that only 25% currently cover GLP-1s but 43% plan to cover them next year.

Treating obesity requires a comprehensive approach, one that evaluates and addresses overall metabolic health, including areas of nutrition, physical activity, sleep, stress and medication management. Furthermore, mental health and obesity are related in complex ways and have been shown to affect each other. People with depression are more likely to experience obesity and people with obesity are more likely to experience depression.

The best way to manage chronic conditions like obesity is through whole-person support that is part of an integrated care ecosystem. We recommend a physician-led approach that guides who should be prescribed GLP-1 medications and how to make them part of a holistic health management plan.

Closing the physician gap for employees

As we move beyond the height of the pandemic, employers and benefits consultants should reflect on key takeaways from the pandemic and invest in ways to close the physician gap—from telehealth and innovative technologies to a partnership strategy that doesn’t leave individuals isolated and confused. Now more than ever, employers need solutions that center the employee-physician relationships and account for barriers to care. All employees benefit from care that is more integrated and holistic. So how do we achieve this? 

Many employers have invested in care navigation and advocacy to help employees connect their benefits and their physicians to ease the burden away from the employee. With a physician-led advocacy model, members and their brick-and-mortar physicians are empowered with the information they need while maintaining connections to the employer’s benefit programs. Doing so will improve the health and well-being of employees while reducing downstream spend for employers.

Shantanu Nundy, MD, MBA, is Accolade’s Chief Health Officer, a practicing primary care physician, and advisor to the World Bank Group on digital health and innovation. He is the author of Care after Covid: What the Pandemic Revealed is Broken in Healthcare and How to Reinvent It.

Dr. Hwang is Accolade’s chief medical officer and is responsible for executing clinical and population health strategies for customers. She brings extensive experience in working with employer and health plan executives to accelerate clinical innovation, value-based care and care delivery transformation.