Social determinants of health and the role of advisors

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How utilizing health benefits reduces cost

Issues with healthcare arise when clients have no coverage. But what about the members who have a plan, but do not use their benefits– especially preventive services?

Surprisingly, many people who have health insurance deliberately avoid using it. The reasoning varies, ranging from fear of out-of-pocket costs and mistrust in the medical system to the recent fears surrounding COVID-19. Other factors come down to other social determinants of health such as transportation, food, economic insecurities, a lack of health literacy, and more.

Many are simply overwhelmed and confused how to navigate the complex landscape of healthcare, so they choose not to utilize it. Many conditions are being left untreated, which can lead to worsened conditions that may result in late detection, delayed treatment, much higher costs, and even avoidable deaths. The longer a condition is left untreated, the higher the likely cost of care.

Every member who avoids healthcare–even when who suspect it to be necessary–is classified as being “care-avoidant.” Among those who choose to be care-avoidant, those who experience behavioral health issues (anxiety, depression, substance abuse, etc.) are at the highest risk of experiencing declining health as a result of forgoing care.

This behavior is not only harmful to the individual, but also to the healthcare industry as a whole. Populations with behavioral health conditions and medical comorbidities can inflate healthcare costs by up to 6.2 times,with little to none of those dollars spent on behavioral care. This can result in as much as $68B in avoidable annual costs, a figure that is growing by upwards of 7% annually by some estimates. Additionally, according to a 2018 study, more than half of Americans do not understand how to navigate the current healthcare landscape because it is so complex, creating an estimated $4.8 billion annual administrative cost burden for payers.

Since the beginning of the COVID-19 pandemic, this issue has only risen. Over the last several months, many have chosen to avoid visiting their healthcare providers for fear of contracting the virus in a public setting, which has created more of an issue for the healthcare system.

It’s important for agents to connect with clients to ensure they are utilizing their benefits completely and, if necessary, to remind them why it’s important for them to do so. Encourage those who exhibit a reluctance to seek care by being persistent and reminding them that it is in their best interest to do so. By encouraging clients to seek care, you will in turn save them from hundreds, if not thousands of dollars in medical bills, the stress and pain of prolonged illness or injury, all while doing your part to stimulate the healthcare industry.

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