Employers: The gatekeepers to changing healthcare in 2019
Open enrollment in 2019 marked an uncertain time for healthcare consumers across the US. Due to recent federal decisions, premiums for individual health insurance plans are more in flux than ever. While this is undoubtedly an uncertain time for patients, these changes are also inducing anxiety for healthcare professionals. Less comprehensive insurance options and weaker protections for pre-existing conditions create the potential for patients to become more reactive in the way they address their health, making it harder for physicians to identify and address the root causes of everything from viruses, to chronic conditions, to mental health disorders.
As personal health insurance plans continue to shift, employer-provided healthcare will become a more valuable resource than ever, particularly as recent premium increases have hit employers hard. The cost of employer health coverage is expected to rise 5% in 2019, marking the sixth consecutive year with a 5% increase in self-funded plans. However, as more and more Americans turn to their employers for healthcare coverage, it’s becoming increasingly clear that American businesses are the true gatekeepers to creating positive change in the healthcare industry. In 2019, we’ll see a shift in the way employers interact with healthcare professionals and systems in an effort to lower healthcare costs and continue to provide quality care.
Onsite care is the new standard
Though onsite health clinics have been around for decades, they are just beginning to make headlines as major companies like Apple and Tesla are now implementing their own onsite clinics – and Silicon Valley is not alone. Approximately one-third of all organisations with 5,000 or more employees currently provides a general medical clinic at or near the worksite, marking a 24% increase since 2012.
Bringing healthcare professionals and services to employee populations through worksite health centers has the power to spark significant change in employee engagement with health services. Through regular interactions with patients, clinicians at worksite healthcare centres are provided with the resources and environment to take the time to coach employees through their unique healthcare journeys, without the added cost. By taking a long-term, proactive approach to healthcare through population health management, employers will actually save themselves money down the line by getting ahead of health issues.
Employers who have implemented onsite healthcare services for their employees are reaping the benefits. After enlisting the services of an onsite health centre operated by Marathon Health in 2013, a commercial vehicle manufacturer and distributor in Indiana, has achieved a 91% screening rate among its employee population, helping more than 70% of its high-risk employees make improvements on at least one of their risk factors. The consistency has helped to save the company more than $1.5mn in healthcare spending, showcasing onsite healthcare’s ability to combat the rising costs of self-funded plans, and the impact that a proactive approach to healthcare can have on the quality of care provided to employees.
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Spending related to high-cost claims is projected to continue to rise in 2019, meaning that switching from a reactive approach to healthcare to a more proactive model will be more important than ever. Costs related to musculoskeletal disorders skyrocketed by 131% from 1996 to 2014, and total spending on cancer treatment is expected to increase 27-36% in the next decade. And, with more than 44mn Americans who battle mental illness, a lack of access to resources for these specialized health issues could prove to be dire for employers and employees alike.
The increased engagement in healthcare associated with bringing services onsite allows employers to encourage employees to seek regular screenings for both chronic and mental health issues, which enables the physicians working with employee populations to identify warning signs early on. As such, onsite healthcare is uniquely positioned to help physicians, employees and employers to work together to focus on key preventative behaviors to decrease the prevalence of these health complications all together.
Chronic and mental health disorders are also understandably private matters for many patients, but by de-stigmatizing conditions through worksite education and access to care, employers can help to boost the engagement of patients in managing and preventing these issues.
As we enter the new year, it’s clear that employer organisations will become the most efficient channel for health care professionals to establish lasting relationships with their patients, and help them make progress against their health goals. As such, health systems and employers must make a mutual new year’s resolution to work together to make 2019 a year of positive change for the healthcare industry.
Dr. Michael Huang is the National Medical Director of Marathon Health. Dr. Huang has over 20 years of experience in primary care, completing his Internal Medicine Residency at Vanderbilt University in Nashville, TN in 1996. Following his residency, Dr. Huang joined the faculty of the University of Kentucky College of Medicine where he achieved the rank of Associate Professor of Internal Medicine and served as medical director of the Kentucky Clinic South Primary Care Practice. He joined Marathon Health in 2013 as the medical director of the Lexmark Health and Wellness Center prior to transferring to the Samuel Brown Health Center for LFUCG employees and families in 2017.
Long haul Covid, the brain and digital therapies
It is estimated that around 10% of people who get Covid-19 develop long haul Covid, a debilitating condition that can last many months and cause breathlessness, exhaustion and pain.
Research is underway to find out who is more likely to get it and how to treat it. Here neuroplasticity expert and owner of Harley Street Solutions in London Ashok Gupta tells us how the condition affects the brain.
What is long Covid exactly?
Long Covid is when patients who have experienced Covid-19 go on to have continuing symptoms for weeks and months afterwards. These symptoms can include breathlessness, exhaustion, brain fog, gastric issues, pain, and post-exertional malaise. It is estimated that around 10% of Covid-19 infections may result in developing long haul symptoms, and in the USA, this may be affecting over 3 million people.
How does it affect the brain?
Here at our clinic, we hypothesise that it is due to a malfunction in the unconscious brain, creating a conditioned response that keeps the body in a hyper-aroused state of defensiveness. At the core of this hypothesis is the idea that we are here because our nervous system and immune system have evolved to survive. We are survival machines!
When we encounter something such as Covid-19, the brain perceives it as life threatening, and rightly so. And in the era of the pandemic, with more stress, anxiety and social isolation, our immunity may be compromised, and therefore it may take longer for the immune system to fight off the virus and recover.
If the brain makes the decision that this is potentially life threatening and we get to the stage where we’re overcoming the virus, a legacy is left in the brain; it keeps over-responding to anything that reminds us of the virus. Even if we’ve fought off the virus, the brain will react in a precautionary way to stimuli reminiscent of the virus.
The brain may get stuck in that overprotective response, and keeps stimulating our nervous system and our immune system, just in case the virus may still be present.
What symptoms does this cause?
These signals cause a cascade of symptoms including breathlessness, extreme fatigue, brain fog, loss of taste or smell, headaches, and many others. And these are caused by our own immunes system.
In the case of long-haul Covid, symptoms in the body get detected by a hypersensitive brain which thinks we’re still in danger. The brain then chronically stimulates the immune and nervous systems, and then we have a continuation of a chronic set of symptoms.
This isn’t unique to long-haul Covid. Many patients develop chronic fatigue syndrome, sometimes known as “ME”, for example, after the flu, a stomach bug, or respiratory illness. Covid-19 may be a severe trigger of a form of chronic fatigue syndrome or ME.
How does long-haul Covid affect mental health?
Anxiety is a very common symptom in long haulers. It can be frightening to wonder about what may be happening in your body, and what the prognosis is going to be for one’s long term health. Reaching out for support for mental health is crucial for long-haulers.
How does neuroplasticity treatment work for long-haul COVID patients?
We have been working with patients for two decades with a brain retraining programme using neuroplasticity or “limbic retraining.”
We believe that through neural rewiring, the brain can be “persuaded” that we are no longer in danger and to come back to homeostasis. But to be very clear, we are not saying it is psychological in any way, but we believe there are novel ways of accessing the unconscious brain.
We recently worked successfully with a 56-year-old male with long-haul Covid, who prior to contracting Covid-19 in March of 2020 was running half-marathons and cycling, but afterwards he struggled to get off the sofa for months. Within 3 months he’s now back to 100% and running half marathons again.
At our clinic, we train the patient to be able to recognise those subtle unconscious danger signals on the periphery of consciousness. This, coupled with supportive techniques and the natural hallmarks of good health such as sleep and diet help prepare the patient to respond to perceived threats that might trigger the response.
The natural state of our brain is to default to protection. The brain prioritises survival and passing on our genes to the next generation, over any other impulse. It cares more about that than you feeling healthy and well. Protective responses are evolutionary, and are the right thing for the brain to do – it’s survival.
What digital therapies or apps are proving effective at treating long-haul Covid?
It seems that long haul patients are availing themselves of many online therapies and services, including meditation apps and wellness websites. We have an online neuroplasticity “brain retraining” video course called the “Gupta Program” which hosts 15 interactive videos and many audio exercises. This is proving very popular with long haul patients, and we are currently conducting a trial to test the effectiveness of this therapy.
What is the danger of leaving long-haul Covid untreated?
The longer it goes untreated, we hypothesise that it may become more entrenched in the brain, and become chronic in the longer term. Therefore we advise all patients to get help and advice as soon as possible.