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How employers can prepare for the flu season

By Jeff Levin-Scherz, MD, MBA | August 26, 2022

Our population health leader weighs in on why influenza could be worse this season, the undertreatment of hepatitis C, the effectiveness of blood pressure apps and much more in this monthly update.
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Risque de pandémie

The U.S. has had relatively few cases of influenza (flu) over the last few years, likely due to a combination of decreased travel and in-person activities and increased mask use. Since immunity to flu wanes rapidly and strains differ from year to year, many experts fear that this year we could see a higher rate of flu illness. Mortality rates are higher in those who get flu and COVID-19 simultaneously.

Flu pandemics generally start in Asia in our summer and travel east to North America by fall. This year flu cases increased earlier than usual in Australia, which could mean increased earlier risk in North America. In the Northern hemisphere, influenza cases tend to start in October and peak in late January or early February. Flu is a major cause of time away from work.

Implications for employers:

  • Encouraging flu shots is more important than ever. Employer-sponsored health insurance covers these vaccinations with no cost share at doctors’ offices and pharmacies.
  • Many employers are again offering onsite flu shot clinics as more employees return to the workplace.
  • Covering flu vaccinations through both the pharmacy benefit manager and health insurance carriers increases access and makes it more likely that employees will get vaccinated.

No proof of benefit for full-body preventive MRI scans

My twitter feed is littered with promotional tweets about full-body MRI scans for early detection of cancer or other abnormalities. These scans occasionally find an undetected cancer, but they have an exceptionally high rate of false positives. People can suffer real harm if they need an operation to address a finding that would have posed no danger to them. There is no study showing survival benefit, improved health or decreased cost in a population that receives full-body MRI scanning. The cost of the MRI and follow-up tests will increase total cost of care for a population and this will not be offset by future savings.

Implications for employers:

  • Cover and promote evidence-based screening tests like mammography, cervical cancer screening, and colonoscopy and other colorectal cancer screening tests.
  • Limit MRI coverage to diagnostic tests that are medically necessary. Don’t offer coverage for whole-body MRIs.

Undertreatment of hepatitis C in private health insurance plans

Hepatitis C is a terrible disease that causes liver failure and liver cancer. Fourteen thousand a year die of this disease in the U.S., and it is the number one reason for liver transplants in the U.S., Europe and Japan. Hepatitis C is often associated with intravenous drug use, and many with hepatitis C are insured by Medicaid or incarcerated. Still about 20% of those with positive tests are covered by private insurance.

Hepatitis C is also curable, with drugs that were very expensive when they were first introduced but are now available as generics. Treatment per case is now often under $30,000, which is substantially less than the cost of treating advanced liver disease. But not enough people are treated.

Researchers at the Centers for Disease Control and Prevention reviewed a large database that included around 6,500 people who had a positive hepatitis C test with private insurance, and found that only 35% filled a prescription for antiviral drugs within a year of diagnosis.

Implications for employers:

  • The U.S. Preventive Services Task Force recommends one-time screening of all adults ages 18 to 79 for hepatitis C. This should be covered without out-of-pocket cost.
  • Employers can ask their health plans what they are doing to be sure that providers are screening members and those who have positive hepatitis C tests get the necessary therapy.
  • This would be an appropriate future standardized quality measure, which would attract additional provider attention.

Smartphone app to guide blood pressure control didn’t lower blood pressure more than a device alone

Uncontrolled high blood pressure increases risk of premature heart attack and stroke and other vascular disease. Unfortunately, hypertension is very common, many who have high blood pressure are unaware, and the majority of adults with hypertension do not have their blood pressure under good control, generally meaning blood pressure of under 120/80.

Researchers randomized 2,101 people with newly diagnosed, poorly controlled hypertension to receive either a “smart” home blood pressure monitor with associated smartphone app, or a home blood pressure monitor with no app. There were no other interventions for either group, and no blood pressure readings were reported to treating physicians. The good news is that each group showed a decrease in systolic blood pressure. Slightly more of those with the app (32% versus 29%) achieved the target of blood pressure of 140/90 or less. Participants reported they were satisfied with either device.

Implications for employers:

  • Home blood pressure monitoring can help improve blood pressure control and allow patients to assess what raises or lowers their blood pressure outside of a physician’s office.
  • A low-cost home blood pressure monitor can be as effective as a more expensive solution.
  • This is an evaluation of a single mobile app that is marketed by a manufacturer of the smartphone, not an evaluation of stand-alone programs currently marketed to employers.
  • Employers should push digital vendors for high quality evaluation studies. These won’t always show positive results, but they will help employers purchase more valuable digital health services.

COVID-19 update: Better quality masks associated with lower rates of infection

Formal reported U.S. cases of COVID-19 are down almost 20% from two weeks ago, though these represent only a small portion of total cases and hospitalizations and intensive care stays are down slightly. Laboratory test positivity rate remains high (16%), and 93% of counties have a high transmission rate. The Biden administration is likely to extend the pandemic health emergency until January 2023, which delays Medicaid disenrollment for as many as 14 million people.

Researchers in Switzerland studied the rate of COVID-19 infections in healthcare workers exposed to patients with COVID-19 for a year from September 2020. All workers wore at least surgical masks, and about 22% always wore respirators (the European equivalent of N95 masks). Those who always wore the better quality well-fitted masks were about 40% less likely to get infected.

Implications for employers:

  • This adds to the evidence that high quality masks provide the best protection available against respiratory spread of COVID-19.
  • Although mask mandates outside of healthcare have dwindled, individuals can increase their protection against COVID-19 or other respiratory diseases, including flu, by using N95 or KN95 masks.
  • Employers that provide masks to employees should consider furnishing KN95 or N95 masks rather than surgical masks.

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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