Self-Funded Employers and The Flu

As we head into a new flu season, self-funded employers have good reason to be concerned about healthcare costs. Let’s face it, the flu is bad news for everyone. The best case scenario involves a healthy adult getting a mild case, spending a week feeling miserable and maybe making a single trip to the doctor. But others aren’t as lucky. What starts out as a simple case of the flu can turn into a lengthy and costly hospitalization. In fact, the first flu-related death of the 2019-2020 flu season has already been reported.

Do you find yourself debating whether or not to get a flu shot each year? Individuals who get the flu vaccine are much more likely to make it through the winter in good health. Here’s everything to know about this year’s flu shot.

What the Experts are Saying

The Centers for Disease Control and Prevention tracks flu data every year. The CDC reported that last year’s flu season stretched 21 weeks, making it the longest in a decade. There were also two waves of flu outbreak during the 2018-2019 season. The first was caused by a strain of H1N1, the virus that caused a pandemic in 2009. The second wave was caused by a strain of the H3N2 virus.

The CDC can’t accurately predict how severe this year’s flu season will be, but some experts say that this year’s vaccine might not provide as much protection as it could. Each year, a group of international experts on influenza and vaccines meets at the World Health Organization to make recommendations about the next year’s vaccines. This group identifies the strains they think will be prevalent in the coming flu season and decides how vaccines should be composed to combat those strains. Typically, four viruses are chosen and the vaccine is tailored to fight all four of them.

One meeting is focused on the Southern Hemisphere and another on the Northern Hemisphere. At the time of the Northern Hemisphere meeting earlier this year, the H3N2 strain was causing late-season illnesses, and the committee chose that strain to focus on as part of this year’s vaccine. Now there’s concern that the strain that was chosen isn’t one that will be dominant this flu season. In fact, two of the four strains in this year’s vaccine may not be optimized to combat this year’s viruses, according to influenza epidemiologist Dr. Danuta Skowronski. The bottom line? The flu shot is still beneficial, but we can’t know for sure how effective it will be until the season is well underway.

Who Needs a Flu Shot This Year

Nothing yet suggests that this flu season will be unusually severe. As such, the CDC’s recommendations echo those made in previous flu seasons. Specifically, it recommends the vaccine for anyone who is a) 6 months old or older and b) has no contraindications to the vaccine, like a history of a severe allergic reaction to it.

Some individuals may not realize that there are multiple versions of the flu vaccine and that not all versions are safe for all people. People who have severe egg allergies, for example, should not get flu vaccines that include egg proteins, as some versions do. There’s also a nasal spray vaccine that is safe for people between 2 and 49 but isn’t approved for use in pregnant women and people with certain medical conditions. Ultimately, whether someone gets the flu vaccine, and how it’s administered, is a conversation for the individual and their doctor.

Ideally, the CDC says, everyone would get their flu shots by the end of October. But as long as flu viruses are circulating, which typically happens well into May, getting the vaccine can be an effective protectant.

The Flu Shot and Self-Funded Employers

Minimizing the number of people who get the flu is pretty obviously a worthwhile goal. For self-funded employers, one severe flu outbreak can trigger many members’ serious health conditions and drastically increase your healthcare costs for the year. The flu costs the U.S. an average of around $10.4 billion per year in medical expenses, according to the CDC, to say nothing of the costs employers incur related to employee absences. (One estimate predicted that U.S. employers would lose $17 billion in productivity during last year’s flu season.)

It’s not just the costs of treating the flu that a self-funded employer should worry about. Some flu patients develop life-threatening complications including pneumonia and inflammation of the heart or brain. The flu can also trigger and worsen serious health conditions including heart disease and asthma, or cause complications in pregnant women. And because the flu is highly contagious, it only takes one sick person in a workplace or home to cause an already medically-vulnerable person to become severely ill.

It’s important to remember that even if every eligible member of your health plan gets the flu shot, some of them will likely still get sick. The CDC studies data from five study sites, collectively called the U.S. Flu Vaccine Effectiveness Networks, to analyze how well the year’s flu vaccine works. The 2018-2019 study included 10,041 patients and found a vaccine effectiveness rate of just 29%. So while some employers wisely organize flu shot clinics for employees, that alone isn’t enough to combat the spread of flu. Companies can minimize outbreaks by creating stay-at-home policies for sick employees. Urging flu-stricken workers to stay home until they’re well may affect productivity, but for self-funded employers especially, it’s the best way to control healthcare costs during this season.  

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