By Sarah Gunter
According to Michael Thompson, CEO and founder of the National Alliance of Healthcare Purchaser Coalitions, if you want to know what direction the market will move towards, listen to what employers are talking about right now. Thompson attributes a lot of power to employers in influencing the industry, especially employers who harness their purchasing power and mindshare. National Alliance’s membership consists of purchaser-led business coalitions from across the United States serving 12,000 purchasers and 45 million Americans. While not all companies favor the purchasing coalition model, Thompson’s industry experience gives him valuable insight into the healthcare market, and he’s not wrong that employers have massive potential to create and control demand. So, what are employers talking about right now? Many different solutions, but Thompson sees whole-person care as one of the most important and innovative.
Whole-person, or holistic, care is exactly what it sounds like: care that accounts for the whole person, meaning all of the interrelated factors contributing to their health, like social determinants such as geographic location and access to food. It is absolutely related to health equity, an issue the National Alliance has refocused on after covid and the racial justice movements of the past year. “It’s a losing strategy to treat everyone the same,” explains Thompson, “You need to be intentional and understand the experiences of certain pockets of your workforce in order to truly support them.” Holistic care promises a more hyper-personalized experience and better outcomes, but in a market where employers and employees are already struggling to foot the bill, how is it possible to afford a higher level of care? Holistic care can actually cut costs if implemented effectively, but in order to understand how, it’s crucial to consider other trends at play in the market.
First, let’s look at healthcare consumerism, a trend that has largely shaped what the market looks like today. The idea behind consumerism sounds great: give the individual employee more freedom of choice by putting the purchasing power in their hands. However, the average employee doesn’t tend to make the most informed purchasing decisions. It’s understandable, considering that the healthcare market is notoriously difficult to navigate. This, coupled, with high deductible healthcare plans (HDHPs), leads employees to put off seeking care to avoid the confusion and expense. Rising costs show this clearly isn’t sustainable: Thompson cites a statistic that over the past decade, wages went up 20%, while inflation went up 26%, family premiums went up 52%, and deductibles went up 160%, meaning that deductibles now cost about 4 times what the average person can afford. It’s a precarious system where any type of material illness can jeopardize people paying their own bill.
Next, consider the long-term impact of putting off care alongside some of the top health issues facing employees right now: mental health and substance abuse. The CDC reported a drastic surge in these two issues over covid, with 40% of adults reporting in late June of 2020 that they struggle with either mental health or substance abuse. This is where employers can feel the burden of consumerism and HDHPs; employees avoiding care while struggling with these issues are prone to presenteeism, absenteeism, burnout, and mental and physical fatigue. When employees do finally seek treatment, it’s often at the last possible moment, after the worst has happened, meaning care is intensive and likely includes hospitalization, just as it would with any other serious health issue. This expense hurts the employee and can really hurt the employer: “The biggest threat to employer-sponsored healthcare is high-cost claims… it’s not because everyone gets one, it’s because it’s a problem if you do,” says Thompson.
The need for innovative solutions is clear, but how does holistic care help? The power of holistic care is that it is personalized and proactive. Solutions in the past have been siloed approaches, but the same wellness program does not help every employee equally. This is where a hyper-personalized approach where healthcare providers and administrators holistically consider an individual’s health is important in optimizing treatment and the distribution of resources. “If you’re depressed, you’re not going out and jogging any time soon… treat the depression first and then work on the physical wellness and nutrition,” says Thompson, describing a possible scenario. Implementing this kind of personalization might seem impossible, but innovations in technology and vendor solutions are making it increasingly easier. Holistic care is also proactive—investing in benefits that make primary care and therapy more affordable and accessible for employees or that help them tackle major stressors in their lives like financial planning and access to nutritional foods can help reduce the risk of high-cost claims, which lowers expenses in the long run.
Consider the statistics around substance abuse; it’s the leading cause of death for Americans age 1-50, but Greg Williams, Manager at the Alliance for Addiction Payment Reform explains that if an individual can stay clean through a five-year period of recovery, their risk factor for substance abuse decreases all the way back to that of the general population. However, most plans only provide limited coverage for addiction treatment including acute episodes of expensive inpatient care, but not including preventative and long-term treatments like therapy. Williams also notes that the cheaper inpatient programs many plan members are steered towards have a financial incentive not to help them get well, as there’s less value in patients who don’t return. Investing in an employee’s holistic wellbeing, their living conditions and access to treatment, what William calls “recovery capital,” actually creates the most value for employers and employees.
“Where there are disproportionate needs, you invest disproportionately,” says Thompson, “It’s not only the right thing to do, it’s also the smart thing.” Instead of treating an entire population that same, work on reaching similar outcomes for people across the population. Employers who adopt this approach can help their employees, themselves, and the entire industry, directing demand away providers pedaling consumerism and HDHP’s and towards the innovative providers focused on making holistic care a reality.
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