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For some, not having health insurance is the main issue with their healthcare. But what about the members who have a plan, but do not use it?
Members who avoid healthcare are said to be “care-avoidant.” Care-avoidant members may have behavioural health issues such as anxiety, depression, substance abuse, etc. and are at the highest risk of declining health, co-morbidities and higher costs as a result of delaying or forgoing care.
Aside from behavioral health issues, members may be concerned about out-of-pocket costs or unsure how to access the medical system. Other factors can play a part, such as transportation, food, economic insecurities, a lack of health literacy or just being overwhelmed.
Health conditions left untreated can lead to worsening conditions, more complex treatment or even death. Delayed treatment also leads to significantly higher medical bills.
Care-avoidant behaviour is not only harmful to the individual–it impacts cost for everyone. Care avoidance may be inflating healthcare costs up to 6.2 times–around $68B in avoidable annual costs–and is growing 7% per year with current trends. According to a 2018 study, over half of Americans do not know how to navigate the healthcare system. This is creating an additional $4.8 billion in administrative costs for payers. As a result, these extra costs impact premiums.
Since the beginning of the COVID-19 pandemic, care avoidance has significantly worsened, though providers and insurers are expecting a “boomerang” in demand through the rest of 2021. As members begin returning to appointments, we will likely see a higher number of people experiencing issues with delayed diagnosis and treatment.
It’s important for agents to connect with clients to ensure they understand networks and are utilizing their benefits effectively. Communication is key throughout the year– take time to check in and remind your clients about all the features and benefits of their plan.
Some clients will need you to better understand the challenges they face in order to provide the right guidance. Done right, agents can save clients thousands of dollars and reduce the stress and pain of prolonged illness or injury, all while helping to improve the health and lower costs across our society.
As an agent, you’re doing your part to educate and support your community and the members you serve. It’s important that you continue doing so through education, so each of your clients may live their healthiest life.