The Benefits Hierarchy of Needs: Why Employers & Payers Should Prioritize Gut Health Benefits

Maslow’s famous hierarchy of needs pyramid offers a framework for understanding human psychology and motivation. To reach higher levels of meaning and purpose (like self-actualization), the theory goes, humans must first meet their basic physiological needs (for food, water, shelter, and rest).

A hierarchy of needs is a helpful framework for thinking about employer-sponsored benefits, too, especially in this era of ever-increasing healthcare costs.

At the base of the hierarchy (often portrayed as a pyramid) should be those benefits that let employees achieve or maintain basic physiological health – the “need to haves,” in other words. As you move up the pyramid, benefits become closer to the “nice to haves,” until you reach the top, where there’s a ping pong table in the office.

The question, then, is which benefits truly belong in the base of the pyramid and which should go further up. Logically, those “need to haves” should be the ones with the greatest ROI: the benefits that not only enable employees to maintain their health but also those that do it efficiently, those that create an excellent user experience, and those that improve health and wellness holistically.

For all of these reasons, benefits specific to gastrointestinal (GI) health deserve to be at the pyramid’s base. In this piece, I’ll explain why that is.

GI health impacts every other facet of wellness

Between 70 and 80 percent of immune cells are in the gut. As we all know, the immune system impacts overall wellness, including our ability to fight diseases we’re exposed to. And that ability is directly mediated by the health of the gut.

But the relationship between GI health and other types of health is even more deeply woven and complex than that figure suggests.

For example: 95 percent of serotonin is produced in the gut. Serotonin, of course, plays a big role in mental illnesses like depression and bipolar disorder. An imbalanced gut, then, can impact mental health.

But the relationship is even more complicated: depression can lead us to crave highly palatable foods like french fries and ice cream. And yet consumption of these highly palatable (and highly processed) foods can negatively affect the bacteria in the gut where serotonin is made. That’s a complex interplay many mental healthcare professionals aren’t trained to navigate.

GI health also impacts a variety of other systems in the body:

• Vision – There are retina-specific T-cells in the gut. The condition uveitis, a precursor to glaucoma and cataracts, has been linked to those T-cells. It’s also been shown that the condition is more common in those with less-diverse gut microbiota and fewer anti-inflammatory species in the gut.
• Heart health – Heart disease and strokes are the number-one cause of death in the United States. Nutrition is a major factor in developing and treating heart health.
• Diabetes – Another leading chronic condition, diabetes can be managed in part with nutrition interventions. One common side effect of diabetes is gastroparesis, a painful GI condition.
• Obesity – Yet another chronic condition in the US, obesity contributes to a variety of digestive diseases. Not only that, digestive side effects are the most common type for those on GLP-1 drugs, the breakthrough success in treating obesity. In fact, seven percent of patients discontinue GLP-1s because of these unpleasant side effects.
• Dental health – Tooth decay is another leading chronic health condition in the US. It can lead to problems eating, which can trigger or exacerbate existing digestive difficulties.

In short, GI health interplays in complex ways with all other aspects of health and wellness. For employers looking to choose the right benefits for their workers, that’s actually a good thing.

A lack of GI benefits Is costing employers money

Digestive health is one of the most overlooked and misunderstood problems in healthcare. In fact, 40 percent of Americans experience GI problems that are painful and debilitating. These symptoms can be particularly pernicious because they’re often hard to diagnose and treat.

Primary care physicians rarely have specialized training in GI issues or nutrition, which means an initial doctor’s visit typically leads to a referral. But wait times for GI specialists are often long, thanks to a severe shortage of GI physicians.

Even once a patient gets a referral, they often have a long road ahead. GI issues are notoriously difficult to diagnose; more than 40 percent of IBS patients experience symptoms for more than five years before receiving a diagnosis. In that time, many people end up in acute pain at some point and so go to the ER. Digestive issues are, in fact, a leading cause of ER admissions. Patients who visit the ER with GI issues are admitted to the hospital in about two-thirds of cases.

All this adds up. The average healthcare cost of individuals with digestive disease is $17,200 per year.

These are all direct financial costs related to GI issues. There are also productivity costs. In our own research, we’ve found that employees report being less productive at work while they’re experiencing GI symptoms. A sizable minority even report missing work to deal with their symptoms.

How GI-specific benefits can improve overall health outcomes and drive down costs

GI-specific benefits help reduce these costs by connecting employees directly with trained specialists (including gastroenterologists, general practitioner physicians, registered dietitians, and health coaches) who can both help them manage diagnosed disorders and identify the underlying causes of undiagnosed symptoms.

This is true particularly when GI benefits are delivered digitally. Digital delivery allows for better access, shorter wait times, and greater personalization than benefits mediated via in-person visits.

When an employee can virtually meet with a registered dietitian, a health coach or a gastroenterologist, they’re less likely to need time off work for office visits. And employees with greater social vulnerability (limited access to transit, for example) are at less of a disadvantage than with in-person benefits.

GI benefits belong in the base of the benefits hierarchy

The digestive system affects every other aspect of human health and wellness. It’s only logical, then, that members should have access to benefits that let them directly address their GI health.

When employers and payers invest in such benefits, they set people up with the resources and access to manage their health efficiently and proactively – while setting themselves up for financial savings throughout the year.

When it comes time to build your benefits package, consider the impact that adding GI-specific benefits can have on member wellbeing, organizational productivity, and your bottom line.

Photo: Nuthawut Somsuk, Getty Images

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