In the push to keep healthcare costs down and employees healthy, large employers have identified an emerging threat: cancer.
That is one of the key findings of the Business Group on Health’s annual health benefits survey of large employers for 2022. The Washington, D.C.-based organization surveyed 135 employers representing some 18.3 million covered employees.
In all, 44% of respondents said they expected a higher prevalence of late-stage cancers in their employee populations due to delayed preventative screenings, a trend that employer-sponsored healthcare observers have long feared due to the closure of care centers caused by COVID-19.
“We have a lot of concern that this situation may actually worsen,” Brenna Shebel, vice president at BGH, said during a virtual press event Tuesday announcing the survey results. Shebel noted that 13% of employers were already seeing a higher prevalence of late-stage cancer at the time of the survey. “We will have to keep an eye on this as we move through future years and [see] the overall effect of the pandemic.”
The findings come after a 2021 in which large employers’ overall health spending — already difficult to project because of COVID–19 — exceeded BGH members’ expectations. Accounting for plan design changes, BGH respondents projected average median health cost increases of 6% for 2021.
In actuality, last year saw a median increase of 8.2%. That is the highest increase BGH has recorded going back to 2017 and a complete reversal from 2020, when most members saw zero cost growth, BGH President and CEO Ellen Kelsay said Tuesday.
She added that BGH attributes this jump in part to plan members catching up on chronic condition management that may have gone off course during the pandemic, along with other factors such as longer hospital stays. For 2023, BGH members project increases closer to those seen in pre-pandemic years, or about 5%.
“But a return to normalization is not a return to good,” Kelsay said. “A 5% trend is still high. These numbers continue to go up at a rate that is quite honestly unsustainable.”
Cancer topped the list of conditions driving respondents’ healthcare costs in 2021, overtaking that spot from musculoskeletal conditions. In response, half of employers said they would have centers of excellence coverage for cancer in place for 2023, while an additional 26% said they were considering doing so through 2025.
Other strategies include covering genomic testing for cancer treatments, while common incentives include reimbursement for travel and accommodations related to care. Prevention and screening also are being prioritized, with employers expanding or providing alternatives to traditional colonoscopies as well as updating their plans’ definitions of preventive screenings for breast cancer.
Some employers are focused on covering early detection blood tests within the next few years, Shebel said, noting that these tests tend to be less invasive while offering the potential to detect more cancers at earlier stages.
Health equity a growing priority
Most employers identified addressing healthcare inequities as a priority for their plans in 2021, at 75% of respondents compared to 70% in 2020.
Underneath this category, childcare access emerged as the top area of focus for health equity efforts, with 47% stating they had already implemented solutions for childcare this year and 6% stating that they were considering such efforts in 2023. Further out, 20% of employers are considering addressing food access and insecurity in 2024 and 2025.
A strong majority of employers, 85%, said they planned to implement at least one strategy to address women’s health and reproductive health by 2023. Employers viewed these areas as a component of their health equity efforts, Kelsay said. A BGH spokesperson told HR Dive that the survey was conducted on both sides of the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, with some respondents completing the survey prior to the June 24 decision and others completing it afterwards.
Asked if they had implemented, or were planning to implement, programs or initiatives to improve access to abortion services, 44% of employers answered in the affirmative, while another 33% said they would consider doing so. Abortion coverage continues to be a pressing topic for organizations despite the potential logisitical and legal challenges involved.
Among employers that had made or were considering changes, 96% said they were looking to provide financial assistance to help with travel and lodging costs incurred by employees who seek to obtain reproductive care in a different state or location, the spokesperson said.
Virtual care now a mainstay, with new applications on horizon
An open question for health plans in recent years concerns whether the massive utilization growth of telehealth and virtual care options during the pandemic will continue once in-person healthcare visits resume. While BGH observed a year-over-year drop in the number of employers that said virtual health offerings would have a significant impact on how care is delivered — 74% in 2022 compared to 85% in 2021 — Shebel noted that this share is still elevated compared to 2019, when just 52% of employers said so.
“That’s much higher than before the pandemic,” Shebel said. “We know the pandemic did play a role in the growth and interest in virtual health, but it’s been building since long before that.”
More than half of respondents said virtual health opportunities were a top healthcare priority for 2023, followed closely by the expansion of mental health services at 47%.
Virtual care is primarily being used for acute and minor services, mental health, diabetes care management, health and lifestyle coaching, BGH found. Other use cases are less common, but have the potential for future growth, such as sleep management, cardiac care management, chronic kidney disease management and care for specific patient populations, such as employees of color and employees who identify as part of the LGBTQ+ community.
The latter is an area of particular interest to BGH, Shebel said; “That is going to be supportive of an employer’s health equity efforts.”
At the same time, respondents noted concerns about virtual care. Sixty-nine percent said they were concerned about siloed care experiences on virtual platforms, while 60% said they were concerned about a lack of integration between vendors.
“Employers, particularly our members, offer many different types of virtual health programming … and so the concern is that some of those offerings may not be working in concert with one another,” Shebel said.
