Why It’s More Critical Than Ever to Support Mental Health and How Insurers Can Help
I’ve written on this topic before (see here, here, and here) but I want to add some fresh content, blend it in with some previous material, and serve up something new— all with the goal of stirring up some discussion and provoking some additional research on the part of my reader community.
The U.S. Census Bureau-administered Household Pulse Survey is chugging along in its fourth phase (actually, the current phase is labelled as Phase 3.1; go figure). Since its inception in April of 2020, the HPS has attempted to track “the ways this pandemic has affected people’s lives and livelihoods.” It includes a variety of questions developed by multiple federal agencies, among them the National Center for Health Statistics, a unit of the Centers for Disease Control and Prevention. Readers of my work on LinkedIn will be familiar with my analyses of HPS data on mental health symptoms and treatment [Note: See here, here, here, here, and here], but in this piece I’d like to focus on another set of NCHS-provided questions on reduced access to care.
From Day One of the survey, HPS participants have been asked these two questions:
- At any time in the last 4 weeks, did you DELAY getting medical care because of the coronavirus pandemic?
- At any time in the last 4 weeks, did you need medical care for something other than coronavirus, but DID NOT GET IT because of the coronavirus pandemic?
Looking at working adults’ responses, here’s what we see for those answering “yes” to either (or both) of those questions, by survey phase:
Two comments:
- The number of working adults reporting delayed or foregone care during the current survey phase is down considerably from a year ago—but it’s still quite high (just short of one out of every four). By contrast, as NCHS notes, in 2019 just a bit more than 8% of U.S. adults reported not getting needed medical care in the past twelve months because of cost, which at that time was the leading barrier to getting care.
- There’s a definite gender gap: A higher percentage of working women have reported pandemic-related delayed or foregone medical care (a year ago, in the first survey phase, basically half of all working women were in this category). This is of particular interest because, based on earlier research we’ve done at The CDA, there’s good evidence that women have higher short-term disability incidence rates (even when factoring out pregnancy-related claims). [Note: We’ve shared highlights of this research with non-CDA audiences at a few webinars. Look for details in a future LinkedIn article.]
So, what does this mean? Let’s hypothesize that, in terms of STD claims incidence— and no, I’m not taking about that kind of STD ;-)— we would expect to see a drop of substantial magnitude, followed by a “snap-back” further on down the line. [Note: At one of my previous work gigs, I saw a similar phenomenon as a result of the Great Recession of 2008: In the depths of the recession, for a cohort of client companies I was following, there was a drop in incidence, with a snap-back emerging once the economy improved.]
We had a first test of this hypothesis in the summer of 2020, when I attended a webinar sponsored by Employee Benefit News [“Patterns of Time Off During Covid-19,” July 7, 2020]. The presenter was affiliated with a third-party claims administrator that works with large employers providing self-insured STD coverage. She was doing a case study of one of their clients (I believe it may have been a utility company) whose employee population divided into two different sub-groups: One of them included support personnel who could work from home, and the other included “community-facing” workers that had to go out of the home to do their jobs.
Here’s the key slide (from a screenshot I took):
The data for 2020 are based on January through May; likewise for the pre-pandemic (2018-19) baseline. So, for the employer overall, and for the work from home subgroup in particular, incidence rates were down as a result of the pandemic.
I had some follow-up correspondence with the presenter and asked if she could share incidence numbers for the “community-facing” sub-group as well. She was kind enough to do so:
Incidence for that sub-group, she noted, didn’t drop as significantly as for the WFH, but it was still down about 9% from pre-pandemic levels.
Back to the webinar. Another slide dealt with what this employer was seeing with respect to musculoskeletal claims, its largest diagnostic category (and, if you exclude pregnancy claims, the largest category for the vast majority of all other employers):
In my follow-up correspondence, I asked the presenter whether the decrease in MSK claims as a percentage of total claims meant that there was also a decrease in the incidence of those claims (i.e., as a percentage of total covered employee population). She answered that, yes, this was indeed the case, and that “MSK STD incidence rates were down ~30% from 2018/2019 levels.”
So, here was validation for the first part of the hypothesis (an initial drop in STD incidence). Admittedly, findings were based on only one employer, but as the presenter noted in response to my follow-up correspondence, they were “seeing similar trends across our book.”
In the months since then, however, I haven’t seen any other carriers or TPA’s come forward with comparable data. Which to me, as a devoted data guy, is profoundly unsettling. After all, to use the tagline of a 1980’s commercial, “inquiring minds want to know!”
Recently, one of The CDA’s member companies stepped up to the plate to help shed more light on how STD incidence rates may have changed as a result of the Covid-19 pandemic and the various lockdown measures implemented to bring it under control. They have a very robust block of business in the Education Services sector, and they focused on that block. They calculated monthly incidence rates for 2018 through 2020, and looked at diagnostic category detail as well.
Here’s what they found (for illness/injury claims—that is, excluding pregnancy-related disability):
For non-Covid illness/injury claims, there was an almost 25% drop in incidence from 2019 to 2020 (compared with about a 5% drop from 2018 to 2019). For each major non-Covid illness/injury diagnostic categories, there was a comparable drop in incidence from 2019 to 2020.
So, the hypothesis about a decrease in incidence for the near term checks out. But what, if anything, do we see by way of a snap-back?
To answer that question, let’s look at year-over-year incidence trends by month:
The steep drop in incidence for April was unique in 2020. But subsequent months—except for September (interestingly enough, the beginning of the school year in many jurisdictions)—continued to run below 2018 and 2019 levels. Which means the snap-back looks to be more gradual and may take a while to play out.
There you have it: data that suggests the pandemic may actually have had the effect of reducing (at least in the near term) rates of short-term work disability.
And what of longer-term disability? That’s a whole ‘nother question. For now, let’s chew on this finding from our member company’s analysis: Covid-19 claims whose duration ran to the three-month mark (nowadays, that’s increasingly considered the point at which a disability claim transitions to long-term disability) comprised 10% of the total for that diagnostic category. That’s in line with a couple of recent estimates of how many people with Covid go on to become “long-haulers” (see here and here).
Let me end this piece with a call to action. If you’re affiliated with an insurance carrier or TPA that manages short- or long-term disability claims, I’d like to challenge you to share your organization’s data on disability-claims incidence, pre- and post-pandemic. It doesn’t have to be your entire book; you can use several large employers or an entire industry sector. But you should at least be able to show incidence rates, preferably on a monthly basis, both pre- and post-pandemic. And if you can do so at diagnostic category level, so much the better.
Are you up to the challenge? I and other “inquiring minds” would like to know!
A concluding note from Fred (August 13, 2021): “Since the end of June, when I published this article on my personal LinkedIn page, I’ve had a number of industry insiders comment to me that, yes, they’ve also seen a similar phenomenon (namely: a sharp drop in non-Covid short-term disability incidence during the early stages of the pandemic, followed by a very gradual snap-back to levels that are still below where they were pre-pandemic) in the books of business with which they’re familiar. But they’ve stopped short of providing details and specifics.”
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