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How you can help employees as COVID-19 infections rise

By Jeff Levin-Scherz, MD, MBA | September 29, 2023

Our population health leader weighs in on recommended vaccinations, medical care and financial insecurity, the impact of Wegovy on heart failure and more.
Health and Benefits

The autumn vaccination season

The Center for Disease Control and Prevention (CDC) has recommended a new COVID-19 vaccine for all those over six months of age. Available now, the vaccine is designed for the XBB strain that is currently in wide circulation and is likely effective against the BA.2.86 strain with multiple mutations, which epidemiologists worry could cause a surge of infections this fall and winter. This new vaccine will replace all previous vaccines.

The CDC found that last fall’s booster was 60% effective at preventing urgent care and emergency department visits and 65% effective at preventing hospitalizations, although the effectiveness against hospitalization waned over six months. The vaccine was also highly effective at preventing ICU admissions, and those who were vaccinated were less likely to get long COVID. Nonetheless, only 17% of Americans received the bivalent booster vaccine.

The CDC also found that the incidence of myocarditis as a side effect is no longer elevated, possibly because of a longer time period between vaccinations. They found that the benefits exceeded harms from booster vaccination for all age groups, with infants and the elderly gaining the largest benefit.

The new COVID-19 vaccinations can be administered with the influenza vaccine, which is also recommended for all over six months of age. It is generally administered in a different arm.

Additional recommended vaccinations

For adults age 60 years and older, there are two new RSV (respiratory syncytial virus) vaccinations available: Arexvy and Abrysvo. RSV causes 60,000 to 160,000 hospitalizations and 6,000 to 10,000 deaths in the elderly each year. This vaccine should be given separately, at least two weeks before or after the flu and COVID-19 vaccinations as it is new, and it’s unclear how individuals will be affected by it.

For infants under eight months, Beyfortus, an RSV monoclonal antibody (not technically a vaccine) is recommended by the CDC. We expect a vaccination for pregnant women aiming to provide their infants with RSV immunity will be recommended later this year, too. is expected to endorse it soon.

Implications for employers:

  • The COVID-19 vaccination will be available at pharmacies. Many physician offices will likely not offer the vaccine, as there are large minimum orders and the vaccine is no longer provided free by the federal government. Relatively few employers will offer COVID-19 vaccinations (or RSV vaccinations) onsite, so members should seek these at local pharmacies or from their providers
  • Employer-sponsored health plans will pay the cost of these vaccines with no member cost sharing because they are recommended by CDC’s Advisory Committee on Immunization Practices.
  • Employers should cover the COVID-19 booster both through the pharmacy benefit and the medical benefit so members can get the vaccine from the most convenient provider.
  • Plan members can choose to get influenza and COVID-19 vaccinations at the same time. This increases convenience and makes it less likely someone will get infected while they are waiting to get the other vaccination.
  • The RSV vaccination is recommended for those over age 60.
  • Those who had COVID-19 over the summer should wait at least three months after their infection to get the new vaccine. Those who had the old bivalent booster this summer should space their booster out at least two months from the last vaccination.

Medical care causes financial insecurity for many older employees

The Commonwealth Fund analyzed its 2022 health survey to focus on employees between 50 and 64 years of age and found that nearly half of low-income respondents (annual income around $60,000 for a family of four) reported that it was difficult to afford premiums. Over a third of moderate income (annual income around $120,000 for a family of four) reported difficulty affording premiums.

Nearly half of those with low income with employer-sponsored health insurance reported that they skipped or delayed medical care due to cost. Those who reported that they were struggling with medical bills were most likely to report they were not confident they had enough money for retirement.

The research showed that over a quarter (26%) of all employees ages 50 to 64 were underinsured. The authors defined underinsured in two ways:

  • Out-of-pocket costs, excluding premium, exceeding 10% of income (or 5% for those under 200% of the federal poverty level)
  • Deductibles exceeding 5% of household income.

Implications for employers:

  • Affordability is highly relevant to adults ages 50 to 64 years. Those over 50 are most likely to have significant medical expenses, so deductibles and cost sharing can lead to financial insecurity, especially among low- or moderate-wage workers.
  • Even some with six-figure incomes report skipping care due to cost. If affordability is not addressed, employers may see worse outcomes as employees skip needed care.
  • Many employers are offering a preferred provider organization plan with lower deductibles to address the issue of affordability. Such plans will attract adverse selection (as they are more attractive to those with significant illness), so employers should not expect lower costs from this type of plan.

About a quarter of employers who had full-replacement high-deductible health plans have added a plan with lower out-of-pocket costs over the last five years according to WTW’s 2022 Best Practices Survey.

Study shows Wegovy associated with lower symptoms of heart failure

The New England Journal of Medicine published research recently that examined the impact of Wegovy (semaglutide) on patients who had heart failure but were not diabetic. They randomly assigned 529 patients to either receive a semaglutide injection weekly or a placebo for a year.

At the end of the year, they found patients had statistically significantly lower symptom scores and could walk further. Lastly, and no surprise, the weight loss was greater in the semaglutide group (–13.3%) versus the placebo (–2.6%). While the study was small, the study group was not diverse and the follow-up period only a year – these results are quite promising.

Implications for employers:

  • This study provides new data showing the benefit of semaglutide and possibly other GLP-1 anti-obesity medications for heart failure.
  • There will be more studies in other conditions to assess the impact of GLP-1s.
  • Employers should be considering their broader obesity and cardiovascular strategy, which may include the GLP-1 medications.

Substance use disorder touches two-thirds of U.S. adults

KFF reported last month that three in 10 U.S. adults (29%) say that they or someone in their family have been addicted to opioids, and two-thirds (66%) say that they or someone in their families have been:

  • Addicted to alcohol, prescription painkillers, any illegal drug
  • Experienced homelessness due to addiction
  • Required emergency or inpatient care from an overdose
  • Died from an overdose.

KFF reports that a minority of those with substance use disorder received inpatient or outpatient therapy.

Researchers analyzing a large federal survey database in JAMA Network Open found similar results. Of those with opioid use disorder, only 26% received medication assisted therapy (MAT), which is the only approach clinically proven to be effective at decreasing risk of opioid use. Factors that significantly increased use of MAT were more severe opioid use, income under $20,000 and use of telemedicine.

Implications for employers:

  • The impact of substance use disorder is enormous, especially when combined with alcoholism
  • Employers can support a Recovery-Friendly Workplace and promote community-based support (SMART Recovery, 12-step programs or Life Ring)
  • Employee assistance programs can help employees address their own or family members’ substance use
  • Access to substance use disorder treatment is severely constrained in many communities
  • Employers can ask their carriers to report on substance use disorder treatment access and MAT use
  • Telemedicine is a promising approach to monitoring use of MAT, and those getting their medication monitoring through telemedicine may be more likely to be able to continue their work without disruption.

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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