Numerous surveys have found that US adults trust their employers as a source of health care information generally and for COVID-19 information, specifically above other sources. (Photo: Shutterstock)
Since the COVID-19 pandemic was announced in the US in mid-March, our hospitals have been filled with patients seeking care for illness associated with the coronavirus—however, children and adults in the US have been avoiding getting both preventive care and non-urgent care for other conditions.
Colleagues at Castlight Health, RAND, USC, and the National Bureau of Economic Research recently published a study, "Changes in Health Services Utilization Among Commercially Insured U.S. Populations During the COVID-19 Pandemic," in JAMA Network Open. In our analysis of nearly seven million children and adults with employer-sponsored health insurance in all 50 states, we found that overall health care utilization decreased by 23% in March and 52% in April of 2020. However, this average is far less important than the details: Astonishingly, in these early months of the pandemic, adults deferred nearly 70% of important preventive services such as mammograms, colonoscopies, and routine testing for diabetes. Moreover, children did not receive about a quarter of their routine immunizations.
Recommended For You
Although the rates of deferred care have improved in the past few months, we would have to see a surge in preventive care to make up for the services that have been avoided. The consequences of this deferred care are grim: A recent study in England estimated a 7.9 to 9.6% increase in breast cancer deaths and a 15.3 to 16.6% increase in lung cancer deaths due to delays in diagnosis over the next five years. Similarly, delays in routine vaccinations can lead to decreased immunity to common childhood illness—a potentially significant issue as schools consider more widespread reopening.
Employers have a unique opportunity to help. Numerous surveys have found that US adults trust their employers as a source of health care information generally and for COVID-19 information, specifically above other sources, including governmental agencies. This suggests that employers can use their trusted position to provide key information about the importance of getting routine care and how to do so safely. Moreover, employers often have access to platforms and tools, such as those that Castlight provides, to identify the most vulnerable populations and effectively communicate specific evidence-based actions for them. For example, employers can use such technologies to develop compelling outreach campaigns to engage women who have missed their mammograms and provide them with clear help on where best to safely get one.
Employers can help with three other key barriers to getting deferred care: anxiety about seeking health care during the pandemic, poor access given strapped health care systems, and cost. A recent Kaiser Family Foundation survey found that 53% of US adults report that the stresses of the pandemic have negatively affected their mental health. Castlight's data suggest that anxiety and insomnia are among the most common symptoms.
Companies have traditionally provided employee assistance programs, which can support employees with these symptoms—including with free or low-cost psychotherapy. It has never been more important to communicate effectively about these historically underutilized programs, especially for populations at greatest risk for behavioral health concerns (for example, those with a history of mental illness or substance misuse disorder, low-income employees who may be facing increased financial stresses due to the pandemic, and those with multiple chronic medical conditions).
In our study of deferred care during the pandemic, we found a dramatic increase in the use of telehealth with an increase of 1,024 percent in March and 4,081 percent in April. Telemedicine is a potentially powerful way to increase access to health care services while keeping patients safely isolated from those with COVID-19. Importantly, four of the top five reasons for a telehealth visit was for a mental health issue such as depression or anxiety (notably, the other top five reason for a telehealth visit was for COVID-19-associated symptoms). Unfortunately, we found that low-income and non-white populations were less likely to use telemedicine to make up deferred care—putting these individuals at higher risk for potential exposure to COVID-19 in clinical settings.
Employers can expand telehealth benefits, especially for teletherapy and telepsychiatry. Such services could be targeted to populations with known behavioral health needs and to vulnerable populations with the greatest deferred care.
During the pandemic, numerous digital health companies provided free and low-cost offerings (including digital psychotherapy services, nutrition counseling, and chronic disease self-management). Dozens of Castlights' employer customers took advantage of these offerings to deliver additional services to help offset deferred care. Many of these interventions have protocols for escalating users with worrisome clinical conditions for telehealth or in-person care. Thus, these services can help identify the highest priority employees in need of getting additional care. Coupling these technological interventions with in-person clinical support (such as nurse navigators and care managers who can help with appointment scheduling, self-management, and medication adherence), can be an effective means of providing the highly-personalized intervention required by the most fragile members.
As the infections and deaths associated with the pandemic continue, and widespread availability of the vaccines is still some months away, it is critical for employers to seek opportunities to help their populations get the care they need today for both COVID-19 and all other conditions. If we don't, we will face post-pandemic increases in preventable illness and its associated unnecessary costs.
Dena M. Bravata, M.D., M.S., is a Stanford health services researcher, the co-founder of Lyra Health, and serves as Chief Medical Officer for Castlight Health.
Read more:
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
