Four health conditions that can lead to hesitation in care
Various health conditions can be challenging to comprehend or manage for any member or patient. Understanding sources of hesitancy for individual care conditions—be it personal, societal, or financial—can help health plans strategize for engagement and outreach preventive care programs to encourage care follow-ups and screenings.
1. Perimenopause and menopause
Menopausal symptoms have been generally under-treated and under-reported, and many women still suffer from stigma, embarrassment, or lack of awareness that prevents them from seeking treatment. By not addressing perimenopause and menopause symptoms, the impacts on women’s lives can be widespread—a Mayo Clinic study estimated menopause costs American women an estimated $1.8 billion in lost working time per year. Additionally, women of menopausal age contribute approximately 50% of paid work in some countries and around 70% of unpaid work.
This stigma means a significant percentage of members are not seeking care for symptoms and are less likely to report major challenges, greatly impacting their own lives and the community around them. A qualitative study suggests healthcare professionals can provide appropriate educational content and leaflets to help reduce barriers and hesitation—in 2025, consumer education on menopause was accessed within UpToDate® over 53,000 times.
2. Male breast cancer
While rare, just under one out of every 100 breast cancers in the US is diagnosed in a man with the typical age range between 60 and 70 years old. Screenings for breast cancer in female patients have improved over the decades; however, awareness of male breast cancer remains low and treatment can be delayed, resulting in 25% higher mortality rates. A 2023 study of both male and female patients showed 61.1% of participants were unaware of the possibility of male breast cancer.
With awareness low and stigma present, members can benefit from empathetic, helpful health education that is gender-specific and presented in an approachable way.
3. Colon cancer screenings
The lifetime risk of developing colorectal cancer is one in 23 for men and one in 25 for women. While it is generally a risk for older populations—and rates have been dropping due to increased screenings—the rates have been increasing by 1-2% for people under 55. This led the US Preventative Services Task Force to drop age recommendations for screenings from 50 to 45.
Despite the recommendations, plenty of hesitancy surrounds colonoscopies including fear, lack of information, negative past experiences, and bowel preparation. Preparing members for colonoscopies through educational information can help alleviate hesitancy and improve screening follow-ups.
4. Unaddressed mental health challenges
Society provided a huge focus on mental health during and following the COVID-19 pandemic, but it remains a challenge and a stigma for many members. Nearly 22% of Americans received mental health treatment in 2022; however, 60% of those with a mental illness don’t receive treatment in the early stages.
Unaddressed mental health challenges can lead to long-term physical health challenges as well. Direct medical costs are 149% higher for people with unrecognized symptoms of depression, and 51% of people with a mental health disorder also have a chronic medical condition. Early screenings, especially in the primary care setting, can identify early interventions and care managers can help reduce gaps in mental healthcare by engaging members with information and outreach efforts.
Demystify preventative care appointments with member education
As value-based care continues to emphasize whole-person health and improved care outcomes, payers can harness empathetic, engaging member education to make meaningful inroads and demystify health stigmas and hesitancies. In fact, the right care management programs might find value in anticipating points of hesitancy for common conditions, and empathetic communication can do just that.
The UpToDate® Member Engagement solutions are helping improve member adherence and educate ahead of care appointments. Through empathetic, diverse patient education content available digitally and automated interactive voice response (IVR) campaigns, customers have been able to make meaningful impacts on engagement rates and ROI:
- Cleveland Clinic was able to cut avoidable repeat colonoscopies by nearly 50% through engagement programs*.
- University of Alabama Medicine patients who engaged with educational outreach programs had 75% lower cancellation rates for endoscopy or coloscopy appointments.
- Memorial Gulfport found a 50% higher likelihood of attending follow-up appointments with primary care providers within 21 days of discharge.
With the right evidence-based education and engagement solutions and a solid data strategy to understand the whole person, payers can make inroads on preventative care appointments. To gain deeper insights into these considerations and how they impact care delivery, download the UpToDate® Point of Care Report, “Leveraging AI for prevention.”
Learn more about impacting member outcomes through evidence-based solutions from UpToDate and download the eBook “Care management: Building trust through personalized member engagement”.
*At the time of the study, UpToDate Patient and Member Engagement was called Emmi® Solutions.
