How delayed care causes chronic conditions to spiral out of control

At this point, we’re setting inflation records on a monthly basis.

According to data released by the US Bureau of Labor Statistics in early June, the Consumer Price Index increased by 8.6% in May from a year earlier. It was the biggest 12-month CPI increase since December 1981.

With inflation on the rise, people have less wiggle room in their budgets. These dynamics are impacting spending in every area of ​​our lives, and healthcare is no exception. Per the Bureau of Labor Statistics, health insurance costs increased by 13.8% from May 2021 to May 2022.

Based on inflation trends, an employee who makes $50,000 a year actually has $2,500 less to spend on healthcare than they did just 12 months ago. These constraints are only making it more difficult for people to afford the care they need — and the result will be an uptick in delayed or foregone care. Deferred care has negative consequences for employees as well as employers.

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This is particularly true for folks dealing with chronic medical conditions. While in practice, I cared for countless patients who had problems like high blood pressure, diabetes or depression.

Managed well, these conditions follow a simple pattern of disease: Their symptoms are easy to live with, and they pay relatively minimal out-of-pocket costs. But when their conditions are not managed appropriately, these same patients can face incredibly disruptive symptoms and rapidly rising expenses.

Let’s think about diabetes, which impacts an estimated 37.3 million US adults. A person with high blood sugar can usually take an oral medication, make some basic modifications to their diet, and live an otherwise normal life. But in other cases, diabetes families.

When a primary care doctor sees this change, they typically refer the patient to an endocrinologist — a doctor who specializes in diabetes care. The specialist will order a variety of lab tests, and they might start the patient on a low dose of insulin. If the primary care doctor and specialist act together to help the patient, things return to normal.

But if the patient can’t see a specialist or take these crucial steps, their high blood sugar can quickly spiral out of control. Uncontrolled diabetes can eventually lead to nerve problems, heart disease, and even blindness or amputation. These secondary problems pretty quickly decrease the patient’s quality of life and increase their medical costs.

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High blood pressure is another common medical condition, affecting about 47% of adults in the US For most people, it’s a problem that has no symptoms at all. Often, doctors only discover the issue during routine exams. It’s easy to treat, and most people do fine with one or two inexpensive medications that have minimal side effects.

Most people with high blood pressure have “primary hypertension” (ie, high blood pressure without an identifiable cause). But a small number of patients have “secondary hypertension.” In these patients, they might be dealing with an abnormality like a tumor or problems in the arteries of the kidneys. Doctors might suspect secondary hypertension when medications that usually work to treat high blood pressure aren’t helping; routine lab work can also detect these problems.

When doctors suspect secondary hypertension, they can order lab tests and imaging studies (eg, CT scans) to sort things out. These tests do carry costs, and patients are frequently responsible for covering at least a portion of those bills.

People who are worried about paying out of pocket for care before they’ve met their deductible might delay or avoid those tests. This means their blood pressure remains high while the root cause goes untreated. And having high blood pressure over a long period of time can lead to heart attacks, strokes, and kidney disease.

Finally, I’d like to touch on depression. Anxiety and depression are extremely common, and rates have increased by 25% since the start of the pandemic. Being depressed can have grave effects on people, causing their satisfaction with all areas of life — including work — to plummet.

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Nefariously, depression can make other health problems worse by robbing people of their motivation to take care of themselves. Managing high blood pressure, diabetes, or any other medical problem takes energy — and depression steals that energy from the people it affects. People diagnosed with major depression generally have twice as much healthcare spending as other commercially insured Americans.

Most depression is simple to treat. Therapy is quite effective for those who have access to it, and many cases can be treated with a single medication. But there are times that doctors need to add more medications or even involve a psychiatrist. Psychiatrists frequently order testing to help narrow down potential issues — and help the doctor understand how to best help the patient — but those tests can cost as much as $2,000.

A few patients may even require sophisticated treatment like transcranial magnetic stimulation, or TMS, to help resolve their symptoms. These treatments also carry significant costs, and any delays of those treatments mean the depression is not getting better — and might even worsen.

In each of these examples, costs can be a barrier to getting people the care they need. Copays to see primary care doctors tend to be low (sometimes even free), though specialist visits usually cost more. Lab tests, medications, and supplies bring extra expenses. In light of this, some patients choose to delay care. In fact, 34% of the members we cover through Paytient tell us that they’d skip or delay care if they didn’t have access to interest-free credit to give them more time to pay.

With all of these chronic problems, preventive care is cheaper and more effective than reactive care. At each stage, skipped care leads to higher costs and worse outcomes, which is painful for the employee while hurting the company’s bottom line.

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What can employers do to help solve the affordability problem? Wellness programs that incentivize early primary care are a good start — perhaps those who see their doctor in a timely fashion can get a rebate on their health plan contribution.

Virtual solutions are another good benefit to offer. Solutions such as Galileo (which provides virtual primary care) and Hinge Health (which offers in-home physical therapy) can be cheaper than traditional alternatives, and they allow for better access. Finally, products like Paytient (where I work) help people afford care by giving them access to interest-free credit they can use to cover healthcare expenses regardless of their health condition or health plan design.

Solutions that allow employees to manage issues of affordability and access will pay dividends — both in employee quality of life and in the financial health of the employer’s health plan. Just one question remains: How are you helping your team?


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