Screening for Chronic Conditions

Primary care accounts for less than 10% of total health care expenditures: however, primary care providers (PCPs) are often seen by their patients as their most trusted health advisors.


May 09, 2023

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.

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.10 While screening for type 1 diabetes is not recommended, the USPSTF recommends screening for abnormal blood glucose as part of a cardiovascular risk assessment for adults aged 35 to 70 who are overweight or obese.11 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. Timely diabetes screenings can lead to early detection and enrollment in appropriate wellness and chronic disease management programs.

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 among adults in the United States.12> 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. 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.13 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.14 CKD patients also tend to suffer from diabetes, high blood pressure or both. Roughly 15% of the adult U.S. population has CKD, with the majority of those diagnosed at age 65 or older.15 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. Therefore, those at a higher risk (someone with a metabolic disorder like high cholesterol or a genetic predisposition) should be tested regularly.15,16

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 virus (AIDs)

“For every HIV infection prevented, an estimated $360,000 is saved in the cost of providing lifetime HIV treatment,” according to the CDC.17 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.18 In 2021, 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.19 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.20

Reproductive Health as Preventive Care

In December 2022, HRSA updated its Women’s Preventive Services Guidelines21 to include expanded required services for plan years starting in 2024. 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.

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  1. Abnormal Blood Glucose and Type 2 Diabetes
  2. Cardiovascular Disease (CVD)
  3. Chronic Kidney Disease (CKD)
  4. Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency virus (AIDs)
  5. Reproductive Health as Preventive Care