U.S. employers are quietly absorbing the cost of a $4.5 trillion crisis: chronic disease. But here’s the reality: up to 80% of it is preventable.
We have a health care system designed to react, rather than to prevent chronic illness. And employers and benefits advisors hold more power than they realize. If an employer is offering health benefits, they’re already paying for preventative care. The question is — are employees using it?
Statistically, only 5.3% of adults receive all recommended preventative services. That’s not a health care problem; it’s a communication and education problem.
So why aren’t employees using it?
The Affordable Care Act (ACA) mandates free preventative care under all health plans. That means no co-pays, no deductibles, no coinsurance — if the care is coded and delivered correctly. But here’s what happens every day:
- An employee books an annual physical. Mentions they’ve been extra tired lately. Boom — the visit gets coded as diagnostic.
- Two weeks later, they get a $300 bill. Trust erodes. They skip their next visit. A manageable condition becomes a chronic one.
- This isn’t a rare case. It’s typical. And it’s costing employers in claims, productivity loss, absenteeism, and rising premiums.
How benefits advisors can help
This isn’t about offering more benefits. Many people simply avoid preventative health care because they fear the expense. Due to high costs, 28% of adults report delaying health care. Guiding employees to access and understand their benefits will help them become proactive health care consumers.
Here are five tips to empower employees to confidently seek preventative health care services:
1. Tell them it’s free and what that means: Most people don’t know preventative care is covered 100% when done right. Be loud about it during onboarding, open enrollment, and year-round.
2. Explain the coding trap: Help employees understand the difference between a preventative visit and a diagnostic one. One offhand comment can cost hundreds. A 5-minute explainer can prevent it.
3. Empower employees to ask better questions: Give employees the confidence to advocate for themselves. One question — “Is this coded as preventative?” — can stop a bad billing experience in its tracks.
4. Promote embedded benefits they’re already ignoring: Virtual nutrition visits, fertility guidance, annual screenings, telehealth check-ins. Many are included; few are used. Shine a spotlight.
5. Simplify support: When claims get denied, employees shouldn’t be stuck in red tape. Offer help navigating appeals or resolving billing errors quickly.
The bottom line
The ACA transformed our health care system into one that focuses on prevention and equitable access care, but most people aren’t reaping the benefits, leading to an increase in chronic diseases which can often be prevented.
But prevention pays off. Research shows that 72% of employers see a reduction in health care costs after implementing a wellness program; it keeps workforces healthier, costs lower, and productivity higher.
Employers and benefits advisors who work together to fundamentally change employees’ perspectives about preventative care will promote a healthier, happier workforce with fewer illnesses, sick days and claims. It’s a win-win strategy for all.
Alison Myers is President of Corporate Benefits & Specialty Health at Venbrook Group, LLC, one of the fastest growing, independently owned insurance brokerage, claims, and risk management consulting companies in the U.S.
© Arc, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to TMSalesOperations@arc-network.com. For more information visit Asset & Logo Licensing.