GI issues & billing problems: Here's how they show up in claims

Gastrointestinal issues cost Americans a whopping $136 billion per year; more than heart disease, trauma, or mental health. But too often, these problems fly under the radar in health claims, meaning benefits advisors don’t realize there’s an unmet need for care.

In this article, I’ll explain how GI issues show up in medical claims and what benefits professionals can do to bring relief to the people whose lives they have the power to impact (along with better workplace outcomes to their customers).

The major impacts of GI issues

Awareness of the role of gut health in overall wellness has gone mainstream in the last few years, but that doesn’t mean we’ve solved the problems GI issues cause. For example, fully 40% of Americans live with painful or debilitating GI issues.

Before that experience ever leads to a doctor’s visit, it impacts a person’s life. In the early stages, the impact might look like becoming slightly less focused or engaged at work. It might mean experiencing stress about being near a bathroom or about being in required meetings when symptoms are flaring.

As the situation progresses, people may start skipping social events because of pain or discomfort. Further, they may not feel comfortable telling friends the real reason they’re skipping events, as there’s still a certain amount of stigma around digestive health issues. This can lead to feelings of social isolation, which can contribute to anxiety and depression, often impacting overall wellbeing – including the ability to focus and be productive at work.

Depending on the nature of the symptoms, GI issues can also have secondary health effects: Pain that makes exercise uncomfortable can lead to more sedentary behaviors, which, if left untreated, can lead to metabolic disorder, diabetes, and heart disease.

And because many GI issues come on gradually, there can be a kind of “frog in boiling water” effect, where people acclimate to their new normal again and again. This means they may not seek medical care until something more dramatic happens or until they disclose the extent of their discomfort to someone else.

How GI issues show up in medical claims

When people eventually do visit health care providers about their GI issues, the claims are often “disguised.”

For example, many people’s first visit is to a primary care physician (PCP). During the 15-minute consultation, the PCP may request several tests to identify the root of the problem. Often, though, those tests are inconclusive. So while the patient has begun their GI health care journey, that’s not yet clear from claims data.

When tests don’t offer an answer, the PCP may refer the patient to a specialist like a gastroenterologist. That, of course, shows up as a GI claim, but the appointment may take six months to secure. If the GI provider wants to run further tests, they may take more time to schedule. In the meantime, the patient is likely experiencing increasing discomfort and may even have an urgent medical need related to their symptoms.

Indeed, abdominal pain is among the top reasons people visit ERs, but that’s not always clear from claims data.

There is good news here, though; there are effective, inexpensive ways to provide care to people with GI issues. Let’s take a look at some.

Strategies for addressing GI health and overall wellness

One reason GI issues can be so challenging to diagnose is that many people have one or two “trigger foods” that are causing the bulk of their problems. Broccoli, for instance. Or lactose. But often, neither PCPs nor GI specialists have the tools or resources to properly evaluate a patient’s nutrition and dietary habits, meaning many people miss out on a straightforward solution to their problems.

Part of the solution, then, is to connect people with professionals like registered dietitians working collaboratively with other health care providers to solve health issues gut-first.

But that’s not enough. People also need the power to confidently manage their own care. They need to be able to access relevant information about their symptoms and – when they have a diagnosis – their condition.

When looking to meet these needs via benefits, I recommend seeking a solution that offers…

• Access to a coordinated care team. Practitioners should be able to offer support and guidance to those with both diagnosed conditions and undiagnosed symptoms.
• User-friendly digital tools that let patients get the right care and the right insights at the right time.
• Evidence-based clinical pathways that are customized to the needs of each patient.

Empower employees to live their best lives

Benefits professionals play a crucial role in ensuring that workers can not only be their most productive selves on the clock but also live life to the fullest at all times. GI issues hold many Americans back from both, but the evidence is often buried in medical claims that appear unrelated.

Learning about the prevalence of GI issues – and how effective and accessible treatment can be – is among the most important things benefits professionals can do. Bringing this issue to the forefront can have a significant impact on the lives of the people who depend on you, while also enriching the businesses you serve.

Bill Snyder is the Chief Executive Officer of Vivante Health, a leading digital digestive health company and sponsored benefit, and has over 15 years of experience in health care technology and leadership.