The Most Expensive Appointment Is the One That Never Happens

Why the collapse in preventive care is the benefits story nobody’s talking about and the cost crisis everyone will feel

There’s a quiet trend building inside employer health plans right now that won’t show up in a claims report for another 12 to 36 months. It won’t trigger a stop-loss conversation this year. It won’t appear on a renewal summary or a pharmacy cost analysis. But when it does arrive (and it will) it’ll be one of the most expensive line items on the plan, and it starts with a skipped appointment.

According to our 2026 Member Health Goals Report, just 17% of members plan to complete an annual physical this year. That’s a 45.3% decline in a single year, across a population of more than 100,000 members. That’s self-reported intent data, which means the actual completion rate is likely lower still. Not a blip. Not a post-pandemic correction. A steady, significant withdrawal from the single most important touchpoint in preventive healthcare.

Primary Care is the Front Line and It's Going Unmanned

The annual physical isn’t just a wellness ritual. It's how the healthcare system catches what members can't see coming like the silent hypertension, the elevated A1C, the lump that warrants a referral. It's the appointment that sets everything else in motion, and when that appointment doesn't happen, none of those early diagnoses or catches happen either. The conditions don't disappear. They progress: undetected, unmanaged, and increasingly expensive.

The math on this is unambiguous. Early-stage cancer diagnoses cost an average of $200,000 to $250,000 less in the first year of treatment compared to late-stage diagnoses.¹ But the cancer scenario, while dramatic, is the tail risk. The more probable and cumulative cost story lives in the conditions that don't make headlines: the undetected pre-diabetes that becomes Type 2 diabetes and eventually dialysis. The unmanaged hypertension that becomes a cardiac event. The untreated depression that becomes disability leave. Across a workforce of any meaningful size, the probability that at least one of these trajectories is already in motion and undetected, because they didn’t see a doctor this year, isn’t low. It’s close to certain.

The annual physical isn't a cost. It's the cheapest intervention in the entire benefits stack and it's the one members are skipping at the highest rate.

Why Members Are Disengaging and Why Education Won't Fix It

The instinct when utilization drops is to assume an awareness problem. Send a reminder. Post something on the benefits portal. Add a line to the open enrollment email. If members just knew their preventive visit was fully covered, they would go.

But the evidence doesn’t support that assumption. Most members know preventive care is covered. The barriers driving disengagement are structural, not informational and solving them requires removing friction, not adding messaging.

Primary care physician (PCP) shortages have reached crisis levels in many parts of the country, with the Association of American Medical Colleges projecting a shortage of up to 86,000 physicians by 2036.³ In practical terms, members who try to schedule an annual physical are often looking at wait times of months, long enough that the intention fades before the appointment is ever made. For younger members, many of whom have never established care with a PCP, the friction of finding an in-network provider, verifying availability, and navigating a scheduling system is enough to make avoidance the path of least resistance.

Cost perception is suppressing utilization in ways most employers don’t realize. Despite ACA requirements that preventive care be covered at zero cost-sharing, a meaningful share of members assume there will be a bill because there’s been one before. Plan design errors, coding issues, or services delivered during a preventive visit that get billed as diagnostic are more common than most benefits teams realize. That assumption, once formed, is hard to dislodge with a generic reminder because the reminder doesn’t address the underlying distrust.

Then there’s the category of members who are just simply not engaged with their benefits at all, the ones who only activate when something goes wrong. For this group, the annual physical isn’t on their radar because their benefits experience has never given them a reason to put it there.

The Alarming 12 to 36 Month Lag

Here’s what makes the preventive care decline uniquely dangerous as a cost signal: the consequences are delayed. A chronic condition that goes undetected at a 2025 physical appears in a claims report in 2026 or 2027, often in a more expensive and advanced form. By then, the plan design decisions that could’ve changed the trajectory are already in the past.

This is the claims lag problem that makes preventive care so chronically under-prioritized. The cost of inaction is real but deferred. The ROI of action is real but slow. And in an industry that measures success at annual renewal, deferred consequences tend to lose to immediate costs.

But the data makes the case clearly: the benefits leaders who treat the 45.3% decline in preventive care intent as a 2025 planning problem, rather than a 2027 claims problem, are the ones who’ll be ahead of the curve when the bill arrives. And based on everything HealthJoy's data shows about what follows an undetected chronic condition, an unscreened cancer, or an unaddressed mental health concern, the bill is coming.

What High-Performing Employers Are Doing Differently

The employers making progress on preventive care utilization aren’t the ones sending better emails. They’re removing friction at the moment a member is most likely to act.

1. Fix the cost perception problem first: Before investing in any outreach campaign, audit how preventive visits are actually being adjudicated on your plan. If members have received unexpected bills for visits that should’ve been fully covered due to coding errors, diagnostic add-ons, or plan design gaps, no reminder will overcome the distrust that creates. Pull a sample of preventive visit claims from the last 12 months and verify that zero cost-sharing is being applied correctly. This is a high-ROI, low-cost action.
2. Replace the supply problem with a virtual solution: If your members can't get a PCP appointment within a reasonable timeframe, a personalized reminder to schedule one isn’t a solution. Virtual primary care has matured significantly and now offers a clinically credible alternative for the annual wellness visit. Employers who add virtual primary care access don't just improve preventive utilization, they eliminate the wait time or transportation barriers entirely for the segment of the population most likely to disengage.
3. Personalize outreach around timing and friction removal: A generic reminder to "schedule your annual physical" is easy to ignore. The distinction that moves members isn't better copy, it's removing the next step entirely. A prompt that identifies a member as overdue for a specific screening and connects them directly to an available in-network provider with open appointments or to the virtual solution eliminates the friction between intent and action. That’s the difference between a campaign and a closed loop.
4. Treat the annual physical as an entry point, not an endpoint: The most effective preventive care strategies don't just get members to a visit they connect what happens at that visit to the rest of the benefits ecosystem. A member flagged for pre-diabetes should have a clear, frictionless path to a chronic condition management program. A member who discloses a mental health concern should have an immediate warm handoff to mental health support. When the physical becomes the starting point of a coordinated care experience rather than a standalone transaction, utilization goes up because members experience a reason to come back.

The Window Is Now

The 17% of members who plan to complete their annual physical will, in aggregate, generate fewer undetected conditions, fewer late-stage diagnoses, and lower long-term plan costs than the 83% who don't.

That gap is addressable with a plan design that removes unintended barriers, a virtual care option that solves for access, and an outreach infrastructure that eliminates friction.

Here's one thing you can do now regardless of your vendor situation: pull your preventive care adjudication data from the last plan year and find out how many members received unexpected cost-sharing on a visit that should’ve been fully covered. If the answer is more than zero, and for most plans, it will be, you have a fixable problem that’s actively suppressing the utilization you're trying to drive.

The claims that will define 2027 renewals are being set right now, in the appointments members aren’t making. The employers who understand that (and act on it now) are the ones who will have a different conversation at their next renewal than everyone else.

Read the full 2026 Member Health Goals Report.

This article is part of HealthJoy's 2026 Member Health Goals Report series: our annual analysis of self-reported member health intent data across more than 100,000 members. The full report covers eight workforce health trends shaping 2027 employer costs.

Based on self-reported health intent data from 106,768 members collected January 1, 2025 – February 28, 2026.

¹ Mariotto AB, et al. Projections of the Cost of Cancer Care in the United States: 2010–2020. JNCI, 2011; updated estimates. ² Buttorff C, et al. Multiple Chronic Conditions in the United States. RAND Corporation, 2017. ³ Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections from 2021 to 2036. 2023.