Surgeon General promotes social connectedness to address loneliness
Vivek Murthy discovered that he was profoundly lonely during his first stint as Surgeon General in the Obama Administration, which led him to write a book about loneliness. He is now back as Surgeon General with an advisory on loneliness that includes comprehensive review of current data and recommendations for many stakeholders, including employers. The advisory was released in May to coincide with National Mental Health Awareness Month.
Findings from the publication show that Americans are clearly lonelier than they were in the past:
Loneliness is also bad for health. Those who suffer from loneliness have higher overall mortality rates. The risk of heart attack in those who reported high rates of loneliness is 29% higher, and the risk of stroke is 32% higher. Those with heart failure who are lonely are more likely to have hospital admissions.
The advisory’s recommendations for employers:
Researchers at Mayo Clinic reviewed survey results from about 4,400 women ages 45 to 50 years old and found that many reported menopausal symptoms interfered with their lives and work.
The respondents were disproportionately white (93%), married (77%) and college graduates (59%). The authors extrapolated this work absence to a loss of $1.8 billion in productivity annually.
Implications for employers:
Luckily, most children are healthy and relatively few are hospitalized. But recent data show that when kids are sick enough to be hospitalized, their families incur substantial out-of-pocket costs.
Researchers in JAMA Pediatrics reviewed around 10 million claims from hospitalized children from 2017 to 2019, and found that, on average, out-of-pocket cost was $1,313, and out-of-pocket cost exceeded $3,000 for more than one in seven kids hospitalized. When possible, researchers matched patients to the type of health plan they had and found that those with high deductible health plans faced the highest out-of-pocket costs.
These findings don’t fully account for the financial damage to families whose children are hospitalized. Parents often lose income when they miss work, and the costs of medicine, outpatient care and even parking can further stress family finances.
Implications for employers:
Biomarker tests analyze cancer cells to determine what therapy is most likely to be effective at curing or slowing cancer. Many anticancer drugs are highly effective for cancers with certain genetic mutations but do little to help patients with cancers that lack those mutations.
Biomarker tests are indicated for most people who are diagnosed with
Many of these biomarker tests are laboratory developed and do not require approval from the Food and Drug Administration (FDA). As a result, there is often not a specific billing code for each test. Some are FDA approved as companion diagnostic devices.
These biomarker tests are increasingly included in National Comprehensive Cancer Network guidelines. Researchers for the American Cancer Society found that coverage of oncology biomarkers was “widespread but not universal.” Some claims for these tests are subject to prior authorization and some claims are denied.
Current legislation requires or regulates coverage in six states, and there are legislative proposals in nine additional states. These requirements only apply to fully insured health plans that are state regulated, and almost two-thirds of those who have employer-sponsored health insurance are in self-funded health plans, which are exempted from state regulation.
Cancercare.org, a charitable advocacy and service group, recently published a survey of 295 people treated for cancer and found that 29% who had cancer biomarker tests did not receive coverage for the tests. The survey also notes that one in 10 respondents said the biomarker test made them eligible for a clinical trial, and one in five said it saved them from unnecessary chemotherapy or radiation.
The oncology community recognizes that underuse of cancer biomarker tests means some patients don’t get the most optimal medical care and could suffer unnecessary complications of therapy or die earlier.
In a review of electronic medical records that included over 120,000 patients with three types of cancer from 2017 to 2020, researchers found racial disparities in the use of biomarker tests. They found substantial disparities in use of these tests in lung cancer and colorectal cancer treatment, but no significant difference in breast cancer treatment.
Implications for employers:
The temperature was in the 90s on much of the east coast in early April, and there was so little snow in Boston this winter that our snowshoes never made it out of the basement. This dramatic change in temperatures will impact health and healthcare. Here are some of the reasons why global warming is likely to lead to higher healthcare costs.
Not all news is grim. We know that moving away from fossil fuels and toward renewable energy sources can substantially decrease air pollution, especially in urban areas. This could decrease cardiac and respiratory disease. Furthermore, a warmer planet could mean fewer cold-related injuries.
Also, the transition to alternative energy sources can support good paying jobs that increase financial security, which is associated with improved physical as well as mental health.
Implications for employers:
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.
