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.

RELATED STORIES

Revolutionizing Mental Health in the Workplace: The Power of Psychedelic-Assisted Therapies

With heightened isolation during the pandemic, mental health conditions like anxiety and depression saw an increase, leading to a surge in mental health care spending and usage. Today, ninety percent of the public state they believe there is a mental health crisis in the U.S., showing the continual relevance and demand for mental health care.Talk therapy or medications like antidepressants are commonly used in treating mental health conditions but studies have shown these treatments may not work for everybody. For example, in one study, researchers found antidepressants only worked for 15% of the participants.Sherry Rais, CEO and co-founder of Enthea is working to change the healthcare industry and revolutionize effective treatment. Enthea is currently the sole healthcare partner offering psychedelic healthcare as a workplace benefit and recently won the 2023 Global Recognition Award for being a transformative pioneer in the medical field.For Rais, Enthea is only the beginning of a well-needed change to the mental health care space. In a thought leadership spotlight at From Day One’s April virtual conference, Rais spoke about the promising results Enthea has seen and how psychedelic healthcare can be a win for both employers and employees.Gaps in Traditional Mental Health Care TreatmentsIneffective treatments, dangerous withdrawal symptoms, and relapses are all reasons for the need for change in traditional mental health care treatments, Rais says.“20-60% of people with a significant mental health condition are actually treatment resistant, so anything that we have to offer them from traditional methods, to talk therapy and antidepressants, won’t work on them,” Rais said.The National Alliance on Mental Illness estimates untreated mental illness can cost up to $300 billion annually, an expensive cost for employers, and can result in lost productivity, absenteeism, and turnovers.Sherry Rais of Enthea led the virtual thought leadership spotlight“Employers have improved their mental health offerings in the U.S., yet employees still say that they’re not getting the mental health care they need. There is this disconnect,” Rais said. “It’s like a broken system, we’re spending more but people are not getting better. This is where ketamine and psychedelic therapy can play a huge role for these treatment-resistant populations as they work differently.”Psychedelic therapy has been shown to bring promising results. A single dose of a psychedelic drug can have a long-lasting impact on mental health disorders like depression and PTSD. Additionally, people who undergo psychedelic therapy can see results in as little as one session.“We have a lot of people in the construction industry who deal with high rates of suicide, and a psychedelic drug like ketamine is one of the only substances that reduces suicidal ideation quickly,” Rais said. “A drug like ketamine is magical because it starts working in as little as six hours.”The Challenges to Destigmatize Psychedelic TherapyMaking psychedelic therapy more accessible requires a change in its reputation.Since the 1960s, ketamine has been a drug in clinical practices, proving valuable in the anesthesiology and critical care medicine fields. However, with the increase in recreational use in the 1980s, ketamine quickly became known as a party drug, dubbed “Vitamin K” or “Special K.”But it’s not just ketamine with the bad reputation: MDMA, commonly known as ecstasy, and psilocybin, commonly known as magic mushrooms, are both drugs used recreationally and have been outspokenly used by celebrities.These recreational uses are far different than psychedelic therapy, Rais says.“When we are talking about psychedelic-assisted therapy, it is the use of a high dose psychedelic in a clinically supervised setting with a trained therapist who administers the psychedelic and then does therapy with you while you are in this altered state where your brain has an increased neuroplasticity,” Rais said.To shift people’s views on psychedelic healthcare, Rais advises focusing on the benefits of these drugs. “Focus on patient outcomes and data because when administered in a clinical setting, we’re seeing results like people no longer needing to be on antidepressants after just a few sessions and that goes beyond any kind of recreational intent.”With key approvals from the FDA, psychedelic therapy is well on its way to becoming a changing force in the mental health care field, Rais says.“In the future, I hope that the stigma that’s still associated with psychedelics is removed, and people can talk freely and openly about psychedelic-assisted therapy,” Rais said. “I hope that it will be a basic mental health treatment that we will all have access to.”Editor's note: From Day One thanks our partner, Enthea, for sponsoring this thought leadership spotlight. Wanly Chen is a writer and poet based in New York City.

Wanly Chen | April 17, 2024

Bridging the Human Connection Gap: How Technology Can Bring Workers Together

The sense of disconnection that Dave Wilkin felt while growing up was painful, but it became a powerful motivator that would change his life. “I learned the hard way that if you don’t have mentors, if you don’t have networks, and if you don’t have relationships–you just don’t get access to the same career or learning opportunities,” Wilkin told From Day One. “I was a gay kid in a really small town, and that’s a really tough place to be. How could I find people who were like me that I could aspire to be like?”Ten Thousand Coffees–or 10KC for short–a networking tech company that Wilkin co-founded and now leads as CEO, is how he hopes to rectify the connection deficit. It’s one that millions of workers experience, especially in the era of remote and hybrid work. Wilkin remembers how it felt to be isolated, imagining a career but with no way to get there. “It’s like sitting on an island all by yourself,” he said.Networks of close relationships grow careers, engage employees, boost morale, and keep workforces intact. According to a 2023 survey by Gallup, employees who have a mentor are 58% more likely to feel that their employer offers equal opportunities for advancement. Forty-eight percent of those who have sponsors feel the same way.Yet for Wilkin, it’s not good enough to leave such relationships up to chance, so he’s giving it a shot with a fast-rising technology: machine learning. His solution is 10KC, which adapts the tech that powers online dating matches to identify meaningful workplace connections, combined with a learning platform to make the most of those connections. The mixture produces connectivity at scale. The platform connects workers based on 50 factors, including skills, career path, location, time zone, interest areas, and affinity networks, then brings them together for productive conversation.The results are impressive. “We’ve decreased employee churn by 25% to 35% among our platform users, and we’re looking at tens of thousands of data points,” he said. Plus, 10KC has been able to increase participation in employee resource groups (ERGs) by two to three times. “A lot of HR and talent leaders think about mentoring and networking in its traditional formats–one-directional relationships where a mentor guides a mentee–but the new world of artificial intelligence and machine learning allows HR leaders to think about mentoring and networking in much more dynamic, personalized ways.”Dave Wilkin, co-founder and CEO of Ten Thousand Coffees (Photo courtesy of 10KC)Ultimately, Wilkin’s ticket out of his hometown of Lively, Ontario, was a full ride to the University of Waterloo. That marked a change in his life, not only because it was an exceptional education, but because it came with mentors and role models. “Those were the most game-changing people in my life because they helped me figure out what skills I needed to learn, what kind of programs I should study to get involved, and how to job-search.”No single relationship gave Wilkin his footing, but it was the sum of his mentors that made the difference. “There’s no such thing as a single mentor,” Wilkins said. “It’s much more dynamic than that.” It takes mentors, sponsors, peer-to-peer relationships, and reverse mentors, where a more junior employee supports one of their seniors, to create a network that propels a career.Preventing Those Missed ConnectionsThough Wilkin had to wait around for serendipity to bring in mentors, he saw a better way: Don’t leave it up to chance. Expecting workers to network on their own creates too many missed connections. With planning, companies can create proximity in distributed workforces.This can be especially important following a merger or acquisition in which two discrete organizations must come together to form something greater than the sum of its parts. And for leaders who travel, a smart network match can help them make the most of site visits. “The next time you travel, schedule a time to get to know your teams and have career conversations, rather than hoping that you bump into your colleagues in the elevator,” Wilkin said. “Find reverse mentoring opportunities so you can pick up new skills while on the road. Promote your practice area or simply learn who’s sitting in your company.”The Network Opportunity GapThere’s a distinct difference between the well-connected employee, who knows a lot of people by name (and maybe some office gossip), and the engaged employee, asserted Emily Dickens, head of government affairs for the Society of Human Resource Management (SHRM) in a 2022 interview with Gallup. “She’s happy, and she knows who to talk to in order to get things done,” Dickens said. “To really thrive and have a life well-lived, you have to have a work experience that is personal. You need to create relationships that outlast your time with the company. Unfortunately, this can be difficult for many professionals.”Traditional networking programs fail too many people. There’s a gender gap when it comes to mentorship and sponsorship. McKinsey and LeanIn.org’s 2023 Women in the Workplace report found that women are less likely than men to be “in the know,” and be able to access both mentorship and sponsorship opportunities at their company. Women are less likely than men to feel included in important company networks, according to SHRM’s Dickens.Another opportunity gap is based on seniority. Though internal mobility rates are up since 2021, according to LinkedIn, advancement opportunities are not evenly distributed. Workers at the manager and director levels are more than twice as likely as individual contributors to make a move within the company. Consider also that workers at the highest echelons are less likely to be female, less likely to be people of color, and less likely to be disabled.Taking the initiative in networking isn’t well-received in every workplace, said Wilkin. Skipping a level can get you in trouble, or at least earn you some suspicious looks. Asking around about other people’s jobs while seeking out sponsorship and mentorship can look like you’re trying to circumvent authority, leave your team, or conduct some (light) espionage. “If you’re a sales manager and you go above your boss to talk to somebody inside the company, you might get your wrist slapped,” he said. “There’s a lot of bias and barriers to networking inside of a company.”Yet companies that are too hung up on the norms of the hierarchy may be passing up major engagement and retention opportunities. Employees who have access to mentors and sponsors are twice as likely to be engaged than those who don’t, per a 2023 survey by Gallup. And according to LinkedIn, employees who make an internal move are 64% more likely than their non-moving peers to stay with their employer for at least three years. Beyond Mere Connection: Learning Skills and CollaboratingLately, Wilkin has been particularly interested in turning networking into learning communities. What if you could form a network of people learning skills independently, then bring them together for application and collaboration?“To reinforce a learning program, you might just think of pairing an intern to a senior leader to close that loop, but a more strategic talent and HR leader is looking at how they drive transformation through networking experiences,” he said. When a company can create a web of new managers or a web of workers adopting new AI applications, that new knowledge can be reinforced in a dozen new ways. “A network of relationships is where the majority of learning, talent, retention, career growth, inclusion all happen, but that has to be deliberate,” Wilkin said. “Using networks to help organizations become more innovative, retain their best colleagues, and be more efficient–it’s the next frontier of learning and development.”Editor’s note: From Day One thanks our partner, Ten Thousand Coffees, for sponsoring this story.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.(Featured photo by PeopleImages/iStock by Getty Images)    

Emily McCrary-Ruiz-Esparza | April 15, 2024

Sharing Their Truths: Working Parents Reveal the Benefits That Matter Most

Each year, HR leaders ask themselves: What benefits do my employees want? And what will provide me the most ROI? But many are left without answers.In a recent survey of 2,000 working parents conducted by Ovia Health, 62% said that their employers are not family friendly enough.The need for family friendly benefits is clear. Additionally, 94% said family benefits are a top priority and 73% said they would consider making a lateral move to another organization that offered better benefits and a family-friendly culture.In a From Day One webinar, Corrinne Hobbs, general manager and vice president, employer market organization at Ovia Health, discussed the results of the survey. Hobbs offered insight on current benefits offerings, where more support is needed, and what matters most to employees. Family Benefits That Match Today’s Culture“Women’s health benefits are one of the fastest growing segments within healthcare,” Hobbs said.  This is due to changing circumstances during and post-pandemic as more and more workers experienced shifting work-life balance due to hybrid schedules. It’s also due to the increasing range of types of families that need to be accounted for as lifestyles become more diverse. In this current marketplace, “employees have more control and more power than they have had in the past,” said moderator Siobhan O’Connor, chief content officer at Atria Institute. Therefore, it’s even more critical that employers make sure these specific needs are being served.While most companies do offer some family benefits, Hobbs says, there is often a disconnect between perceived needs and actual needs of employees. “There’s a strong push for employees to have better fertility benefits in their workplace. And 38% of respondents said that they’re looking for their employer to provide alternate family planning support,” Hobbs said. This is especially true with more and more single by choice or LGBTQIA+ parents in the workforce, and an overall trend of people waiting until later in life to have children. Unfortunately, many workplaces do not offer benefits to cover the costs of these services, which can be exorbitant.Siobhan O'Connor of Atria Institute interviewed Corrinne Hobbs of Ovia Health during the webinar on family-friendly benefits (photo by From Day One)Incorporating these benefits helps build an overall inclusive corporate culture and can be a way to help retain senior level female employees. Additionally, 83% of respondents said that perimenopausal or menopausal symptoms affect their ability to work, but only 1% receive benefits to help with those symptoms, says Hobbs. In order to “make sure that whatever you’re providing is equitable and inclusive all around,” a diverse range of age and gender must also be factors incorporated into a comprehensive benefits plan.Providing Better Family BenefitsWith family benefits top of mind for employees, Hobbs says there is a clear way forward for organizations looking to provide better care. The most important, according to respondents, is family leave. Hobbs advises: “Make sure that it’s paid, that it’s for at least four months, that it’s inclusive to both parents and that you don’t have to dip into your sick leave or your PTO before taking leave. That is a stress factor for many.” And employers must account for alternate pathways to parenthood, such as adoption, which might entail different costs or timeframes, she says.Hobbs says employers should not only plan for parental leave, but also for parental return. One way to do this is by setting up a return-to-work program to make it easier for parents to re-enter the workforce, noting that it’s a smarter investment than having to endure the cost of hiring someone new. Gradual part-time schedules can ease the burden on stressed parents, as can accommodating PTO policies, flex time, and hybrid or work from home options.Additionally, managers need to be prepped on how to work with returning parents. “A manager training program to ensure a family friendly workplace and ensure that people are able to bring their full selves to work without fear of repercussions is critical,” Hobbs said. ERG support groups can also provide a sense of community support within the workplace.Incorporating Digital Healthcare and AdvocacyOvia Health uses predictive analytics to power millions of members’ care and engagement with their health. Such apps can help provide crucial education about health symptoms, Hobbs says. For example, 85% of respondents said they don’t know much about menopause and how it may affect their performance. Ovia can help fill that gap through online resources, and also provide peer support groups. “We have a community wall where people with uteruses can talk about symptoms together and really feel a sense of community and commonality with others who are going through some of the [same] things,” Hobbs said. Finally, Ovia can also match employees with proper treatment.Using health assessments and surveys, Ovia gets to know its users and can provide highly personalized information to current, expecting, or potential parents. Health alerts will pop up based on users’ reported symptoms, and the app even provides proactive healthcare outreach to guide users through any bumps on their fertility journey.“Digital solutions offer round the clock access, education, and opportunities to really delve deeper into topics,” Hobbs said. “And they also come with advocacy, helping you navigate and understand these complex situations.” The app accounts for a wide variety of families and lifestyles, helping employers provide better care to a diverse workforce. “We have 50+ personalized clinical pathways and programs to support women and families, and then we personalize the experience for each member based on the dynamic health assessments and digital symptom report,” Hobbs said, describing the data-driven service as “person-centered care.”Hobbs says that while women have increasingly reached the upper echelons of the corporate world in recent years, women’s participation in the labor market is currently at a 33-year low. Having a family-friendly workplace can help ensure talented women stay on. “It costs upwards of $75,000 to replace an employee,” Hobbs said. By offering a diverse suite of benefits companies can retain top talent, encourage a more diverse workforce, and save money in the process.Editor's note: From Day One thanks our partner, Ovia Health, for sponsoring this webinar. 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 Cheddar News, iWomanTV, and CBS New York.

Katie Chambers | April 10, 2024