Access Denied: The Growing Gaps in Care

You’ve probably heard the story — or lived it yourself. An employee leaves the emergency department after being told to follow up with a specialist within a week. The first available appointment? Four months out. By the time that visit happens, the issue has worsened, the cost of care has doubled, and your health plan is paying for a medical issue that could have been avoided. Stories like this remind us why we, as employers, must stay focused on helping to create better access pathways. 

And scenarios like this are happening more often than not. They point to a growing challenge in healthcare: limited access and a lack of cohesive care coordination. You’re providing your employees with valuable benefits, but that doesn’t mean they can actually get care when they need it.

Access Isn’t the Same as Availability

Having coverage doesn’t guarantee access. In 2024, the average wait time to see a specialist reached 26 days, a 24% increase since 2004, according to a physician access survey by the healthcare staffing and consultancy AMN Healthcare. 

When your people can’t get an appointment, they likely head to the emergency room (ER). The Agency for Healthcare Research and Quality (AHRQ) conducts and funds research to improve the safety, quality, accessibility and affordability of healthcare. It estimates that 13% to 27% of ER visits in the U.S. could be managed in physician offices, clinics, or urgent-care centers. ER visits drive up costs for your plan and ultimately delay care.

But even when employees get in the door, their care isn’t always connected. Sub-specialization has created a maze of providers who don’t necessarily communicate. A referral gets lost, a follow-up is delayed, or a procedure isn’t coordinated. Each gap adds friction and expense. 

Fragmented care has measurable business impact. Employees who can’t get timely, coordinated treatment stay out of work longer and often need more intensive care later. Now, add the medical crisis wait times to chronic condition patients who face treatment delays, and costs may increase while productivity declines.

Research consistently shows that patients with chronic conditions who delay or skip necessary care face higher health-care utilization and costs compared to those whose care is timely and well-coordinated. 

But the healthcare system isn’t always built for coordination. Primary care, specialists, hospitals, urgent care, and pharmacies often work in silos rather than in sync. Each has its own processes and priorities, which can make it difficult for patients to move smoothly from one step to the next. As a result, you may see the effects — rising costs, employee frustration and care experiences that fall short of expectations when you’re doing all you can to provide a robust health benefits program. 

The good news is, we can influence these outcomes through education and strategic partnerships, and ongoing communication with our employees. 

The Cost of Care Wait Times

Access to care directly impacts your operations. When employees can’t schedule timely appointments or navigate follow-up care, productivity and performance lag. Missed workdays accumulate. Chronic conditions worsen. Behavioral-health needs go unmet.

From a financial standpoint, when employees turn to emergency or urgent care for non-emergent needs, the cost can be several times higher than a primary-care visit. For example, UnitedHealthcare’s data show that the average emergency-department visit costs around $1,700, compared to roughly $165 for urgent care and $140 for a primary-care visit. 

These ER visits and multiple specialty appointments lead to duplicate testing, imaging, and prescriptions that might have been avoided. Those dollars add up, and they don’t improve outcomes.

You also invest significantly in benefits to attract and retain talent. If your employees can’t use those benefits effectively, the investment is not fully maximized. Health coverage only matters when it leads to real, timely care. Ensuring that employees can access and navigate that care is essential to maintaining a healthy, productive workforce.

Know Your Numbers

You can’t fix every flaw in the healthcare system, but you can take practical steps to protect your employees and your bottom line. Start by evaluating access metrics. Ask your carrier or third-party administrator for hard data: How long does it take to get a primary-care or specialist appointment? Which providers have open panels? What percentage of referrals result in completed visits? 

Next, reinforce the role of primary care. Encourage models that use a full team — physicians, nurse practitioners, physician assistants and care navigators. This expands capacity and improves follow-through. A strong primary-care team prevents unnecessary ER use and coordinates specialty referrals more efficiently.

You can also invest in navigation and education, and you don’t have to do it alone. Health Action Council offers tools, data, and programs that help members guide employees to the right care, in the right place at the right time. Employees need to understand how and where to access care: when to go to urgent care versus the ER, how to use telehealth, and which providers are in-network. The more confident they are in navigating the system, the fewer unnecessary claims and delays you’ll see.

Finally, connect access with productivity. Track absenteeism, disability claims, and employee engagement alongside health-plan data. You’ll often find that teams with fewer care delays also show stronger performance and lower turnover. 

Better access reduces costs — and it builds a culture of health that benefits everyone. 

A True Benefit 

As employers, you play a pivotal role in how people experience healthcare. By demanding transparency from your partners, strengthening primary-care coordination, and helping employees access the right care at the right time, you can close the growing gaps in the system.

Access to care should mean more than having insurance. It should mean getting timely, connected, and effective treatment. When care is delayed, everyone loses. When it’s accessible and cohesive, everyone benefits. 

Plan on joining us for our 2026 In-Value-Able Conference on Feb. 3–4, 2026. And tune into our webinars, compliance calls, and just-in-time programming for relevant topics. Let us know, how can we help make your benefits a true benefit?​​​​​​