January 09, 2025

Exploring Innovation in Preventive Care

A fresh look at updated screening guidelines and evolving testing methods to assist employers in evaluating ways to improve their members’ screening compliance and reduce hidden cost barriers to accessing preventive care.

Full Series

Abnormal Blood Glucose and Type 2 Diabetes

Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage.¹ While screening for type 2 diabetes is not recommended by the UK’s National Screening Committee (NSC), the USPSTF does recommend screening for abnormal blood glucose as part of a cardiovascular risk assessment for adults aged 35 to 70 who are overweight or obese.^2,3 The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 with major risk factors.

Cardiovascular Disease (CVD)

Cardiovascular disease (CVD), which encompasses conditions such as coronary heart disease, cerebrovascular disease and peripheral arterial disease, is the most common cause of death globally.⁴ Screening for high blood pressure and cholesterol should be part of the routine preventive visit and can also be offered on-site during health fairs or in on-site clinics. For example, in the UK, workplace health checkups are being piloted by transportation and hospitality companies to determine employee risk for CVDs.⁵ Statins are deemed preventive drugs for adults ages 40–75 years who have one or more cardiovascular risk factors and an estimated 10-year CVD risk of 10% or greater.⁶ In some cases statins alone are an insufficient treatment course for secondary prevention of CVD. As such, in December of 2023, the UK-based NICE updated their guidance to include a new cholesterol target (i.e., low-density lipoprotein (LDL) cholesterol levels at 2.0 mmol per litre or less) for people who have had a heart attack or stroke in order to reduce their chances of having another.⁷ In the U.S., HDHPs typically cover the prescription cost before employees satisfy their deductible and cannot require cost sharing of any kind. However, for patients outside of the 40-75 age window, the plan can require cost sharing.

Chronic Kidney Disease (CKD)

CKD is a common but underdiagnosed condition in which the kidneys have been damaged and have reduced function for at least 3 months.8 CKD patients also tend to suffer from diabetes, high blood pressure or both. More than 10% of the general population in the world has CKD, with the majority of those diagnosed at age 65 or older.^9,10 Typically, CKD can be diagnosed using blood and/or urine tests. As many as 9 in 10 adults with CKD do not know they have the disease because it often has no symptoms in the early stages.^10,11 Therefore, those at a higher risk (someone with a metabolic disorder like high cholesterol or a genetic predisposition) should be tested regularly.¹¹ At this point, the USPSTF has determined that there is not enough evidence to support the potential benefits and harms of screening all adults for CKD.

At this point, the USPSTF has determined that there is not enough evidence to determine the potential benefits and harms of screening all adults for CKD. But it is important to note that their recommendations do not apply to those with diabetes or high blood pressure. For these populations, routine kidney function screening can lead to earlier CKD detection and more treatment options with respect to diet and lifestyle adjustments to slow the disease’s progression.

Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS)

“For every HIV infection prevented, an estimated $360,000 is saved in the cost of providing lifetime HIV treatment,” according to the CDC.¹² The USPSTF gave preexposure prophylaxis (PrEP) for the prevention of HIV infection an “A” rating for plan years beginning on or after June 11, 2020, in addition to annual screenings and risk assessments for HIV infection in adolescents and adults.¹³ In 2021 and 2024, the Department of Labor (DOL) clarified that employers should cover the full cost of services associated with a PrEP prescription, including lab testing and doctors’ appointments.^14,15 Following the USPSTF’s “A” rating, more generic PrEP medications have entered the market, lessening the cost burden. Currently, the cost of a monthly supply of PrEP is about $60 for generics and $2,000 for brand names, including Descovy and Truvada^.16

When building a prevention strategy to meet the needs of employees across different countries, it’s important to factor in existing stigma and discrimination associated with some diseases such as HIV/AIDS. To tackle this challenge, a multinational employer can foster a culture of health, dispel myths and emphasize voluntary screenings.

Reproductive Health as Preventive Care

In December 2022, HRSA updated its Women’s Preventive Services Guidelines to include expanded required services for plan years starting in 2024.¹⁷ These expanded services are focused on screening for gestational diabetes mellitus during and after pregnancy. More information about these recommendations and coverage considerations can be found on the HRSA website.

Globally, coverage for reproductive health for preventive purposes varies across countries. In Japan, for example, the government offers people who are pregnant a series of subsidized checkups through the pregnancy and following childbirth.¹⁸

More Topics

Resource Plan Design & Administration Preventive Services Primary Care