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Healthcare roundup: Loneliness as a health risk, menopause and work absences, and cancer biomarkers

Surgeon General promotes social connectedness to address loneliness

By Jeff Levin-Scherz, MD | May 26, 2023

Our population health leader weighs in on loneliness, the high costs of pediatric hospitalization, climate change impacts on healthcare costs and more.
Health and Benefits|Wellbeing

Vivek Murthy discovered that he was profoundly lonely during his first stint as Surgeon General in the Obama Administration, which led him to write a book about loneliness. He is now back as Surgeon General with an advisory on loneliness that includes comprehensive review of current data and recommendations for many stakeholders, including employers. The advisory was released in May to coincide with National Mental Health Awareness Month.

Findings from the publication show that Americans are clearly lonelier than they were in the past:

  • We spent 12 hours more by ourselves each month in 2019 compared to 2003 (up from 143 hours to 155 hours). This increased again in 2020 but could be blamed on the pandemic.
  • Almost half of Americans (49%) reported having three or fewer close friends in 2021, up from 27% in 1990.
  • Marriage rates and family size are down.
  • Only 16% of respondents reported that they felt “very attached” to their local community in 2018.
  • Social isolation is more common in those with chronic illness including mental illness and those with lower income.

Loneliness is also bad for health. Those who suffer from loneliness have higher overall mortality rates. The risk of heart attack in those who reported high rates of loneliness is 29% higher, and the risk of stroke is 32% higher. Those with heart failure who are lonely are more likely to have hospital admissions.

The advisory’s recommendations for employers:

  • Make social connection a strategic priority.
  • Create a workplace culture to promote connections, inclusion and belonging – both inside and outside of work.
  • Implement policies that protect workers’ ability to nurture relationships outside of work.
  • Consider the opportunities and challenges associated with flexible work hours and remote and hybrid work.

Menopause symptoms lead to $1.8 billion in lost working time

Researchers at Mayo Clinic reviewed survey results from about 4,400 women ages 45 to 50 years old and found that many reported menopausal symptoms interfered with their lives and work.

  • 13% reported at least one adverse work outcome due to menopause symptoms.
  • 11% reported missing a median of three days of work in the last year.
  • 5% said they cut back on hours in the last six months.
  • 1% said that their symptoms were so severe that they quit or were laid off from their jobs.

The respondents were disproportionately white (93%), married (77%) and college graduates (59%). The authors extrapolated this work absence to a loss of $1.8 billion in productivity annually.

Implications for employers:

  • Health plans and other vendors are increasingly adding offerings specifically targeted to women in menopause.
  • Employers, especially supervisors, should be sensitive to the fact that many women who are going through menopause are reluctant to discuss their symptoms and needs.
  • Accommodations, such as fans to cool down an office or flexible work arrangements, should be provided.
  • Sensitivity to these issues can help companies retain valuable employees and follow all applicable antidiscrimination laws.

Families face high costs when children are hospitalized

Luckily, most children are healthy and relatively few are hospitalized. But recent data show that when kids are sick enough to be hospitalized, their families incur substantial out-of-pocket costs.

Researchers in JAMA Pediatrics reviewed around 10 million claims from hospitalized children from 2017 to 2019, and found that, on average, out-of-pocket cost was $1,313, and out-of-pocket cost exceeded $3,000 for more than one in seven kids hospitalized. When possible, researchers matched patients to the type of health plan they had and found that those with high deductible health plans faced the highest out-of-pocket costs.

These findings don’t fully account for the financial damage to families whose children are hospitalized. Parents often lose income when they miss work, and the costs of medicine, outpatient care and even parking can further stress family finances.

Implications for employers:

  • Careful health plan design that limits out of pocket expenses for those with low incomes can help prevent financial insecurity due to hospitalizations.

Cancer biomarkers are underused

Biomarker tests analyze cancer cells to determine what therapy is most likely to be effective at curing or slowing cancer. Many anticancer drugs are highly effective for cancers with certain genetic mutations but do little to help patients with cancers that lack those mutations.

Biomarker tests are indicated for most people who are diagnosed with

  • Melanoma
  • Breast cancer
  • Colorectal cancer
  • Non-small cell lung cancer
  • As well as those with other cancers that have spread widely

Many of these biomarker tests are laboratory developed and do not require approval from the Food and Drug Administration (FDA). As a result, there is often not a specific billing code for each test. Some are FDA approved as companion diagnostic devices.

These biomarker tests are increasingly included in National Comprehensive Cancer Network guidelines. Researchers for the American Cancer Society found that coverage of oncology biomarkers was “widespread but not universal.” Some claims for these tests are subject to prior authorization and some claims are denied.

Current legislation requires or regulates coverage in six states, and there are legislative proposals in nine additional states. These requirements only apply to fully insured health plans that are state regulated, and almost two-thirds of those who have employer-sponsored health insurance are in self-funded health plans, which are exempted from state regulation., a charitable advocacy and service group, recently published a survey of 295 people treated for cancer and found that 29% who had cancer biomarker tests did not receive coverage for the tests. The survey also notes that one in 10 respondents said the biomarker test made them eligible for a clinical trial, and one in five said it saved them from unnecessary chemotherapy or radiation.

The oncology community recognizes that underuse of cancer biomarker tests means some patients don’t get the most optimal medical care and could suffer unnecessary complications of therapy or die earlier.

In a review of electronic medical records that included over 120,000 patients with three types of cancer from 2017 to 2020, researchers found racial disparities in the use of biomarker tests. They found substantial disparities in use of these tests in lung cancer and colorectal cancer treatment, but no significant difference in breast cancer treatment.

Implications for employers:

  • Employers can check with their carriers about coverage for cancer biomarker tests.
  • These tests are expensive and not indicated for all cases of cancer, so many carriers implement prior authorization with expert review to avoid waste.
  • Oncology practice is increasingly specialized, and many members receiving treatment from community oncologists will benefit from an expert medical opinion or a second opinion at a National Comprehensive Cancer Center.

Global warming and the cost of employer-sponsored health insurance

The temperature was in the 90s on much of the east coast in early April, and there was so little snow in Boston this winter that our snowshoes never made it out of the basement. This dramatic change in temperatures will impact health and healthcare. Here are some of the reasons why global warming is likely to lead to higher healthcare costs.

  1. Mosquitoes that carry infections including dengue fever, chikungunya, West Nile virus, and malaria will increase their geographic range and be active for more of the year.
  2. Mild, short winters have meant more ticks, which spread diseases including Lyme disease, babesiosis and Rocky Mountain spotted fever.
  3. Hotter temperatures will mean more cases of overheating. In some geographies, it will restrict the time of day and number of hours workers can safely spend outside.
  4. Higher average temperatures dramatically increase the likelihood of extreme heat days, which were associated with over 1,300 excess annual deaths in the U.S. from 2008 to 2017.
  5. Wildfires associated with increased temperatures cause an increase in air pollution. Researchers in Australia estimated that this could be causing over 50,000 excess deaths in the U.S. The most harmful particulates from wildfires, p2.5, causes an increase in cardiac as well as respiratory disease.
  6. Milder temperatures are leading to more ragweed and other pollen sources that can worsen allergy symptoms.
  7. Climate change is likely to cause economic upheaval such as geographic displacement or loss of jobs. This will increase mental health needs.
  8. Global pharmaceutical supply chains may be upended resulting in critical drug shortages due to weather events as they were during Hurricane Maria in 2017.

Not all news is grim. We know that moving away from fossil fuels and toward renewable energy sources can substantially decrease air pollution, especially in urban areas. This could decrease cardiac and respiratory disease. Furthermore, a warmer planet could mean fewer cold-related injuries.

Also, the transition to alternative energy sources can support good paying jobs that increase financial security, which is associated with improved physical as well as mental health.

Implications for employers:

  • Climate change is likely to increase overall healthcare costs, although work to mitigate global warming could help decrease risk.
  • Employers should continue to evaluate opportunities to improve access to mental health services.
  • Company efforts to decrease carbon footprints can help decrease the adverse impacts of climate change and demonstrate concern for employee wellbeing.

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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