Deferred Health Care: Why Americans Are Due for a Checkup

BY Emily McCrary-Ruiz-Esparza | July 12, 2021

It’s very likely that in the last year, you postponed a medical appointment. It’s also very likely that it had something to do with Covid-19.

Putting off medical checkups is not a new phenomenon, of course, but the scale of deferred care doctors have seen in the last year is unique. The CDC estimates that as many as 41% of adults delayed or avoided medical care because of concerns related to Covid.

The reasons were abundant: fears about visiting health care facilities and bringing home the virus, burnout from too much work, the struggle to balance work and childcare, or the loss of employer-based health insurance. With all of these factors stressing people out, it’s understandable that routine checkups got pushed back. Even some doctors deferred their own self-care.

The result, however, can be bad for your health, as well as your finances. That’s why health care leaders are urging Americans to get back into the habit of regularly seeing their doctors.

Leah Rothman, D.O., is a family physician and the Northern California regional medical director for One Medical, a national advanced primary care provider. From Day One spoke with her about the risks of deferred care and how we can all safely return to making timely visits to our clinicians. Excerpts:

What is deferred care?

Deferred care is a reaction to Covid. We know that a lot of people during sheltering-in-place orders deferred care for things that were active issues, new things that may have popped up, chronic issues, things that they had a diagnosis for–or even things that were preventative. Because the threat of Covid was looming so large, there was so much fear and anxiety and uncertainty as to whether or not the health-care setting was a safe place to interact with.

Is this a phenomenon unique to Covid?

I think Covid has really accentuated the concept of, “I have a health care question. Am I going to be motivated to act on that question by seeking the guidance of a clinician?” In the past, I'd say delaying care was intermittent, but not nearly as large. Deferred care in the past was predominantly influenced by access. So if you had a clinical question but the next available appointment wasn't until a month out, you'd say, “Ah, what's the point? It'll probably be better by then.” So barriers to access in primary care and medicine, I think, was previously the largest influencer of whether or not somebody would engage.

Who has been deferring their health care and why?

I would be hard pressed to come up with a group that hasn't been deferring care. Adolescents defer care because a lot of times adolescents are drawn in when they're required to see a doctor for sports physicals. I've seen young adults defer care because they're working from home and they want to stay safely in their bubble. I've seen parents defer care for those same reasons, with the addition of “How do I manage everything that's going on at home?” I've seen a lot of elders defer care because they feel like they are in the highest-risk group of contracting or having a very negative impact from Covid. I couldn't tell you that there's a single group that's reliably come in during the pandemic and said, “This is great, your waiting rooms are empty, and I'm happy to be here.”

Leah Rothman, D.O., is a family physician with the primary care provider One Medical (Photo courtesy of One Medical)

Have physicians, yourself included, deferred care?

Yes. I will say that not sheepishly or apologetically. I think it's really important for us to acknowledge that amid the fears and uncertainty, the health-care team was not outside of that. We too had all of the same information the general public had, and there were big gaps of time where we didn't know what the risk of coming to work was, or what the risks that we ourselves might bring to others.

For my own personal example, I forwent any dental-cleaning appointments in the year of 2020. It was related to that concern or the potential guilt that I would have if I exposed somebody, because here I am interacting with others with Covid testing or treating for Covid.

What are the dangers of deferring even the most routine health-care appointments?

There are a couple of things I think of as the downstream effects. The first one is that the intention of screening is to identify things early, before they get more difficult, before they get messy, before they get too big to recover from. You want to find something early so that you can make changes early and prevent it from being more costly.

The other thing that can happen is just not diagnosing something. So something that may have been found and prevented from becoming a cancer is now a cancer. And just that diagnosis alone, even if it's treatable, is something that really looms large on people's psyche.

What could be the long-term effects of delayed care for communities and populations?

What plays out in the community is highlighted by deferred care for chronic conditions. Let's say an individual has elevated blood pressure and they're seeing that their blood pressure at home is not what their provider told them is the goal, but they're not inclined to go into the health care setting. This becomes a ticking time bomb. Rather than address it early on to bring an uncontrolled blood pressure under control, it might progress to the level of being an acute issue where this person has chest pain and needs ER care.

The message we've been trying to get out throughout Covid is ensuring that people know the safety of the care that they can get in a primary care setting, so they're not postponing their own needs to the point that they have to go to the hospital, which we'd like to decongest so they can care for the most ill. But it’s also so they themselves don't have to go through the very high stakes and real risks.

What’s the first appointment someone should schedule if they’ve been deferring care for the last year? 

There's no wrong visit. Even if you haven't been seen in a year, even if you think your health is optimal, there is a visit for you, and that is an annual wellness exam. It's a great way to just get a tune-up on knowledge and screening and then set you up for success for another year.

An annual wellness exam is intended to allow a conversation between the clinician and the individual to take stock of their current lifestyle and habits that will inform their health today and in the future. What are the screening tests that you are eligible for? What are the vaccines that you might be due for? What are the over-the-counter medications you're taking? And is it safe with the frequency with which you're using them?

The other thing that we've seen a lot of is deferred care around mental health, whether it was your concerns around Covid itself, the isolation that you may have felt and depression from a grief response–if you lost a loved one, a neighbor, a family member–or just the anxiety of saying, “Oh my gosh, I've lost any sense of organization to my time, I work at home, I live at home, I do child care at home, I'm a home teacher. I didn't sign up for any of this.” Pretty overwhelming.

Primary care is a great place to go when you need to take stock of how those thoughts and emotions or feelings are influencing your health or influencing your relationships and maybe even your productivity or your sleep. The beauty of primary care is that there's always something to come in for. And it's always the right place for any clinical question. If you've thought, “I'm going to Google this,” then the primary care provider is the right place to go with that question.

To what extent can virtual-care visits take the place of in-office visits?

I am delighted to say almost seamlessly for a large number of conditions. It’s about having a dialogue and the clinician asking probing questions around it and then coming up with what the plan is. In a number of instances, the exam is not the highest-value item for that discussion. So for people who aren't able to come into the office, remote visits with One Medical are a really wonderful way to stay connected. Rather than be uncertain about which one to book, I welcome everybody to book for a remote visit and know that I as a clinician will guide you if an office visit is truly warranted.

When is it safe for someone to resume their in-office health-care visits?

Today! It has been safe for a very long time to come into a doctor's office. I know each office comes up with its own tools to de-risk the office. There is not a time where I could tell you that a health-care setting is a zero-risk experience, but all of the tools that we use significantly lower the risk. Offices are a very safe place to come, not only because of the tools that we have in place, but the knowledge that we have gained over a year’s worth of information about Covid.

How will your relationship with patients and your relationship with your profession change post-Covid?

While empathy, relationship building, and interest have always been important, the opportunity for us to invite the questions and really bring our own humility into the room as clinicians and say, “Yep, that happened to me too.”

What else do you want people to know about resuming regular health checks?

I really want to encourage people to know that our offices should always be a place where there's no judgment. We can offer validation and humility as clinicians that we ourselves have had the same struggles, that we are not above them. We can use that as a bonding moment to say, “Yep, we've been there.” The important thing is not to have a lot of self-judgment around it, but rather know that we can partner together to build a plan to get back to what your idea of optimal health is.

I really want to encourage people to return to that clinical consultation, knowing that you have a champion who's looking out for your health. There really isn't any substitute for the primary care clinician who knows your health and who can make an informed recommendation. They know what's in the background and not just what's on the surface. Having a person in your corner, having a conductor of the orchestra, a coach in the room, is a great way to know that you're making really informed decisions that are based on the best evidence we have today.

Editor's note: From Day One thanks our partner who sponsored this story, One Medical.

Emily McCrary-Ruiz-Esparza is a writer, editor, and content strategist based in Richmond, Va.


Empowering People With Eating Disorders to Recover at Home

Eating disorders affect nearly one in 10 Americans, and 10,200 deaths each year are the direct result of one of these illnesses. However, the United States has a shortage of experts providing treatment, says Dr. Erin Parks, co-founder and chief clinical officer of Equip, a 100% virtual eating disorder treatment program. “I think it’s generous to say that there’s even 5,000 outpatient specialists,” Parks told Lauren Burkavage, senior director of the strategic partnerships team at Accolade, during a From Day One webinar. Another key issue in eating disorder treatment is it requires a multidisciplinary approach to be effective, says Parks. “It’s hard to put together a team because it often takes both medical and mental health professionals to help someone recover,” she said. Equip not only provides a five-person team for each patient, but also lets them recover in their own home. “We think it’s important to be at work, to be at school, to be at soccer practice, to be in their book club, because those are the reasons we recover,” Parks said. “We wanted to make sure treatment was being delivered at home around your schedule instead of having to give up on life to get better.”From an employer’s perspective, Equip results in reduced absenteeism because an employee who is either dealing with an eating disorder themselves or has a child dealing with one doesn’t have to “take them to appointments or travel to a residential treatment center, which many times aren’t closely located to where people live,” Burkavage said.Other Equip AdvantagesThere are four different kinds of treatment for eating disorders: a residential treatment center (RTC), where patients live full-time for a month or more; partial hospitalization (PHP), where the individual stays in a hospital for six to nine hours a day for five to seven days a week; intensive outpatient treatment (IOP), which lasts three hours a day for three to five days a week; and outpatient treatment, which is what Equip provides in a virtual setting.“Right now, about 85% of our patients meet criteria to go to IOP, PHP or residential, but choose to use Equip instead,” she said. One reason is a patient’s insurance might cover care at a residential treatment center, but when they go home, they can’t find a PHP, IOP, or even an outpatient provider.“That really contributes to the fact that 50% of patients usually relapse within a year of treatment, and it’s because treatment doesn’t last that long, just a couple of months,” Parks said. But in the Equip system, “a lot of our patients stay with us for a full year, really getting them to a solid place and giving them more than just a foundation,” she said. “They can see their life without an eating disorder by the time they leave.”Provider Diversity and Peer MentorsThe webinar featured Erin Parks, co-founder and chief clinical officer of Equip (company photo) One thing that prevents people from seeking treatment for eating disorders is the stereotype that they only affect thin, white teenage girls or young women, says Parks. “But the truth is eating disorders don’t discriminate,” she said. “At Equip, we’ve had patients as young as 5, and we’ve had adults in their 70s. Up to 40% of people who suffer are male. It affects all races and ethnicities equally, and it affects people at all areas of the socio-economic spectrum. And probably the most surprising thing is people with eating disorders come in all shapes and sizes.”Seniors, males, and people of color tend to want a provider that has a similar lived experience as they do, says Parks. In addition, someone who is transgender or gender non-conforming is four to five times more likely to develop an eating disorder than someone who is cisgender, Parks says. “It’s less safe for them to get treatment when they don’t have providers who understand the intersection between their gender identity and their eating disorder,” she said. This is why Equip is dedicated to increasing the diversity of its providers. The organization also has peer mentors, who are employees who have recovered from an eating disorder themselves. “Our patients really love working with their peer mentors because they have a shared identity.” Peer mentors “help to increase motivation, build a life worth living, and figure out why you want to recover from your eating disorder.” Editor's note: From Day One thanks our partner, Accolade, for sponsoring this thought leadership spotlight. Mary Pieper is a freelancer reporter based in Mason City, Iowa.

Mary Pieper | February 28, 2024

Lifestyle Spending Accounts: Offering Employees a Flexible Benefits Choice

It’s not always about dollars and cents, but about what you can do with them. That’s the takeaway that flexible benefits company Forma has found working with 280 companies across the globe.Megan Burns, benefits strategy team lead at Forma, spoke to these findings at a From Day One Webinar titled “How Lifestyle Spending Accounts (LSAs) Revitalize Benefits for the Most Employee.” As a newer benefit in the industry, Lifestyle Spending Accounts (LSAs) are growing. Fast. The biggest reasons?“The power in these programs is employee flexibility and choice,” Burns said. “Since employees can choose how to spend their money, there’s always something valuable for every employee to use those dollars on, and then no one is left out.”A Changing MarketplaceIt’s no surprise that the cost of employee benefits increases year after year. So benefits leaders need to ensure their dollars are working efficiently without compromising the quality of benefits. Employees are already feeling the pinch financially, Burns says, as the cost of living keeps going up.“This type of stress is impacting both workplace productivity, and also makes employees more likely to explore alternative positions outside of your organization, directly impacting your overall retention,” she said.Traditionally, lifestyle benefits solutions relied on a confusing point system, leading to low engagement and low appreciation. Meanwhile, it takes more work for the admin to run these programs. Enter LSAs: this new way of looking at benefits can be a win-win for companies in more ways than one.An LSA, which can be called by many names, is a customizable spending account that the employer designs and sets up, then the employee decides how to spend those funds within the parameters. LSAs look different from company to company, depending on their goals.Megan Burns, benefits strategy team lead at Forma, led the webinar (company photo)Empowering EmployeesSupporting employee wellness is one common way of structuring an LSA, Burns told the audience. You as the employer set the pillars and budget with specific parameters. For example, a company could allot $50 per month for each employee as part of their LSA.“Once that’s set in place, the employee then gets to decide how to spend that $50. Within those program parameters, those pillars, they may choose to spend that $50 on a local gym membership, or purchasing a bicycle or running shoes because they like to be outdoors.”But it doesn’t have to stop there. Employers could set up parameters for financial wellness, caregiving support, or other benefits that could help support employee wellness. Forma can help companies set it up and offer employees a debit card to a discounted store with 250 vendors, making each dollar go further.Dollars are only debited from the company if they are used by the employee, and Burns said a majority of employees don’t always use 100 percent of what’s allotted to them. Not only that, but there is cost savings thanks to lower call volume and admin time required. For one company, Forma was able to save them $500,000 in the first six months, partially because they could use the Forma platform and offload their expensive benefits software.“We worked cross functionally across a number of different teams to realize what that amount would look like. For this particular client, they did choose to reimburse for gym, home office expenses like internet, cell phone, and other wellness items.”Gaining PopularityEmployers and employees have both benefited from this program, which is why Burns said LSAs continue to grow. In fact, 70% of employers are currently considering adding a lifestyle spending account. A projected 13% of companies will have them in place by 2024 and 43% by the end of 2025.“Employers are more diverse and dispersed than ever before. There’s five different generations in the workforce, and the most efficient way to meet their unique needs is to provide them with choice and give them benefit dollars that they can then use towards what matters most to them.” That’s why LSAs also translate well across global populations, since they are customizable and can adapt needs country by country.According to a Radford analysis, employees ranked their 401k match as the most appreciated and valued benefit program, with LSA as a close second. It’s interesting to note, too, that employees actually ranked less dollars given to them and an LSA as high as having higher value than more dollars put into a program that's specifically designed with strict parameters and less choice, Burns explained.In Forma’s recent benchmark report of 200 companies with 450,000 members as of December 2023, the broad all-inclusive LSA is the most popular. One likely reason is that it helps companies reach their DEI goals.“They want to lean into that flexibility of choice where everyone gets the same dollar value, the same dollar amount, and then they get to choose on how to spend that money,” Burns said.One account some companies have set up is medical travel. Especially for those who are in underserved areas and require medical services in another area, employees can get reimbursed for travel costs associated with medical procedures. Education repayment and other development reimbursement is also high on the list of LSAs for companies, as are home office reimbursements, rewards and recognition, caregiving, and even meal delivery service. The opportunities are endless.Editor’s note: From Day One thanks our partner, Forma, for sponsoring this webinar.Carrie Snider is a Phoenix-based journalist and marketing copywriter.

Carrie Snider | February 27, 2024

Helping Employees Organize Their Lives Now for When They're Not Around Later

On the proverbial starting line of her new life, excitedly using wedding planning websites and apps, Abby Schneiderman started wondering about the finish line. Where were all the websites and apps and guides for end of life?That was the small beginning of what would eventually become Everplans, a platform that helps people get prepared for the unexpected. Schneiderman detailed the company’s story and pillars at From Day One’s conference in Atlanta. A tech entrepreneur, her curiosity wasn’t that out of the ordinary. She researched and found plenty of resources for having children, buying a home, financial planning, and retirement planning. But that’s where it ended. “There were no other life stages covered online,” she said. Schneiderman brought her findings to tech veteran Adam Seifer. “I said, who's helping people deal with death?” It’s interesting to note that not all big life stages happen for everyone. Not everyone gets married or has kids, but each person will face death.“Everybody has to deal with this one day,” she said, whether it’s for themselves or for their aging parents, but this is something we can’t avoid.”To fill the online gaps, Schneiderman and Seifer started writing content. Over 500 articles worth of content at first, which has grown into the thousands. It covers every conceivable end-of-life topic, such as how to write a will, what to wear to a funeral, and how to name a health care proxy. Everplans was born. They immediately saw the value of their work.“We started coming up very highly in Google searches for every article we were writing.”A New PerspectiveThen came hard, personal experience. Schneiderman’s 51-year-old brother was killed by a drunk driver. In an instant, everything changed for her and her family. Thankfully he had life insurance, but that was where the documents and pre-planning stopped. No will, no organization of his accounts, no funeral wishes. That’s when Everplans made a major pivot. Rather than only provide articles and resources, Schneiderman and Seifer wanted to do more. “We wanted to help people get a plan in place ahead of time, so that when the time does come or when an emergency strikes, families have access to what they need.”Today, Everplans is a technology platform that helps people to organize, store, share, and everything from wills to policies to health directives to online accounts up to date. To date, over 30 million have engaged their resources since we launched, and over 160,000 people have created “vaults” on the platform, with over 3 million pieces of information stored and shared.Abby Schneiderman, co-founder and co-CEO of Everplans, led the thought leadership spotlight in Atlanta (photo by Dustin Chambers for From Day One)The co-founders also wrote a book, In Case You Get Hit By a Bus: How to Organize Your Life Now for When You're Not Around Later, in the hopes of helping people be better prepared for what’s to come. That’s why Everplans has entered the benefits space—to help companies help employees get the peace of mind that comes with getting things in order. “There’s a major tie between personal productivity and workplace productivity,” Schneiderman said.  Speaking of full-time employees in the U.S., here are some statistics she reported: 65% feel anxious when critical information and documents are all over the place, 84% are less productive when they feel disorganized, and 86% are less stressed when they feel more organized. And Everplans aims to help remedy that. After creating an Everplans vault, you can upload documents and pertinent information, as well as designate “deputies” or loved ones who should have access to your vault now and after you die. Below are the four pillars Everplans recommends each person looks at when adding to their vaults. The platform also nudges you at regular intervals to make sure everything is up to date.Documents: Things like legal documents, wills, assets, power of attorney, advanced directives, and more. Since end-of-life documents like power of attorney can be hard for many people, Everplans give pointers on how to broach this topic with different people in your life. Insurance: Policies like life, health, auto, home, property, pet, disability, and more. Schneiderman explained that every year, billions of dollars go unclaimed because of policies family members don’t know about. Assets: This includes financial accounts and digital assets. Making sure that bank accounts, safe deposit box information, credit card accounts, 401k and other retirement accounts, and every other account are in the vault is vital for loved ones to be able to access them after you pass. At the very least, put in what the account is even if you don’t put usernames or passwords.  As far as digital assets go, did you know the average person has 240 passwords? Social media, cryptocurrency, cell phone, unlock computer code, email accounts, and just about everything else. Schneiderman said they did a study, and 65% of people keep track of passwords in their heads. She recommends using two password managers, one for work and one for personal. Leaving a Legacy: Think about the different types of things that matter to you that you want to pass down, Schneiderman said. Recipes, videos, photos, stories, and anything else you can think of that leave a legacy.  The great thing about putting your affairs in order is this: you can have peace of mind knowing that if anything does happen to you, your loved ones don’t have to scramble. They can access all of the needed information without searching for it or worrying they’ve missed something. That would make any employee sleep better at night.Editor's note: From Day One thanks our partner, Everplans, for sponsoring this thought leadership spotlight. Carrie Snider is a Phoenix-based journalist and marketing copywriter.

Carrie Snider | February 21, 2024