Dave Chase is co-founder of Health Rosetta, which aims to accelerate the adoption of simple, practical, non-partisan fixes to our healthcare system. He also is the author of The Opioid Crisis Wake-Up Call: Health Care is Stealing the American Dream. Here's How We Take it Back. The views expressed here are the author's own.
With the opioid crisis dominating today's news cycle, it's easy for employers to believe it's an issue far bigger than themselves. But the reality is it isn't.
One hundred fifty-five million Americans have employer-provided health insurance and because of this, employers are unwitting enablers for the sad state our healthcare system is in today, opioid crisis included. Employers have been maintaining the status quo, providing poor healthcare coverage (that is often quite expensive) and failing to realize that doing so could have a profoundly negative impact. For example, employees continue to receive opioid prescriptions for lower back pain despite there being no evidence of their effectiveness (other than temporarily masking pain). With the root cause of the ailment being ignored, it's no surprise that lower back pain continues to be the primary driver of both opioid prescriptions and disability claims.
The silver lining, however, is that employer-provided health insurance — which has historically been part of the problem — can also be a salvation. By offering employees access to value-based care models like direct primary care, employers can save money and stop addiction before it starts, minimizing the opioid crisis' impact on their workplaces.
In 2016 and 2017, more than 11.4 million Americans misused opioids and, according to the U.S. Bureau of Labor Statistics, workplace overdose deaths from drugs and alcohol have been climbing by at least 25% per year since 2012. Despite on-the-job deaths becoming increasingly common, a survey by The Hartford found that 76% of employers and 64% of HR professionals aren't trained on how to deal with opioid addiction in the workplace.
Because opioid abuse has cost employers billions in lost productivity, employers can no longer afford to ignore this issue. Obviously, HR departments can educate workers on the signs of opioid abuse and signs of an overdose. But HR personnel may also consider teaching employees how to use the overdose-reversing drug naloxone; some states even offer training and don't require prescriptions. Information on various counseling programs also could be helpful.
While these solutions meet an important, immediate need, they do nothing to fix the cause of the problem: low-quality, expensive and volume-driven healthcare. The industry today revolves around a fee-for-service model in which healthcare organizations are paid not based on how well they do their job — creating healthier patients — but for how many tests and procedures they order. This payment structure has led to long wait times and brief “get in, get out” appointments that typically result in referrals, require follow-up appointments or prescribe addictive opioid drugs for a quick fix.
During this time, health conditions worsen, requiring more expensive treatment down the line. Individuals who don't want to wait for an appointment rack up expensive emergency room or urgent care bills and of those with chronic pain, 21% to 29% end up abusing the drugs they're prescribed. This is the status quo care a majority of employees are receiving.&n
Fortunately, employers have the power to change this by choosing health plans that offer access to value-based primary care. One version of this model is direct primary care, which cuts insurers out of the equation and offers primary care directly to consumers for a monthly, quarterly or annual fee. Compared to the fee-for-service model where one appointment could cost hundreds of dollars (depending on how many tests a physician wants to run), this fee covers a majority of primary care costs. With insurance out of the way, there is no bureaucracy or mountain of paperwork, allowing physicians to spend more time with patients, identifying and treating the cause of their pain rather than prescribing opioid-based painkillers to mask symptoms. In the long run, treating patients right the first time will prevent them from returning multiple times for the same issue, slashing wait times and allowing patients to make same-day appointments.
Further, direct primary care looks at the big picture of a patient's health and wellness, coordinating care between other physicians and treating a patient proactively rather than reactively. As an added bonus, this doesn't have to be done in an office; telehealth allows patients to contact physicians via email, text or video, preferable to their visiting a random physician in an uncoordinated urgent care setting. This model will keep employees out of expensive emergency rooms and urgent cares and, most importantly, give them truly high-quality care.
To give employees this kind of high-quality care, employers should first find out if their benefits brokers have experience working with value-based primary care practices (the good ones do) and if they do not, encourage them to research which primary care organizations would be able to provide such services. Before deciding which organization to move forward with, employers also should visit value-based primary care practices, compare prices and revise their benefits plan to include incentives for employees and their families that use value-based primary care practices.
To that last point, all health plans are unsuccessful if they're not properly introduced and communicated to employees. According to an Arthur J. Gallagher 2018 Benefits Strategy and Benchmarking Survey, even though 74% of employers are confident that they offer competitive health benefits, only 61% think their employees are satisfied. This could be largely because 44% of employees say they aren't sure they're making the right benefits decisions. HR professionals can fix this by holding benefits presentations, workshops and webinars, as well as providing online and print handouts about coverage. Naturally, these efforts only work when there is a high-value benefits program in place, but these efforts will pay off in fewer HR calls and, with the plan working appropriately, saved money.
Employers have been unknowingly contributing to the nation's opioid crisis by paying too much for poor benefits. Now is the time for employers to act, join a healthcare revolution and provide employees with value-based care to stop addiction before it starts.