Preventative Care: A Win-Win For Employers And Employees
When it comes to taming employer-sponsored healthcare costs, virtually nothing tops a workforce that takes advantage of fully covered preventative care benefits and age appropriate screenings. Unfortunately, current estimates indicate that Americans use preventive services at about half the recommended rate. There are a variety of reasons for this, but perhaps the largest reason involves a misconception about what constitutes covered preventive care.
Preventative Care Often Results In Early Detection
Each year, 7 in 10 American deaths are from chronic diseases like diabetes and heart disease. Many of these diseases can be prevented with early detection and appropriate care. According to the CDC, if everyone in the U.S. received recommended clinical preventive care, over 100,000 lives a year could be saved. With statistics like this, it is easy to see why it’s so important for employees to take advantage of fully covered preventive care benefits provided by employer-sponsored health plans.
What is Preventive Care?
You likely engage in some form of preventive care on a regular basis as a matter of course. Perhaps you exercise regularly, or you decide against that extra slice of pie after dinner. These are choices you make in an effort to prevent health problems in the future. In this way, you are using a preventive measure to improve your health.
But true preventive care involves much more. Taking advantage of preventive health services such as cancer screenings, blood pressure checks and vaccinations, to name just a few, can do a lot to help you stay healthy, avoid or delay the onset of disease, keep existing health conditions under control, and reduce your healthcare costs as well.
While Americans spend billions of dollars on healthcare each year, most of that money goes to the diagnosis and treatment of existing illness.
This is perhaps a result of the way the healthcare system came into being in the first place. For many decades, preventive services were considered a luxury by cash-strapped Americans. Medical science itself did not put a large emphasis on preventive care. But as advances in medical research began to reveal a strong correlation between early detection of disease and successful treatment outcomes, the outline for preventive care services came into being.
Preventive or Diagnostic?
Preventive services are tests or treatments that your physician provides to prevent illnesses before they cause you to have symptoms or problems. For instance, your doctor may suggest that you have a colon cancer screening because of your age or family history. In this case, your screening would be considered preventive care, and would normally be covered under a preventive care provision in your insurance plan.
On the other hand, suppose your doctor orders the same screening test because you are experiencing troubling symptoms like bleeding or irregularity that lead him to suspect you have a problem. For the purposes of your insurer, the screening in this scenario would be diagnostic in nature and may not be fully covered by your plan.
Who Makes the Guidelines?
In an effort to encourage Americans to take advantage of preventive care services and thereby save lives, the U.S. Preventive Services Task Force was established in 1984. An independent group of national experts in prevention and evidence-based medicine, the USPSTF is made up of 16 volunteer members who come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology, and nursing. These volunteers work to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
Each year, the USPSTF issues new or revised guidelines about the types of screenings that will produce the best outcomes in terms of disease prevention and lives saved. As an example, recent recommendations include coverage for Hepatitis B and preeclampsia.
PPACA Minimum Requirements for ACA Plan Compliance
Acting in part on the recommendations of the USPSTF, the Affordable Care Act mandates that a wide variety of preventive services be fully covered. Our previous post about effective wellness programs with an emphasis on screenings and immunizations mentions a number of USPSTF recommendations that have been accepted as part of the minimum requirements for preventive care coverage for ACA plan compliance.
According to PHS Section 2713, preventive services under group plans must include the following broad types of services:
- Services that have a rating of “A” or “B” in the current recommendations of the USPSTF
- Immunizations for routine use in children, adolescents, and adults recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC)
- For infants, children, and adolescents, preventive care and screenings provided for in the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA)
- For women, preventive care and screening provided for in comprehensive guidelines supported by HRSA, which are in addition to the existing recommendations of the USPSTF
Because covered preventive services change periodically based on evidence-based recommendations of the USPSTF, HRSA, ACIP, and CDC, more preventive services are likely to be covered as evidence of their benefit to the population is verified in the future. This is good news for Americans interested in receiving quality health care.
What Should Employers Do?
However, this type of coverage is only effective if covered individuals take advantage of it. How can employers encourage their workers to use preventive care, and why should this be a priority?
Simply put, the more your employees take advantage of preventive care, the more cost-effective their care becomes. Early disease detection and preventive care help bend the curve of healthcare costs for your business. Thus, preventive care is a win-win situation for you and your employees.
In order to encourage your workers to utilize the preventive care available, it is important that you stay informed of what preventive services are covered by your plan. This changes periodically, based on the recommendations of USPSTF and other agencies, so it is wise to stay alert to current coverage information.
Additionally, it is a good practice to bolster employee communication regarding preventive services. If employees are consistently made aware of the services offered, it is likely that they will more readily avail themselves of preventive screenings and tests, saving your business money and potentially saving the lives of your employees as well.
For more information about preventive care communication and employer-sponsored plans, please contact us.