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.


Excellence in Hiring: Designing the Optimal Frontline Employee Selection Process

If a job application takes more than 15 minutes to complete, more than 70% of job seekers say they’ll bounce, according to a 2022 survey reported in HR Dive. This barrier is particularly germane to companies that employ frontline workers, often working against a narrow time-to-hire. Those recruiters have to scale operations quickly, efficiently, and often with little notice. Time matters, and even a small amount of friction can be enough to convince a job seeker to look elsewhere.“Going from three business days down to a one-second communication timeframe was huge for us,” said Carlie Lockey, the founder and CEO of Remarkable People Solutions, a recruitment firm based in coastal North Carolina. Lockey’s business had reached a tipping point: she needed to scale operations quickly, but couldn’t forfeit speed or efficiency. She shared what she learned from the process during a recent From Day One webinar on the optimal employee-selection process for frontline workers.What was she looking for? First, a high degree of automation–Lockey’s staff needs to stay nimble. Second, a high degree of customization–all her clients deploy different recruiting processes. “We needed something that would take a lot of the mindless work off of our hands, provide the best applicant experience, as well as serve each of our clients individually,” she said.Communication, and the speed of communication, was also high on the list for Remarkable People Solutions. The company needed to get its clients communicating with applicants immediately and provide consistent updates on their position in the process.She chose Fountain, a platform for frontline workforce management. It used to take the firm five business days just to notify applicants that they weren’t being sent to the next round. After adopting the platform, Remarkable People Solutions was able to invite top candidates to schedule a phone interview within an hour of applying. As Lockey put it, “the maximum amount of time is saved.”Carlie Lockey of Remarkable People Solutions and Nico Roberts of Fountain were interviewed by Emily McCrary-Ruiz-Esparza during From Day One's webinar (photo by From Day One)Fountain was engineered to be flexible, said the company’s chief business officer Nico Roberts. “We made a decision really early on to allow a ton of customization, so [clients] can hone in on the exact flow that they’re looking for, the experience that they want to tailor, and the target applicant they’re trying to find.”There’s also the matter of bottlenecks that inevitably arise in recruitment cycles, those impediments that prompt so many applicants to abandon the process.Roberts likes to look for opportunities to grease the wheels, breaking it down “day to day, season to season, position to position, state by state, and city by city.” At other times, it’s worth slowing things down. “There might be some markets where you’re getting so many applicants that you want to figure out where the quality is and have those applicants rise to the top,” he said.One way to speed things up is to incorporate text messaging into the application and recruitment process. Roberts said 85–87% of applications that Fountain handles come in via text message or mobile device. The rest are email. “Our number one request is to add more WhatsApp capabilities, so that’s coming soon, and we’re currently building Facebook Messenger capabilities,” he said.It’s not only popular among young workers. Before Covid arrived, Roberts said, text message application users were usually aged 18–40, but that’s changed. There’s no single demographic over-indexing for their text messaging tools. He credits the popularity of delivery apps during lockdowns. “A lot of [people] had to download apps to get groceries and became very proficient on mobile devices.”The trend indicates a frontline worker on the go. “They don’t want to sit in front of a laptop or wait until they get home for a desktop. They want instant communication,” Roberts said. “These folks are applying on lunch breaks or after work. They’re tired, most likely they’re frustrated.  There’s a reason they need another job or a second job or a fourth job. The more barriers you can remove, the bigger success you’ll have with hiring these folks.”Another barrier often overlooked? Talent acquisition isn’t always available when applicants have questions. Fountain has been developing AI bots that keep the recruiting engine running even when recruiters have clocked out for the day. “More than 60% of all applicant questions happen in non-business hours, and [applicants] typically have to wait for recruiters to log back in to help answer,” said Roberts. “But if you have an FAQ bot trained, they can start answering in real time, whether it’s 10 o’clock at night or one o’clock in the morning.”But for every click tech feature one could add to their recruiting cycle, it’s worth asking whether  it should be added. If it isn’t a reflection of your employer brand, skip it or tailor it to suit your employer identity.“The folks that are crushing it have an authentic side,” said Roberts. Where there’s opportunity to connect more personally with applicants–like by sliding in videos of current employees giving advice to prospective workers–employers should do it where it feels natural and true to their brand.“The authenticity piece I think is most crucial, whether you’re scaling up or not,” Lockey said. “If you’re just trying to hire warm bodies–that’s not authentic. You want to hire people for a purpose, to be on a team and make an impact both on your team members’ lives and your clients.”Editor’s note: From Day One thanks our partner, Fountain, for sponsoring this webinar.Emily McCrary-Ruiz-Esparza is a freelance journalist and From Day One contributing editor who writes about work, the job market, and women’s experiences in the workplace. Her work has appeared in the Economist, the BBC, The Washington Post, Quartz, Fast Company, and Digiday’s Worklife.

Emily McCrary-Ruiz-Esparza | June 05, 2024

How Investing in Employee Experience Brings a Positive Return

With all the employee-experience software options to choose from, the idea of choosing one to incorporate into your HR structure can be daunting. And in times of tightening budgets, it can be challenging to make the case for the spending. But according to a recent study by employee experience platform WorkTango, organizations that invest in employee-experience software see a 2-to-3 times return on the money they put into it.The study surveyed 1,077 North American HR leaders, 90% of whom said that knowing which employees are engaged is especially important in an uncertain economic climate. An interested and enthused workforce is a loyal, steady workforce and employee experience (EX) software can help HR managers keep a finger on the pulse of workers’ attitudes, needs, and desires.As WorkTango states in its recent report, “EX investments represent a low risk and high potential reward when it comes to creating an employee experience that connects your workforce across hybrid environments, supports the daily efforts of individual employees, and enables every team member to perform at their highest level.” Ninety-three percent of those surveyed achieved a positive or neutral ROI from investing in EX software.Finding the Right SoftwareAmong the several types of EX software on the market, each has its own unique offering to complement your organization’s long- and short-term strategies and goals. Among those surveyed, 70% prioritized software that helped with performance management, 67% wanted employee recognition and rewards, and 56% needed support with employee listening and surveys.Some employees respond better to certain interactions with organizational leadership than others. WorkTango recommends surveying team members to see what matters most to them, from public recognition to company swag, and then choosing software accordingly. Ideally, you should identify a solution provider that offers several capabilities within a single platform for maximum ROI.Click above to view and download WorkTango's reportAs you make your software selection, WorkTango suggests focusing on the three deciding factors listed as most important among those surveyed: reporting and analytics capabilities, ease of use, and cost. That said, researchers noticed that among the few companies that reported neutral or negative benefits reaped from employee experience software, all named cost as their top deciding factor. It’s important to invest in a quality product, and not just check a box while watching the budget.The ROI on Employee Experience InvestmentsWhat do employers hope to achieve with their investment in employee experience technology? It’s not just about saving money or making the HR department more efficient, although those are certainly added benefits. The focus for many organizations is the return on individual people. The top areas of expected ROI among those surveyed were an increase in employee productivity or performance, an increase in employee retention, and an increase in customer satisfaction.According to WorkTango’s report, it takes time, as well as employee adoption and utilization, to produce positive outcomes. You may not see results overnight, as the employee-experience technology implementation requires a gradual culture shift. Seventy percent of the HR leaders surveyed said that their executive team expects to hear about the impact of these investments within the first six months.It’s important for HR to align on executive expectations for key updates and have a conversation about the timeframe for implementation and what is realistic and measurable. HR leaders should be prepared to report on three key areas: people ROI (employee engagement and regrettable turnover), company ROI (customer satisfaction and performance/productivity), and HR’s ROI (cost savings and team efficiency).The real ROI results are clear: EX software is the smart, meaningful, and financially savvy choice. Out of the 1,077 organizations surveyed who invested in this technology:65% achieved higher employee productivity and performance 58% improved employee retention54% increased customer satisfaction33% saved on costs compared to their previous efforts32% saw a higher employee Net Promoter Score (eNPS), meaning employees are more likely to recommend the company31% reduced the total HR time spent administering employee-experience programs31% saw reduced absenteeism17% saw an increase in Glassdoor ratings16% saw an increase in company stock performanceBest Practices for Achieving ROIA few trends popped up among those surveyed who had success with their employee-experience software. These organizations prioritized data-based measurement of the program’s impact over anecdotal evidence, setting specific goals and then measuring against those goals over time to demonstrate value.They also aligned early with executive leadership on what success for EX investments should look like, whether that’s an increase in productivity, retention, customer satisfaction, referrals, positive brand awareness, or a combination of all those factors. And finally, these organizations encouraged and incentivized employee experience platform adoption.The more the platform is successfully used, the higher the ROI.Frequent employee recognition and engagement was positively correlated to company performance, with those surveyed seeing an increase in quarterly revenue. WorkTango’s ROI report states that “supporting employees by investing in the employee experience leads to what we call the compound interest of a great team member: they stick around longer (retention), they produce at a higher level (performance), and as a bonus, they tell others about what a great company they work for.” By investing in the happiness of their employees, leaders are investing in the success, growth, and longevity of the organization.Editor’s note: From Day One thanks our partner, WorkTango, for sponsoring this sponsor spotlight. Download WorkTango’s ROI report here.Katie Chambers is a freelance writer and award-winning communications executive with a lifelong commitment to supporting artists and advocating for inclusion. Her work has been seen in HuffPost and several printed essay collections, among others, and she has appeared on CBS New York, Cheddar News, and iWomanTV.

Katie Chambers | June 04, 2024

Bridging Business Goals with Human-Centric Hiring to Impact the Bottom Line

As a young finance and real estate professional who witnessed mergers and acquisitions fail from the inside, Stephanie Manzelli realized that a critical component of a deal’s success was in the aftermath: how well the people were integrated culturally into the newly merged workplace.With this revelation, she changed direction and embarked on a career in HR with an emphasis on talent management and acquisition. Now as the senior vice president of human resources and diversity, equity and inclusion at Lever, a talent acquisition suite and an Employ brand, Manzelli has developed key strategies for successful hires.I spoke to Manzelli during From Day One’s webinar, Intentional Recruiting: Bridging Business Goals with Human Centric Hiring to Impact the Bottom Line. During this fireside chat, she shared insights and advice, particularly on how to map out a company’s goals and influence leadership.Manzelli made it clear that knowing a company’s business goals is only one part of understanding its needs. She breaks down each business goal into a four-part roadmap that then allows her to analyze what skills and experience the company needs to meet its objectives. Manzelli calls this horizon mapping.Horizon mapping begins with the ultimate goal and then reverse engineers the interim horizons to meet that goal. She gave the example of a company that wants to go public in a few years. She sets that as horizon four. The three horizons before that are big goals, or “rocks,” the company needs to achieve to successfully attain horizon four. So horizon two might be a successful series A funding round. “Underneath each of these horizons, every business unit has deliverables that they must achieve,” she said.Once the horizon has been mapped, she does a talent gap analysis and develops what she calls a “make versus buy strategy.” ‘Make’ refers to developing skills within the current talent pool of employees at the company, whereas ‘buy’ is talent acquisition. Using horizon mapping, “we find the roadmap that we need to start to build out those talent pools and source the right candidates more proactively, so that we can fill those business needs before our business actually needs them. And that should be the North Star,” Manzelli said.Stephanie Manzelli of Lever was interviewed by journalist Jeanhee Kim during the From Day One webinar (photo by From Day One)Sometimes it’s not easy to know what the business goals are, Manzelli acknowledged, that it takes one-on-one discussions with key business leaders and skill to build the right relationships within the company and communicate effectively. One of the most effective skills she employs is influencing without authority, which requires “flexing your communication style to meet the needs of your audience.”Knowing the styles of your leaders is essential. For data-driven individuals, Manzelli comes to the conversation armed with reports, metrics and return-on-investment figures. Other leaders depend on their gut and intuition. Those conversations are easier, she says, and are based on relationships and trust. But to maintain that trust, she prepares the reports as backup.“I always enter an organization or a conversation as slowly as I can. I really like to build the relationship before we dive into the tasks,” Manzelli said. “It's not a thing that takes me a long time to do, but it does pay off on the backend, and ensures the people that I’m partnering with have the bedrock of a relationship with me.” That relationship building then allows the leadership to have more open dialogue about their goals.These skills, horizon mapping and influencing without authority, are key for any successful HR professional. “HR, right, wrong or indifferent, is oftentimes looked at as a highly administrative function where we’re often only engaged when people need help.”But she said knowing what your company’s goals are and how HR and talent acquisition can get the company to meet its goals is always in the back of her mind. “You always have to make that connection point for the business. That’s our responsibility.”Editor's note: From Day One thanks our partner, Lever, an Employ brand, for sponsoring this webinar. Jeanhee Kim is an independent journalist who has worked for CoinDesk, Crain’s New York Business, Money magazine and Forbes Asia. 

Jeanhee Kim | May 30, 2024