What a difference a year makes. For much of 2021, what a difference a month makes.

One thing that hasn’t changed: The pandemic remains top of mind for employers in the United States, especially when it comes to their workers’ mental and physical health. We’ve seen peaks and valleys of COVID-19 cases over the last year, as vaccinations – and then boosters – rolled out. For some companies, this provided the push to begin bringing at least some employees back to the office.

At the same time, we saw advances in medicine and virtual care, increased availability and reliance on behavioral health services, and a sharper focus on health equity – which all have important implications on America’s workforce.

As we look ahead to 2022 and beyond, here are four top areas of interest, concern – and hope.

1. Behavioral Health Care: More Need, More Availability, and More of a Focus for U.S. Employers

Cigna saw a 27% increase in outpatient behavioral health visits in 2020 over 2019, and the trend has continued throughout 2021, said Dr. Douglas Nemecek, chief medical officer of behavioral health at Evernorth, Cigna Corporation’s health services business. “This is from an increase in the number of customers who are accessing behavioral health benefits as well as an increase in the number of visits being used by each person,” he said. The numbers speak for themselves: Data released by Mental Health America shows that one in four Americans struggled with depression during the pandemic, and one in three developed symptoms of anxiety.

“Even prior to the pandemic, we knew that one in five American adults suffered from a mental health condition in any given year. But we also knew that less than half of those were accessing care or getting the needed support for their condition.”Dr. Douglas Nemecek, chief medical officer of behavioral health at Evernorth, Cigna Corporation’s health services business

 Then, as the pandemic worsened and people dealt with changes in their work, family, and community, they lost their usual support systems. “Many more of us reached a point where we could no longer manage our own stress, and we needed to get help,” he said. “The good news, though, is that the availability of virtual behavioral health care – telehealth – made behavioral health care easier and simpler to access. It is more convenient, more private, and made access available to many people who didn’t know where to go in the past.”

Just as preventive care is important for our physical health, proactive measures are important for our mental health and well-being. With that in mind, Cigna has begun offering coverage of care from behavioral health coaches. By working with a coach, people can address their emotional health concerns as they emerge rather than waiting until they need more serious interventions.

“Also, with more people accessing care sooner, and accessing care and support through less intensive means like coaches and peer support, then the people who have more significant mental health issues will have improved access to the therapists and psychiatrists who can treat them,” Dr. Nemecek said.

What does this mean for America’s employers? Today more than ever, employers have a role to play in supporting their employees’ mental health. In fact, recent Cigna research found that Millennials and Gen Z (the largest portion of America’s workforce) believe that a healthy mind and body are key to their productivity at work. It is imperative that investments into workforce health include mental health services and support to help address employee fatigue, burnout and stress. That means more than providing benefits. Employers also need to proactively work to encourage and incentivize wellness among their employees, because when employees believe their employer cares about their whole health and well-being – mental health and physical health – they are 38% more engaged in their work, according to a study from The Society for Human Resource Management.

2. Working Toward Health Equity: The Role Employers Play

By eliminating health disparities – and enabling everyone to get the care they need, without needless obstacles – we can help everyone achieve optimal health.

Those disparities – referred to as social determinants of health – are systemic and can include race, gender, sexual orientation, income, and geographic location. For example, rural communities and areas with high poverty rates may have few or no hospitals and medical professionals.

 

The chart above shows that social and economic factors such as education, income, and discrimination can impact health and well-being.

The consequences of health inequity can be severe. According to the Centers for Disease Control and Prevention (CDC), people who lack access to quality care are more likely to become sick or disabled and to die at a younger age than people who have no difficulty getting the care they need, when they need it.

COVID-19 has shone a light on health disparities in the United States, the Presidential COVID-19 Health Equity Task Force said in the opening letter of its final report, which was delivered to the White House in November 2021.

“While the events of the past 18 months have made us crucially aware of COVID-19’s skewed toll on communities of color and other underserved populations, there has never been a time in which these communities have not suffered disproportionate burdens of death and disease,” wrote task force Chair Dr. Marcella Nunez-Smith, director of the Equity Research and Innovation Center at Yale School of Medicine.

The report recommends a number of actions, including:

• Investing in community-led solutions to address health inequity
• Enforcing a data ecosystem that promotes equity-driven decision making
• Increasing accountability for health equity outcomes
• Investing in a representative health care workforce

Employers have a role to play here as well. According to the U.S. Census, about 55% of the U.S. population receives health benefits through employers. This puts the onus on employers to foster workforce equity, Dr. Yele Aluko, chief medical officer at EY Americas and director of EY Center for Health Equity, said in a separate interview with Cigna’s Newsroom team.

“Health equity is an aspirational goal that has not been realized as of yet,” Dr. Aluko said in that interview. “It’s a circumstance that occurs when every person has the opportunity to attain and maximize their full health potential. This happens when no one is at a disadvantage to achieving this potential regardless of their social position or other socially determined circumstances.”

Kimberly Funderburk, Cigna’s national vice president and general manager for government & education, recently spoke about employer imperatives around health equity and the ways health disparities negatively impact our workforces during a Cigna panel discussion. “Health disparities don’t stay at home when we go to work,” she said. “Since our workforces reflect the communities where we live and work, they come right into our organizations, and we have to deal with them.”  

3. Drug Costs Continue to Spark Concern for Employers

Specialty drug costs continue to be a concern for employers. These important and essential treatments can be expensive and can have an impact on a company’s bottom line.

The list prices of brand drugs have risen steadily over the last five years, led by specialty medications, which treat rare and complex specialty conditions. In fact, specialty medications – including biologics and gene and cellular therapies – accounted for more than half of pharmacy spend in 2020, although only 2% of the population utilizes these drugs.

On the other hand, the price of generic versions of traditional medications has fallen by 42.3% over the same five-year period, giving patients who can use these therapies access to affordable treatments.

Biologics, which are derived from components of living organisms such as blood, cells, or tissues, are priced as high as $50,000 per dose. Biologic drugs – which can be the only treatment for complex, rare, or genetic disorders – accounted for 43% of total U.S. drug spend in 2019, the most recent data available.

Biosimilars, which are near-identical alternatives to their reference biologics, have the potential to drive cost reductions for specialty drugs. After a slow start in the United States, 20 biosimilar drugs were available at the beginning of 2021, according to a recent report from AmerisourceBergen. The report notes than an additional 73 biosimilars are in the pipeline. In addition, a recent analysis by Evernorth estimates that competition from biosimilars could save the U.S. $225 billion to $375 billion in pharmacy spend by the year 2031.

Gene and cellular therapies – some of which are also biologics – are another main area of cost concern. These therapies, which use genetic manipulation, can treat (and potentially cure) previously untreatable diseases. While prices fall within a huge range, all are extremely high. For example, Luxturna, the first gene therapy to reach the market in the U.S., was initially priced at $850,000 for a one-time dose.

The gene and cellular therapies that have been approved to date by the U.S. Food and Drug Administration (FDA) treat conditions that affect relatively few Americans. However, more than 600 gene and cellular therapies are in the pipeline, many of them aimed at treating more common conditions, such as prostate cancer. By 2025, the FDA estimates it will approve 10 to 20 gene and cellular therapies each year.

The key takeaway for employers is the importance of selecting a pharmacy plan that provides cost-saving options including generic alternatives, home delivery, and innovative solutions for specialty drug management.

4. Virtual Care Provides Ease, Flexibility, and Can Help Foster a Healthy Workforce

Pre-pandemic, less than 2% of outpatient behavioral health and medical claims were for virtual visits. Today they make up nearly 25%. “I think we’ll continue to see more adoption and more innovations,” said Eric Herbek, vice president of virtual care for Evernorth.

One potential stumbling block is the expiration of state laws permitting virtual visits with no visual component conducted over the telephone. As NPR noted recently, government entities moved quickly at the start of the pandemic to expand telehealth, allowing audio-only visits, for example. However, only about half of U.S. states have taken action to continue audio-only visits after the federal public health emergency ends. (Telehealth that uses video or is conducted using phones with cameras will continue to be allowed in those states.)

Another potential issue could be provider payments, Herbek said, noting that insurers are likely to take steps to reduce the amounts paid when providers meet virtually with patients, largely due to expected lower administrative and overhead costs for virtual visits than for physical visits. “I think there will be a natural landing place,” he said, with some providers continuing to offer virtual care broadly while others revert to using it to supplement in-person care.

He noted that some organizations, such as MDLIVE, an Evernorth company, were built to offer virtual care. These organizations excel in four main areas, he said:

• Urgent care
• Behavioral health therapy
• Dermatology
• Wellness and primary care, including ordering lab tests and analyzing the results

“A key to consumer satisfaction with virtual care is being very clear on what we can treat and what we can’t treat,” Herbek said. By utilizing onboarding tools, potential patients can learn if they’re good candidates for virtual care.

Just as usage of virtual care is evolving, so are the tools and resources that health care providers use. Today, hypertension and diabetes can be managed remotely. In the near future, patients may simply look into the camera to have their temperature taken. “Technology is going to continue to transform care,” Herbek said.

For employers, telehealth has the potential to decrease health care costs while keeping employees healthy and productive.

“While employers reap the rewards of lower premiums and costs, employees can take comfort in the knowledge that virtual care won’t rake them over the coals in unnecessary medical costs,” said a recent article from BenefitNews.com that took a deep dive into the value virtual care brings to employers. “About 70% of a patient’s medical complaints don’t require an in-person doctor visit, according to the American Medical Association, and can be handled virtually. By eliminating unnecessary office visits, telemedicine can save employees an expensive copay and reduce the claim costs to the employer's group healthcare plan.”