As if employers didn’t have enough on their plates, now a new concern is emerging. Most U.S. hospitals and outpatient surgery-centers have stopped performing elective surgeries like hip, knee, back and spine due to the current COVID-19 crisis.
As a result, many healthcare providers and insurers are predicting a surge in elective surgeries once the crisis abates. The questions facing employers are how to manage, as well as pay for, the pent-up demand. Of equal importance is the need to help employees impacted by surgery delays who may be in pain, disabled or suffering from anxiety and depression as they wait and worry about what’s next.
The solution for better post-COVID elective surgery management is multi-faceted. It will include:
- Finding ways to prioritize necessary elective surgeries over those where equally effective lesser invasive treatment options could provide optimal outcomes and lower costs.
- Ensuring whatever policy is adopted doesn’t overtax our overburdened healthcare system and workers.
- Focusing efforts on helping employees cope with the physical, psychological and emotional toll of surgery delays.
- Identifying committed partners who can help employers and their employees better navigate the continuing crisis.
Planning today for tomorrow’s elective surgeries
The rationale behind the postponement of elective surgeries is to alleviate the risk of exposure or spread of COVID-19. Additionally, elective surgeries are being deferred to ensure that healthcare workers are available to treat patients. We must do all we can to conserve healthcare resources, including blood supplies, beds, masks and gloves. Even when the most pressing part of the pandemic has waned, we must find ways to avoid unnecessary procedures that could over-tax a healthcare delivery system struggling to recover.
However, the implications for the hundreds of thousands of people not getting scheduled surgeries must also be considered. Without interventions, these people face not only pain, anxiety and depression but also a lack of mobility and concerns over an escalation of the condition’s severity.
The need for relief is just one of the reasons the nation’s insurers predict a deluge of requests for elective surgeries as soon as the current COVID pandemic abates. According to some estimates from a leading national health insurer, there could be more than 2.3 million people who will seek elective surgeries in the coming year.
That potential number is concerning for a number of reasons. Many of the most common elective surgeries are defined by clinicians as “preference-sensitive” – meaning that it is often the preference of the patient and not clinical best practice recommendations driving a surgery decision.
How does all that translate for employers? The average employer can expect 2.14 percent of their population to undergo elective surgeries in a given year. For an employer with 10,000 employees that translates to a little more than 200 workers who will undergo surgeries like hip, knee, or lower back. The cost of those procedures will vary based on a number of factors and will add up quickly.
When will the surge happen? That is an area still up for debate. First, the crisis isn’t going away overnight. It will likely occur at different rates in different regions and even communities. Second, many employees may remain nervous about getting surgeries even after elective surgeries get the green light.
While the situation is complicated, there are steps to take today to plan for tomorrow. Strategic planning supported with the latest data, innovative approaches to benefit design and personalized support for patients in duress can provide the guidance needed.
The need for solutions
Even before the current crisis, a few companies like ConsumerMedical had developed medical decision support (MDS) programs to help manage the surgery decision process. In today’s environment, those programs provide a number of features that can help employers through a potential post-COVID elective surgery surge. They include:
- Nurse and physician allies who can provide concierge-level care, answer questions, and help employees navigate the current healthcare system.
- Insights into treatment alternatives, including injections, physical, and behavioral therapy that could provide optimal relief and help avoid surgery altogether.
- Access to top specialists who can give second opinions about injuries or conditions, including virtual visits when possible.
- Tools and resources to help employees cope and that target stress, anxiety and depression.
- Information for employees on how they can access other resources offered through their health plan and partners.
- Emphasis on best practices. The New England Journal of Medicine reports that 30 percent of all conditions have a known best practice, but those are only followed 50 percent of the time. Thus, identifying cases where surgery may not be medically necessary – or best practice - is a key component of an effective MDS program.
The good news is that data shows us that participants may make different decisions when they fully understand the risks, options and outcomes of available treatment pathways. For example, our experience shows that up to 40% of unnecessary surgeries can be avoided by participating in our Surgery Decision Support (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 be able to drive a guaranteed 1:1 to a maximum of 4:1 ROI depending on engagement strategy and the benefit design in place.
Creating effective programs
There are a number of strategies employers should explore to help manage the post-COVID surgery decision process. One of the most important is to ensure health plans or other partners have the experience, resources and technology needed to provide necessary guidance and support. Additional steps include:
- Identify the potential scope/size and timing of the elective surgery demand the organization will face. Make sure your MDS partner can provide insights using claims and predictive data to give you an accurate picture of planned and projected electives surgeries and cost.
- Ensure you provide help and support for employees who need it today. While many elective surgeries can be avoided, that doesn’t mean the pain and discomfort aren’t real and that help isn’t required. Make sure your employees are getting not only education but also help with managing pain, anxiety and other issues.
- Incorporate innovative benefit design strategies. The most effective designs will include financial incentives as well as penalties tied to program participation and the use of Centers of Excellence should surgery be required.
- Emphasize education, support and best practices. Providing programs that give employees information about elective surgeries and non-surgical alternatives creates a more informed and empowered population. Employers that couple those programs with strong personalized support and an emphasis on best practices will be taking important steps toward better managing elective surgery demand.
A time for action
There’s still much we don’t know about how long the impact of COVID will last and its long-term implications for employers. What we do know is that taking care of workers today, and planning for a projected surge tomorrow, are actions that must be taken.
Embracing new ways to manage surgery demand will help to control the number of procedures over-burdened hospitals will need to manage in the coming months. Of equal importance, it will benefit employees in need and help businesses better navigate the ongoing challenges of a post-COVID world.
