Delayed Care Fuels Chronic Conditions, Drives Health Plan Costs

During the last three years, a new driver of health plan costs has emerged: a growing share of employees are postponing doctor visits, screenings and even medications until conditions worsen.

Instead of early, lower-cost intervention, employees are entering the system later and sicker. This is fueling more catastrophic claims, higher utilization of emergency services and ultimately higher costs for employer-sponsored plans.

Across the country, providers report more late-stage diagnoses and unmanaged chronic conditions. When symptoms become severe, they often require more intensive treatments that drive up costs, including:

• Hospitalization,
• Specialist care,
• Advanced imaging and
• Expensive drug regimens.

Delayed care domino effect

The reasons for this trend are well documented. A survey by the Employee Benefit Research Institute found that four in 10 privately insured adults report higher health care costs. At the same time, polling by KFF found that 36% of adults say they have skipped or postponed needed care due to cost, and about one in five have not filled a prescription for the same reason. 

High-deductible health plans are a major factor. While they can help control premiums, they also require employees to pay sometimes thousands of dollars out of pocket before coverage begins. That financial exposure can lead workers to put off care, particularly if they are unsure whether a visit is necessary.

Medication non-adherence is another driver. About one-third of adults report skipping doses or delaying prescriptions due to costs, according to KFF. This can worsen chronic conditions and lead to hospitalizations that could have been avoided with consistent treatment.

What employers can do

• Lower financial barriers to preventive care — Waive or reduce cost-sharing for primary care visits, screenings and chronic condition management.
• Promote and simplify primary care access — Offer telehealth, onsite or near-site clinics and easy scheduling to reduce friction.
• Educate employees on how their plans work — Many workers do not fully understand deductibles, health savings accounts or covered services, which can lead to unnecessary delays.
• Encourage medication adherence — Consider programs that reduce or eliminate costs for essential medications tied to chronic conditions.
• Use data to identify gaps in care — Analyze claims to find employees who are missing preventive services or managing chronic conditions poorly.
• Steer employees to high-value providers — Offer insurance from carriers that offer networks or incentives that guide workers to high-quality, lower-cost settings for procedures and treatments.
• Leverage wellness and condition management programs — Programs that help employees manage diabetes, musculoskeletal issues or cardiovascular health can improve outcomes and reduce long-term costs.

Employers have more influence than they may realize in addressing delayed care. The goal is to reduce barriers and make it easier for employees to access care early.