Having health insurance does not guarantee access to care. Across Detroit, employers and labor leaders are moving beyond simply paying for coverage—they are shaping how care is delivered. By making primary care for employees more accessible, they are connecting workforces to timely, whole-person care that improves outcomes and lowers costs.
Our healthcare coverage system was designed to give people a pathway to care. But across Detroit, employers and labor leaders are finding that having coverage does not always mean employees can get the care they need.
More than 42% of Michiganders report delaying care because of access issues. Those barriers grow even more complex for people navigating mental health needs, substance use disorder, or other socioeconomic challenges that make care harder to reach.
The problem, then, is not whether people have health insurance. Most Michiganders do. It's whether the healthcare system makes it possible to find the right care, at the right time, in the right setting.
That question sat at the heart of a roundtable we convened in partnership with Crain's Detroit Business. We brought together healthcare, labor, and public health leaders to examine the barriers standing between Detroit workers and meaningful care, along with the role employers and labor organizations can play in closing them.
Moderated by Crain's Detroit Business president Jim Kirk, the conversation featured Dr. Avani Sheth, chief medical officer for Wayne County; LaShawn English, a director at UAW; and Chris Pricco, CEO of Marathon Health. The discussion surfaced a clear takeaway: Healthcare cannot be measured by coverage alone. Improving access and outcomes requires employers and labor organizations to look beyond whether a benefit exists and consider whether their people can access, navigate, and benefit from the care they're paying for.
Why doesn't health coverage guarantee access to care?
Our recent analysis of Michigan's healthcare landscape highlights an important disconnect: the state is not short on healthcare resources. Michigan is home to highly regarded health systems and providers. But having access to those resources on paper does not mean people can use them when they need to.
Chris Pricco drew a sharp distinction between having health coverage and having meaningful access to care. Employers and other healthcare purchasers, he argued, need to look beyond whether a benefit exists and consider whether employees can reach the care they are paying for. When care is difficult to find or navigate, people are less likely to use it, and problems that could have been addressed early can escalate.
The problem is more that there's a structural gap between having health coverage and having true healthcare access. —Chris Pricco, CEO, Marathon Health
That disconnect takes many forms. An employee may have insurance but struggle to find a primary care appointment. Someone experiencing anxiety, depression, or substance use disorder may technically have coverage but still fail to connect with appropriate care. And someone managing multiple chronic conditions may be left navigating a fragmented system that treats each condition separately.
Dr. Sheth described that fragmentation as one of the healthcare system's most fundamental barriers. People don't experience diabetes, depression, substance use, or other conditions in isolation, she noted, yet the system often expects them to connect with multiple providers and systems to get the care they need.
For employers, those gaps carry consequences well beyond the healthcare budget. Pricco pointed to data showing that untreated behavioral health and substance use issues can drive up the cost of other conditions, while poor access to primary care can contribute to greater emergency room use, hospitalizations, and other downstream spending.
The takeaway is straightforward: coverage only works if people can use it. That means making care accessible, timely, convenient, and affordable, and building a system that helps people find the right care before manageable health concerns become more complex and costly. Pricco emphasized that advanced primary care can serve as a central hub for connecting people to the broader healthcare system.
Why is behavioral health a workforce health issue?
The panel challenged the idea that behavioral health and substance use should be treated as separate from overall health.
Dr. Sheth pointed out that substance use disorders are far more common than many people realize, affecting people across workplaces and communities. Yet society has often treated substance use differently from other chronic conditions, framing it as a matter of willpower or personal failure rather than a health condition. That distinction matters because many of the factors shaping an employee's health extend far beyond what happens during a medical appointment.
We know that from a public health perspective, 80% of what determines somebody's health or well-being is not at the doctor's office or the hospital. —Dr. Avani Sheth, chief medical officer, Wayne County
That separation can make it harder for people to get the care they need. Mental health, substance use, and chronic physical conditions frequently overlap, but patients are often expected to navigate different systems and appointments for each. Dr. Sheth suggested turning that model upside down, bringing evidence-based treatment for substance use and other behavioral health needs into a more connected medical home rather than asking patients to coordinate it all themselves.
Stigma is another barrier. Dr. Sheth noted that behavioral health issues are already present in workplaces and primary care settings whether organizations acknowledge them or not. Her message to employers was simple: start talking about mental health and substance use as health issues, just as you would any other health concern.
LaShawn English described the stress and physical toll many workers in the labor sector carry and argued that employers cannot address workforce health without acknowledging the people behind the job. She emphasized the importance of creating an environment where employees feel comfortable asking for help, and where leaders are willing to address mental health, stress, depression, and addiction openly.
You cannot automatically give empathy. You cannot download recovery from an app store. —LaShawn English, director, UAW
Chris Pricco offered a practical example of what that can look like. One manufacturing client had deliberately worked on how it communicated about mental health to reduce stigma. The result was increased demand for Marathon Health's mental health services. So much demand, in fact, that the organization was temporarily oversubscribed. For Pricco, the example underscored an important point: employers can influence whether people seek care simply by changing the way they talk about it.
The implication for employers is bigger than adding another benefit to the list. Behavioral health needs to be part of the broader workforce health strategy, with care integrated into primary care where possible and workplace cultures that make it easier, not harder, for employees to seek help.
How can primary care become the hub for employee healthcare?
Rather than adding a standalone solution every time a new healthcare challenge emerges, the panelists pointed to primary care as the place to connect the pieces.
Pricco described an advanced primary care model built around easy access to primary care, prevention, integrated behavioral health, and ongoing relationships with providers. At Marathon Health, that philosophy translates into primary care located closer to where employees live and work, supported by timely appointments and mental health services available alongside primary care.
I think primary care can serve as the central hub of a lot of what happens after. —Chris Pricco, CEO, Marathon Health
Once patients have a trusted primary care relationship, that team can help them navigate the rest of the healthcare system. Pricco described primary care as a potential central hub for what happens next, particularly as patients move into specialty care or need help coordinating different aspects of their health.
That hub can be especially valuable for people managing multiple health concerns. Dr. Sheth described the current healthcare system as fragmented and siloed, with patients often expected to navigate separate systems for conditions that frequently overlap. A more connected primary care model can provide a foundation for coordinating those needs rather than leaving patients to connect the dots themselves.
Marathon Health's Michigan data suggests this approach can also produce measurable savings. Members who engage with the model see an average of $1,100 in annual healthcare savings.
The goal isn't simply to add another benefit. It's to create a connected entry point where employees can access preventive care, manage chronic conditions, address behavioral health concerns, and receive guidance when they need more specialized treatment. Making that entry point accessible matters. Pricco emphasized the importance of care that is timely, convenient, and affordable, noting that easier access helps people engage with primary care before health issues escalate into more expensive care.
How can employers shape the way healthcare works?
The conversation also highlighted a shift in the role employers and labor organizations play in healthcare.
Rather than simply purchasing a health plan and absorbing annual cost increases, employers can use their purchasing power to influence how care is delivered. Pricco argued that healthcare purchasers need to be active rather than passive, working with partners to build systems that are easier for employees to access and better aligned with their needs. That approach is not only good for the workforce, it also carries a proven return on investment.
For employers and labor organizations, becoming a more active healthcare purchaser starts with asking harder questions:
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Can employees get an appointment when they need one?
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Are physical and behavioral health treated as part of a connected care experience?
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Who helps employees navigate specialty care and other parts of the healthcare system?
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Are we measuring utilization alone, or whether people are getting healthier?
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Where are employees falling out of the system despite having coverage?
Dr. Sheth offered another reason employers have an important role to play. People spend a significant portion of their lives at work, she noted, while much of what determines health happens outside a doctor's office. That gives employers an opportunity to influence health in ways that extend beyond traditional benefits. They can make primary care easier to access, create workplace cultures where employees feel comfortable seeking help, and work with healthcare partners to build models that address the needs of their specific workforce.
English put that responsibility in practical terms, urging employers to look critically at the services they are paying for and whether employees are receiving good care. She argued that employers should hold the system accountable for the value and service it provides rather than accepting the status quo.
I want them to feel the human touch of a human and understand that we are not a piece of paper, and we are not a dollar value. —LaShawn English, director, UAW
The consequences of inaction reach beyond the healthcare budget. Untreated behavioral health and substance use issues can increase the cost and complexity of other conditions, while poor access to primary care can contribute to greater emergency room use, hospitalizations, and other downstream spending. The lesson holds: coverage only works if people can use it. That requires care that is timely, convenient, and affordable, and a system that helps people find the right care before manageable health concerns become more complex and costly.
Closing the gap starts with primary care
The question for employers isn't simply whether employees have healthcare coverage. It's whether they can actually use it.
Closing that gap requires timely access, fewer barriers, connected physical and behavioral healthcare, and trusted providers who can help people navigate what comes next.
Employers and labor organizations have an opportunity to do more than pay for healthcare. They can help shape a system their people can access, navigate, and trust, and primary care can be the place where that connection begins.
