Recognizing trends in health care that align with the COVID-19 pandemic and related racial disparities can improve the design of timely and effective strategies by employers to safely return employees to the workplace. Some of these efforts include less wait time for testing results, an improved focus on social determinants of health, and greater accessibility to care, said Lauren Vela, MBA, senior director at Pacific Business Group on Health.
Safely returning employees to the workplace amid the coronavirus disease 2019 pandemic is a challenge influenced by geographic location and state mandates. As some employers begin this process, testing, social distancing, and personal protective equipment have emerged as vital factors to address when designing preventive strategies.
In a poll conducted by the Pacific Business Group on Health (PBGH), 40 large employers discussed what efforts they are implementing and considering to safely return employees to the workplace. Notably, social distancing was the key takeaway from these strategies, as 94% of employers said they are altering their respective workspaces.
Moreover, many employers have also detailed efforts to address racial inequity by assessing social determinants of health (SDOH) that may identify those at greater risk of worse outcomes due to infection, such as minority populations. In the poll, 64% plan to place a greater focus on SDOH, with nearly half of employers (45%) also stating they will revaluate their benefit design plans to address health system inequities and expand access areas of clinics and network providers.
While efforts that also include temperature checks and onsite questionnaires seek to promote safety during the pandemic, there are still issues that employers must consider when reopening the workplace. Lauren Vela, MBA, senior director at PBGH, highlighted the need for greater mental health services, telehealth utilization, and efficient testing to promote timely and safe interventions.
AJMC®: Hello, I'm Matthew Gavidia. Today on the MJH Life Sciences’ Medical World News, The American Journal of Managed Care® is pleased to welcome Lauren Vela, senior director at Pacific Business Group on Health, or PBGH. Can you just introduce yourself and tell us a little bit about your work?
Vela: Hi, I'm Lauren Vela, I'm with the Pacific Business Group on Health. We are a 501(c)(3) not-for-profit organization. We're a membership organization and we represent very large purchasers of health care—both private employers as well as public purchasers.
AJMC®: Depending on geographic location, some employers have either begun plans or have already transitioned back to the workplace. What are some of the factors that warrant consideration by employers to optimally bring employees back while also promoting safety and comfortability?
Vela: So geography is definitely one of those considerations because depending on the geography, some parts of the country are opening up sooner than others, but also the type of business they're in. So, we have a handful of employers who have essential workers and they never actually stopped working. Then we have some who are all office workers able to work at home very comfortably. So, they're not in as much of a rush to bring folks back to work.
So, it really depends on the type of business they're in, the type of workers they have, the geography. It also depends a bit on corporate culture—just different companies have different approaches. Some, they have a workplace, a work in place type of attitude where they promote coming into the office as part of their culture as opposed to others who maybe have more work at home policies to begin with. So, it really depends on a lot of different factors.
AJMC®: Can you speak on PBGH’s latest employer poll? Were there any findings or reported concerns that surprised you?
Vela: Not really. I mean, I think that one of the things that the poll points out, and I won’t say this is surprising because I see it often in the work and the conversations that we have with our members, is the absolute concern for and respect for patient privacy. So, I mean, it's not really a surprise because like I said, I often see this when we're working with our employers on projects, but there are a handful of reasons that regular routine testing does not make sense or using contact apps does not make sense, but one of them is really to make sure that their employees know that their privacy is protected and they really don't want to do anything that's going to make people feel uncomfortable.
So, in my mind's eye, knowing that a person is positive is helpful for the entire employee community and employers understand that, and employees understand that, but employers will always err on the side of more privacy.
AJMC®: With the growing uncertainty surrounding the pandemic, employee mental health has become a prominent concern, potentially intensified amid social unrest. The poll identified several steps being taken by employers to address these social concerns, can you speak on these?
Vela: We have recognized a trend before COVID-19 in the last couple of years for employers to really recognize the need to engage more densely in mental health. So, we've had a number of our employers change their coverage, change their processes, enable more EAP [employee assistance program] participation—a lot of efforts to really increase mental health access.
So, that's even before COVID. COVID has made that even more important, and has really identified how do we meet the needs of our folks who are feeling anxious or feeling depressed or feeling angry. All of those needs I wouldn't differentiate mental health for what's causing it. They know that our mental health system is broken in this country, and they have an interest in making changes.
AJMC®: Many employers identified the cost of testing employees and employee objections on privacy as notable concerns about their ability to test for COVID-19. Moreover, many haven’t decided how frequent they will require testing. What factors, including those already discussed, do you see as crucial in making this decision?
Vela: If tests could be made available at a very affordable price for every employee every day, I think we'd see a lot more testing by employers—that would be great. If they could get the results back within 30 minutes that would be awesome, but what happens with tests today is accuracy is in question–we saw in our survey as well they don't know that they can truly test accuracy, but also affordability.
So. they cannot test every employee every day. So, they might test and then by the time they get the results back, that employee who was negative could be positive, right? Or they test and they go to work and they go out to the parking lot and they get infected. I mean, testing just needs to be more available, more affordable, so that testing can be more often and for a bigger portion of the population on a more regular basis, and when that happens, I do think that we'll see employers test in a more meaningful way.
AJMC®: The way in which physical and mental health has been perceived has changed dramatically since the onset of this pandemic. What further steps are warranted by employers to promote employee well-being?
Vela: Yeah, so I would say the biggest change is the use of telemedicine and that has really been a good change. So, most employers had telemedicine available for their employees pre-COVID, but utilization was not great. There are some sectors of the population who like to use it. Maybe parents with young children calling about fevers and things like that, but generally speaking, telemedicine was not widely used even though it is a widely available benefit.
So, now enter COVID and telemedicine is the only way people can access their doctors. Thanks to the waivers that CMS put in place that commercial plans have adopted that allows us to use telemedicine within I'm going to say the brick and mortar built—the primary care doctors and the doctors that are longitudinal doctors treating patients and allowing them to really provide telemedicine through whatever tool they have available. Could be phone, could be FaceTime, could be Zoom–employees are loving that.
That's a lesson for all of us. So, perhaps there's an opportunity to have telemedicine be available with appropriate parameters for safety and appropriateness, but to have it be available more widely. I think it's going to be very hard to turn back. Telemedicine is very likely here to stay. I think that there are maybe a few things good that have come out of this pandemic and that might be one of them.
AJMC®: What further employer studies or polls are being considered by PBGH to address employee health?
Vela: As testing becomes more readily available, accessible, and affordable with quicker turnaround, I think that we'll see some changes, we want to keep our finger on the pulse of that. As we learn more about how this virus is actually spread, as we learn more about whether schools are going to be open, this is a really big issue for employers because they have employees working home and even if they try to bring folks back to work, that's not going to work for parents who have children who are at home now.
So, there's a lot of factors changing all the time, and so we will continue to keep our finger on the pulse of what employers are doing. Number one, to bring folks back in a safe way, and number two, to think about the health care system that they're accessing. One of the things that PBGH is really actively working on with our employers is let's recognize some of the learnings from this COVID experience. That's recognizing the value of telemedicine—how desirable it is for our enrolled population. They want it, they want to access it. So, let's make it more user friendly and accessible to them. Let's break down state line barriers. Let's break down some of the privacy barriers.
When push came to shove, and employees and patients are like, FaceTime is fine. I'm not suggesting we should be callous about privacy, we need to be very, very careful, but we also need to be mindful of what patients want. They want to be able to access their doctors timely and efficiently and telemedicine is a really great option.
The other big "aha" for us is we knew how fragile our primary care infrastructure was, and we know how, as a result of that, our health care system is so underserved, because with a weak primary care infrastructure in this country, we only spend about 7% or 8% of our total health care dollar on primary care. In other countries, 14% to 15% of the health care dollar is spent on primary care.
As a result, they have a much lower total cost of care. So, we knew all that, none of that is really new to us, but actually having this strain put on primary care, and the fee-for-service system has just broken the backs of many primary care providers—it's become very, very real for us.
So PBGH is looking actively at ways that we can engage with our primary care differently. We're running a demonstration pilot in the Bay Area, where we're looking at what's an opportunity to pay primary care differently now and going forward so that we don't expose ourselves to these kinds of vulnerabilities just because the system is so broken.
So COVID is a terrible, terrible thing. However, it has given us an opportunity to step back and look at some of the destruction that is really needed in our health care system to do right and spend our dollars in the most efficient, effective way.
AJMC®: Thanks Lauren!
Vela: Thank you!
AJMC®: To learn more, visit our website at ajmc.com. I’m Matthew Gavidia, thanks for joining us!