Eliminating health disparities is a priority of many organizations. Likewise, reducing medical spend is a priority of many organizations. Our polls show, not surprisingly,
But what if I told you that eliminating three specific health disparities could actually save employers money? And also that your clients may not even know they have these three disparities?
Let's take a look and see.
1. Colon screening
Colon screening substantially reduces mortality; data from the
Despite this compelling case, a large percentage of eligible employees don't get screened for colon cancer, even with an incentive. It turns out that not one, but two health disparities discourage hourly workers from getting screened.
Read more:
First, they need to take at least one day off from work,
So even if your clients offer an "incentive" to get a colonoscopy, it still costs hourly employees money. Hence, if they want employees to get colonoscopies, the free test should be accompanied by a "free" day off.
Second, in companies without health literacy training, hourly (and salaried) employees also may not realize that there are three FDA-approved colon screens that do not require time off because they are completely non-invasive. Of these three, by far the least expensive (about 99% less than a colonoscopy) is the Fetal Immunochemical Test, or FIT.
The FIT, like other non-invasive tests, is less accurate than a colonoscopy. However, the U.S. Preventive Services Task Force recommends 10-year screening intervals for the latter, due to the potential hazards, while the FIT is done annually. Aggressive tumors can and do appear, grow and metastasize during those 10 years. The FIT catches them long before the next colonoscopy. Hence, avoided deaths over a lifetime are similar between the two.
Read more:
Teaching non-exempt employees about FIT screens opens up the possibility that many who would have passed on the colonoscopy will get an FIT. Teaching exempt employees may shift some of them into the low-cost alternative as well.
2. Preventive dental care
Many employers do not prioritize dental care because it's a small dollar amount. Yeah, for them, maybe. But for employees who are experiencing dental issues, it can be a lot. That's because most dental maximums are lower than many medical deductibles. And, unlike many medical issues, significant dental issues never go away on their own, and they usually get worse if untreated. Further, it is well-established that they can cascade into medical issues.
Your clients likely cover two preventive visits for everyone, but that's overkill for many people and of little help to employees who need more and will be accounting for much of the
Those employees are by and large the socioeconomically disfavored ones, making the two-visits-fits-all dental model a hidden health disparity. Covering a third or even fourth visit at 100% will easily pay for itself. And, unlike other things covered at 100%, additional coverage will not encourage overuse. Who among us wants to visit the dentist any more than necessary?
The other dental health disparity is treating cavities. The answer to this one is obvious: cover silver diamine fluoride (SDF) to fix cavities without drilling. It makes no economic sense not to give hourly and salaried employees the option of paying much less money and losing much less work time than getting a drill-and-fill. And I know whereof I speak, having been treated with it myself, in two minutes, for $39 uncovered. (A "covered" drill-and-fill would have set me back $80, but at least my wife's employer would be docked the other $80 for their ignorance of SDF.)
Read more:
As with the third dental visit, despite the clearly positive economics and equally clear health equity benefit, almost no one covers this FDA-designated "breakthrough therapy."
3. Fertility and pregnancy
Consider fertility benefits. Yes, they reduce cost and presumably increase the likelihood of becoming pregnant for all employees who have trouble conceiving. But fertility treatments require a ton of time. Every article on balancing fertility treatments and work requirements was written by or about white-collar women who can "balance" work and treatments by working remotely.
What results is another hidden health disparity: eating way into PTO for these visits puts fertility treatment largely out of reach for hourly employees, while salaried employees are subsidized, both for the offering itself and for lost work time.
That brings us to actual premature delivery avoidance. Premature birth is a classic health disparity. For example, the March of Dimes notes that average preterm birth rates in the U.S. between 2018 and 2020 were highest for Black infants (14.2%), followed by American Indian/Alaska Natives (11.6%), Hispanics (9.8%), Whites (9.2%) and Asian/Pacific Islanders (8.8%).
You'd like to be able to resolve that, and yet 90% of companies not using Elevance (which does cover it) do not cover the one product, PreTRM, that predicts premature delivery — with prediction being a necessary first step to prevention.
Read more:
It has always bewildered us how so many companies spend so much money to get women pregnant, and yet won't spend a tiny fraction of that amount to keep them pregnant. This would be an excellent opportunity to resolve a major health disparity.
According to its own studies and to the Validation Institute, PreTRM reduces neonatal intensive care unit (NICU) lengths of stay by 30-plus days on average if followed up with high-risk prenatal care provided at an intensity commensurate with the risk level revealed. For babies admitted to the NICU, the reduction in length of stay is in double-digits — and this doesn't even count all the avoided issues post-discharge for very low birth weight babies.
PreTRM or no PreTRM, high-risk pregnancies require extra clinical visits. And yet most of
Even if your clients decide to cover PreTRM, they still need to educate employees about why they want to get it, as well as how to avoid the other hazards of pregnancy, starting with something as simple as
The next step is pretty straightforward: use this article as a basis for helping your clients identify and eliminate these disparities —and save money in the process.
