When the world shut down due to COVID-19, it wasn’t only schools and public establishments—bars, restaurants, music venues—people stopped going to. They also stopped going to the doctor, either because they were afraid to be around others and risk contracting the virus, or because their provider had to reschedule or completely cancel.
In the short term, this likely helped decrease the spread of COVID-19, which is good. However, it also means a lot of people missed necessary preventive care, such as routine health screenings and care for chronic conditions. This could ultimately lead to late diagnoses and exacerbated medical issues—and thus, increased medical spend for employees and employers alike.
From 2019 to 2020, we saw preventive care spend drop by 12.6% overall, with substantial decreases in general wellness exams (10.8%), hemoglobin A1c tests (11.5%), cervical cancer screenings (16.0%), mammograms (11.7%), and colorectal cancer screenings (24.1%).
While overall preventive care spend rebounded 11.1% from 2020 to 2021, this increase doesn’t make up for all the care missed in 2020. Plus, projections from our rigorous claims analyses indicate that spend in this area will decrease again in 2022. Though we can’t be completely certain why this is, there a few hypotheses: continued fear of exposure to the virus, preventing people from re-entering a clinical setting like their doctor’s office, and concerns about the cost of care, which have been exacerbated by the pandemic’s effects on the economy.
Preventive care and chronic condition management are critical to the health of the individual, the health of the workforce, and the employer’s bottom line. Here’s how Castlight can help.
Castlight’s Clinical Interventions Framework
One way we ensure we’re surfacing the right recommendations for each member is by leveraging our Clinical Interventions Framework, an evidence-based, rigorous, and systematic approach to personalizing each member’s health journey with the goal of engaging them in high-value, clinically-validated interventions.
This proprietary framework is anchored on seven universal clinical goals we want to help every member achieve, plus a list of interventions we can offer to support each goal. For each condition and intervention, we completed an extensive review of evidence-based guidelines—U.S. Preventive Services Task Force, American College of Physicians, American Academy of Orthopaedic Surgeons, and more—to ensure our approach is up to date and aligned with the latest expert advice.
One of the seven pillars of the framework is ensuring members receive recommended screenings on a regular basis to identify clinical conditions as early as possible and to monitor any diagnosed medical conditions. By pulling through clinically-validated guidelines and comparing them against members’ claims data, Castlight can precisely identify the right screenings to recommend to each member at the right time.
Health Check, Castlight’s preventive care program, can pinpoint the preventive screenings each member is eligible for—annual primary care physician (PCP) visits, breast cancer screenings for females between 50 and 74, and colon cancer screenings for adults between 50 and 75, for example—remind the member to schedule and go to the screening, and guide them to high-quality providers who offer those services. Health Check motivates members to complete screenings by showing them what care services they still need to complete and incentivizing them to do so; the incentive is offered in advance and paid out after the member receives the care.
If additional care options are needed, Castlight can connect members to programs and providers such as:
- Second opinion programs like ConsumerMedical
- Chronic condition management programs like 2Morrow, Hello Heart, Livongo, Omada, Vida, and Virta
- Prescription management programs like RazorMetrics, Rx Savings Solutions, and WithMe
- Specialists (e.g., endocrinologist, cardiologist, oncologist)
- Laboratories (like Quest) for further testing
Care Guides in Action
Castlight’s Care Guides, our team of clinical and benefits experts, can play a vital role in ensuring members are aware of and able to access resources, programs, and services available to them—including making sure they complete the screenings they’re eligible for and helping them navigate diagnoses.
Here are some real-life examples of how our Care Guides have helped close care gaps:
- Near the beginning of the pandemic, a member named Arnold* reached out to a Care Guide after receiving an email from Castlight about scheduling a PCP visit. He mentioned he didn’t have a doctor yet and he needed help finding one and scheduling a visit. Since it was the early days of the pandemic, many providers weren’t accepting new patients. But our Care Guide was persistent, determined to connect Arnold with care. She ended up calling 17 PCPs before she found one that would accept a new patient. Arnold was so happy with his experience he asked the Care Guide to help his wife make an appointment, too. He told the Care Guide that, if it had been up to him, he never would have called so many providers. He would have given up without her help.
- After helping Sherry* better understand her health plan status and deductibles, one of our clinical Care Guides went over the preventive screenings she was eligible for to make sure she was up to date. Because Sherry had previously had a hysterectomy, she didn’t need a pap smear, but she was due for a colonoscopy. The Care Guide helped Sherry find a provider and schedule the screening. In addition, the Care Guide helped Sherry navigate other health issues she was facing, including an upcoming surgery and some additional scans she needed.
These are just a few examples of how Castlight’s best-in-class Care Guides have helped our members engage in critical preventive health habits and close care gaps.
*Names have been changed for confidentiality.