Health Disparities Hidden in Your Benefits Plan
- Al Lewis
- Jan 23, 2023
- 6 min read
Last Thursday (January 19th), we did a webinar on health literacy-meets-health equity. Included in that webinar were some polling questions. We posited that many organizations – even those with robust health equity initiatives – were unaware that some of their very well-intentioned benefits and programs ignored, or even created, health disparities.
The first polling question explored the financial aspect of health equity:
The thesis of this webinar was to show that, notwithstanding your best efforts, you have more health disparities that you would expect...but that, notwithstanding these preconceptions in the poll results, closing them can actually save money. We explored six examples. We'll review four here, and then elaborate on the other two in our February 22nd webinar, when we reveal Release 2.0 of Quizzify2Go. Disparities don't stand a chance against Release 2.0.
Colon Screening
Colons are the only body part where cancer screening substantially reduces mortality, as you can see from this chart showing the decline in colon cancer incidence and mortality over a period that coincides with the, uh, penetration of colon screening.
Despite the compelling case, a large percentage of eligible employees don’t get colon screening. Not one, but two health disparities discourage hourly workers from getting screened.
First, you need to take at least one day off from work, if not more. If you are salaried or work from home, you can usually arrange that. But what if you are paid hourly? Do you get compensated separately for that day or does it count against your PTO? We asked that polling question and were not surprised to see this answer:
So even if you offer an “incentive” to get a colonoscopy, it still costs hourly employees money. Hence, if you want employees to get colonoscopies, the free test should be accompanied by a “free” day off.
Second, hourly (and salaried) employees also may not realize that there are three almost-as-good colon screens that do not require time off.
Quizzify teaches that in our screening quiz. An attendee pointed out that colonoscopies find polyps, while the others find only cancers. True indeed. On the other hand, the others are performed much more often, so that whatever cancers they find by screening every year (FIT) or every three years (Cologuard) are much more likely to be Stage One. Hence the rates of avoided deaths below are similar (see the last line, where the red arrows are.) Only the ones with the highest avoided deaths and no radiation are taught by Quizzify.
Also, most importantly, our quizzes can be tweaked so that these non-invasive screens are proposed only to eligible employees who haven't screened at all.
Dental Benefit and Cavities
Next, let’s look at our old friend, the dental benefit. Employers aren’t generally too interested in it because it’s a small dollar amount.
Yeah, for them, maybe. But for employees who are experiencing dental issues, it can be a lot. And, unlike many medical issues, significant dental issues never, ever go away on their own…and they usually get worse if untreated. Further, it is well-established that they can cascade into medical issues as well.
You’re likely covering 2 visits for everyone…but that’s overkill for many people and of little help to employees who need more, and who will be spending much more of your healthcare money if they don’t get them. Those employees are by and large the socioeconomically disfavored ones, making the 2-visits-fits-all dental model a classic health disparity. Covering a third or even fourth visit at 100% will easily pay for itself. And, unlike other things covered at 100%, additional coverage will not encourage overuse. Who amongst us wants to visit the dentist any more than necessary?
And yet, assuming you know how many visits you cover (a big assumption, according to the poll), you likely only cover two. Here is the result of this poll.
Looks like we are changing some minds here...
The other dental health disparity is treating cavities. The answer to this one is obvious: cover silver diamine fluoride. It makes no economic sense not to give hourly and salaried employees the option of paying much less money and losing much less work time than getting a drill-and-fill. And I know whereof I speak, having been treated with it myself, in two minutes, for $39 uncovered dollars. (A "covered" drill-and-fill would have set me back $80, but at least my wife's employer would be docked the other $80 for their ignorance of SDF.) As with the third dental visit, despite the clearly positive economics and equally clear health equity benefit, almost no one covers it.
Or if they are covering it, they don't know they are covering it. If the folks on this webinar don't know, clearly their employees wouldn't know. Even with coverage in both cases, you still have to educate the employees on what their dental benefit covers and why they want it. This is particular the case for SDF, since dentists aren’t going to recommend a treatment that cuts their own revenue by about 75% and obsoletes the major skill, cavity-filling they learned in dental school. You have to learn to ask, which is what Quizzify teaches.
Pregnancy and Birth Events
Finally, let’s turn to pregnancy and birth events. Consider first your fertility benefit. Yes, you reduce the cost and presumably increase the likelihood of becoming pregnant for all employees who have trouble conceiving. But fertility treatments require a ton of time. Every article on balancing fertility treatments and work requirements was written by or about white-collar women who can “balance” work and treatments by working remotely. What results is a classic health disparity: these treatments are still largely out of reach for hourly employees, while salaried employees are subsidized, both for the offering itself and for the lost work time. The good news is that we found one company that does cover lost work time. The bad news is, it is in England.
That brings us to actual premature delivery avoidance. Premature birth is a classic health disparity, by race:
You’d like to be able to resolve that, and yet according to this poll, you are not covering the one product, PreTRM, that predicts premature delivery, prediction being a necessary first step to prevention.
It has always bewildered us how so many companies spend so much money to get women pregnant…and yet won’t spend a tiny fraction of that amount to keep them pregnant. This would be an excellent opportunity to resolve a major health disparity.
According to its own studies and to the Validation Institute, PreTRM reduces NICU lengths of stay by 30+ days on average…if followed up with high-risk prenatal care provided at an intensity commensurate with the risk level revealed. For babies admitted to the NICU, the reduction in length of stay is astounding…and this doesn’t even count all the avoided issues post-discharge for very low birth weight babies:
PreTRM or no PreTRM, high-risk pregnancies require extra clinical visits. And yet the polling revealed that most companies count high-risk maternity doctor visits against PTO, even though it is in their own best interest to keep employees pregnant for the full nine months.
Quizzify jumps in here, too. Even if you cover PreTRM, you still need to educate employees about why they want to get it, as well as the other hazards of pregnancy, starting with something as simple as kitty litter. It should surprise no one that we have 3 prenatal quizzes and of course Quizzify2Go’s Doctor Visit PrepKits cover prenatal visits too – what questions to ask, what to expect, and much more.
Speaking of reveals, we will be revealing our new release of these Doctor Visit PrepKits – which have evolved from just sets of questions into truly a “virtual coach” for 187 clinical encounters – in our February 22nd webinar. There is nothing like these PrepKits anywhere. We hope you’ll join us for The Big Reveal that day. You can sign up here.
Let’s close with the good news: the results of the closing poll. The question was the same as the opening poll, except instead of asking “Do your health equity initiatives save money?” We asked: “Could your health equity initiatives, with Quizzify’s help, save money?” The after-vs--before results exceeded even our expectations:
Presumably, having read these highlights of Thursday's webinar, you too might feel the same way: that resolving certain health disparities also reduces cost, provided you teach employees how to use these innovative but proven benefits, which of course is our job.
