We often talk about getting what you pay for in healthcare. There’s a definite link between financial investment and gain for employers and health plans and doing what’s best for patients. Research shows that supporting patients through their healthcare journeys improves outcomes, while saving companies $30 billion in inappropriate care—plus productivity gains. By connecting the dots between what’s in a patient’s and a payer’s best interests, we’ve improved outcomes for 88% of the patients we’ve worked with and delivered a 4:1 return on investment (ROI) for employer and health plan partners.
The new normal in healthcare includes delayed care of all types, including elective surgeries. Delayed care is a reality for hundreds of thousands of patients waiting for elective procedures, such as hip and knee replacements, lower back surgery, hysterectomies, and weight loss surgery. These patients are often in pain and concerned about how delays will affect them. An analysis of more than 200,000 surgery-related claims across 400 employers illustrates that savvy employers and health plans can help employees manage this uncertainty and control costs. A few noteworthy findings:
- Fewer elective surgeries: Data shows a 65% reduction from March to April 2020, compared with March through April 2019. Even if clinics began unilaterally rescheduling elective surgeries, we’d have a four-month average wait time, which will only compound the human toll of postponed surgeries. Eighty-five percent report increased pain, while 73% describe a decline in quality of life.
- People waiting for surgeries aren’t getting basic care: During that same timeframe, we saw 35% fewer physical therapy visits, 41% fewer cortisone injections, and 30% fewer office visits for surgery-related conditions. This lack of care could increase dependence on opioids and affect depression and anxiety levels.
- Unnecessary care: Many elective surgeries do not align with best practice guidelines, which is concerning on many levels. Our analysis found that 30% of elective surgeries performed in 2019 were potentially unnecessary. This translates to $30 billion in potential savings (out of $100 billion spent).
- People are suffering: While 30% of elective surgeries might not be medically necessary, 70% are. The last thing you want is for people who need medical care to not receive it. Clinical advocacy, second opinions, and decision support demonstrate your organization’s investment in employee health and wellness and provides significant savings—a true win–win when you consider the 4:1 ROI.
Questions to help your executive team ensure the organization is on the right track:
- How many of our employees or members were waiting for elective surgeries before the COVID-19 pandemic and how many need elective surgeries now?
- What are we doing to help those patients? Are they getting the care they need from physical therapy to counseling?
- Have those people considered non-surgical options, including diet and exercise, physical and behavioral therapy, steroid injections, chiropractic care, and acupuncture?
- Which states where our employees and members live and work allow elective surgeries? Consider providing a list on your employee portal.
- What are best practice options to mitigate pain while awaiting surgery? Do our employees or members have knowledge of and access to them?
- How does our organization help employees address mental health issues and seek appropriate care?
Amid ongoing uncertainty, help employees and members find solid ground with the information, guidance, and support they need. Jumpstart the conversation by sharing this data, along with stories from the field and let us know what additional data you’d like to see.
