Pandemic side effect: With prevention lagging, it’s time for employers to step up
The danger of contracting COVID-19 over the last 16 months has taken a toll on our hearts and minds. But even as this risk begins to subside, many people are putting themselves at unnecessary risk of other serious illness by not getting free preventive care.
We don’t fear measles and polio epidemics anymore because of widespread pediatric vaccinations. Mammograms and colonoscopies are the reason people are living long, healthy lives after cancer diagnoses. These low-cost interventions save lives and money. Unfortunately, people are skipping them in droves.
During Spring, 2020, colonoscopies were down 86%, and mammograms and cervical cancer screenings were down 94%. We had hoped these screenings would be performed over the subsequent months as the pandemic receded and other medical care returned, but that hasn’t happened. Colon cancer screening remains down 25%, mammograms remain down 13%, and cervical cancer screening remains down 21% through March 2021. Our decreased cancer screening could mean many have their cancers diagnosed at a later stage, when a cure is less likely.
For children, the situation is just as concerning. Even with our focus on vaccination for COVID-19, we’ve fallen far behind in pediatric vaccinations. The Centers for Disease Control and Prevention reported that orders of all vaccines are down 14% in 2021 compared to 2019, and orders of measles vaccines are down 20%. Political polarization around COVID-19 vaccinations could increase parental hesitation for routine childhood vaccinations, too. This decreased immunization rate could mean a return of diseases that most physicians today have rarely, if ever, seen.
Preventive care, including cancer screening and childhood vaccinations, is already offered without cost sharing in almost all employer-sponsored health insurance plans due to the Affordable Care Act. But some employees aren’t aware that they would bear no cost for these services, and others missed their annual (or less frequent) interval. Now, they are “off schedule” and these services won’t be top of mind.
Here are six steps employers can take to maximize the chances that their employees gain the full value of preventive benefits.
01
Employers remain a trusted source of medical information, and an effective communication campaign can raise the rate of employee and family uptake of preventive care. Messaging to encourage preventive care can focus on what behavioral scientists call “loss aversion.” Employees and family members can lose precious time together if they don’t get appropriate preventive care. Also, draw attention to short-term benefits whenever possible, as we tend to undervalue benefits we receive in the more distant future. Another tactic you can use is storytelling. Powerful stories from employees willing to share the personal loss they avoided by getting preventive care are much more effective at influencing behavior than even the starkest statistics.
02
Employees and their families are most likely to want to exhibit the same behaviors exhibited by those who they respect. Give influencers the opportunity to show that they are returning to preventive care if they want to, through company social media or other communication channels.
03
Preventive care is already free — but sometimes it’s hard to get. Many are reluctant to undergo the preparation for colonoscopies, so employers can offer access to stool tests (some are genetic and some are chemical) with sensitivity for early colon cancer almost as high as colonoscopies when performed every one to three years. With employees returning to the workplace, employers should go back to offering onsite influenza vaccine clinics and continue promoting access to local pharmacies to be vaccinated. Onsite mammogram services can boost rates of breast cancer screening, too.
04
Minority communities, including Black, Indigenous, and People of Color (BIPOC) often have lower screening and vaccination rates, as can low-wage workers and employees with lower educational levels. Be sure that those communicating the importance of preventive care are from diverse groups and backgrounds, and be ready to address concerns that some have about a history of being mistreated and denied access to the medical system.
05
Childhood immunizations are one of the most effective (and cost saving) medical interventions available. Employers tend to focus on adult employees, but children who suffer illness due to preventable childhood diseases will lead to time away from work and extra medical expenses. Employers who promote childhood vaccination help decrease illness across the entire community.
06
Employers have historically used wellbeing incentives to encourage health risk assessments, biometric screening, coaching, and other health-related behavior. These incentives can help draw attention to various activities, although the cost per incremental person getting a vaccine or a screening test is often high. Providing incentives for preventive care today could lead to a decrease in preventive care if incentives are withdrawn at a later point. Raffles draw much more attention per dollar spent, although even these often move the needle only a bit. Incentives can be part of a preventive care strategy, but they can’t be the entire strategy.
The COVID-19 pandemic has led to vast changes in the way we live and the way we work. Let’s do everything we can to prevent a subsequent epidemic of preventable illness by helping employees return to the preventive care they might have missed over the last 18 months.
Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.
