August 17, 2020
Approximately one-third of all adult deaths in the United States can be attributed to heart disease and stroke, with these conditions also costing the U.S. health care system $199 billion per year and causing $131 billion in lost productivity.8 Routine screening for chronic conditions can often result in early detection and more effective management of both the condition identified as well as any comorbidities. Taking a fresh look at some of the updated screening guidelines and evolving test methods may lead to improving compliance with preventive screening and removing the 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.9 While screening for type 1 diabetes is not recommended, the USPSTF recommends (and therefore the ACA mandates) screening for abnormal blood glucose as part of a cardiovascular risk assessment for adults aged 40 to 70 who are overweight or obese.
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. Many chronic condition management solutions offer programs aimed at assisting those living with diabetes in managing their condition. Clinicians can either offer or refer patients to these interventions or others that promote chronic condition management, physical activity and/or healthier diet choices.10 Ensuring that timely diabetes screenings are completed 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.11 Statins are deemed preventive drugs for adults ages 40–75 years with no history of cardiovascular disease (CVD), one or more CVD risk factors, and a calculated 10-year CVD event risk of 10% or greater.12 For employees on HDHPs, the plan can cover the prescription cost before they satisfy their deductible and cannot require cost sharing of any kind. However, if an individual does not fit this description, the plan is permitted to require cost sharing.
Chronic Kidney Disease
Chronic kidney disease (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. It is estimated that about 90% of people living with CKD do so unknowingly. While the USPSTF determined that there is not enough evidence to determine the potential benefits and harms of screening all adults for CKD, 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 adjustment, to slow the disease’s progression.
The USPSTF recently rated preexposure prophylaxis (PrEP) for 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.15 The recent “A” rating given to PrEP will likely trigger an increase in cost to the employer plan in the short term. However, generics due to enter the market next year may soon lessen the initial burden.16
- 1 | United States Preventive Services Task Force (USPSTF). Recommendation Topics. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics. Accessed July 8, 2020.
- 2 | Business Group on Health. ACA Preventive Services Chart. https://www.businessgrouphealth.org/resources/aca-preventive-services-chart. Accessed July 31, 2020.
- 3 | Business Group on Health. HSA/HDHPs Can Now Provide Pre-Deductible Coverage for Insulin and Other Chronic Condition Treatments. https://www.businessgrouphealth.org/resources/hsa-hdhps-can-now-provide-pre-deductible-coverage-for-insulin-and-other-chronic-condition-treatments. Accessed July 8, 2020.
- 4 | Primary Care Collaborative. Spending for Primary Care Fact Sheet. https://www.pcpcc.org/sites/default/files/resources/PCPCC%20Fact%20Sheet%20PC%20Spend%20Aug%202018.pdf. Accessed July 31, 2020.
- 5 | Beckman AL, Becerra AZ, Marcus A, et al. Medicare Annual Wellness Visit association with healthcare quality and costs. Am J Manag Care. 2019;25(3):e76-e82. Published 2019 Mar 1.
- 6 | Medical Mutual. The Difference Between Preventive and Diagnostic Medical Care. https://www.medmutual.com/For-Individuals-and-Families/Healthy-Living/What-Is-Preventive-Healthcare/The-Difference-Between-Preventive-and-Diagnostic-Medical-Care.aspx. Accessed July 8, 2020.
- 7 | American Academy of Family Physicians (AAFP). Choosing Wisely® annual EKGs for low-risk patients. https://www.aafp.org/patient-care/clinical-recommendations/all/cw-ekg.html. Accessed July 8, 2020.
- 8 | Benjamin EJ, Virani SS, Callaway CW, et al. Heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137:e67–e492.
- 9 | Pippitt K, Li M et al. Diabetes mellitus: Screening and diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-109.
- 10 | United States Preventive Services Task Force. Final Recommendation Statement: Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening. October 26, 2015. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/screening-for-abnormal-blood-glucose-and-type-2-diabetes. Accessed July 8, 2020.
- 11 | United States Preventive Services Task Force. Screening for Cardiovascular Disease Risk with Electrocardiography: Recommendation Statement. https://www.aafp.org/afp/2018/0915/od1.html. Am Fam Physician. 2018 Sep 15;98(6):online.
- 12 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medicine. November 13, 2016. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication. Accessed July 31, 2020.
- 13 | United Kingdom National Health Service (NHS). Diagnosis: Chronic kidney disease. August 29, 2019. https://www.nhs.uk/conditions/kidney-disease/diagnosis/. Accessed July 8, 2020.
- 14 | United States Preventive Services Task Force (USPSTF). Understanding Task Force Recommendations: Screening for Chronic Kidney Disease. August 2012. https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/1881. Accessed July 31, 2020.
- 15 | Business Group on Health. New ACA Preventive Service Coverage Requirement for HIV (PrEP). https://www.businessgrouphealth.org/resources/new-aca-preventive-service-coverage-requirement-for-hiv-prep. Accessed July 8, 2020.
- 16 | Business Group on Health. HIV/AIDS: Despite Progress, Much Work Remains. https://www.businessgrouphealth.org/en/resources/hiv-aids-despite-progess-much-work-remains. Accessed July 31, 2020.
- 17 | Centers for Disease Control and Prevention. Breast Cancer Screening Guidelines for Women. https://www.cdc.gov/cancer/breast/pdf/BreastCancerScreeningGuidelines.pdf. Accessed July 8, 2020.
- 18 | National Institute of Health: National Cancer Institute. Dense Breasts: Answers to commonly asked questions. https://www.cancer.gov/types/breast/breast-changes/dense-breasts. Accessed July 8, 2020.
- 19 | Mayo Clinic. Virtual Colonoscopy. https://www.mayoclinic.org/tests-procedures/virtual-colonoscopy/about/pac-20385156. Accessed July 8, 2020.
- 20 | Centers for Disease Control and Prevention. Colorectal (Colon Cancer): Screening Tests. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm. Accessed July 8, 2020.
- 21 | Simon S. Colorectal Cancer Screening: What Are My Options? American Cancer Society. March 2, 2020. https://www.cancer.org/latest-news/understanding-tests-that-screen-for-colon-cancer.html. Accessed July 8, 2020.
- 22 | Cavallo J. Solving the mystery of why colorectal cancer Is on the rise in young adults: A conversation with Kimmie Ng, MD, MPH. The ASCO Post. https://www.ascopost.com/issues/june-25-2019/solving-the-mystery-of-why-colorectal-cancer-is-on-the-rise-in-young-adults/. Accessed July 8, 2020.
- 23 | Centers for Disease Control and Prevention. Lung Cancer: Who Should Be Screened for Lung Cancer? https://www.cdc.gov/cancer/lung/basic_info/screening.htm. Accessed July 8, 2020.
- 24 | American Cancer Society. Can lung cancer be found early? https://www.cancer.org/content/cancer/en/cancer/lung-cancer/detection-diagnosis-staging/detection.html. Accessed July 8, 2020.
- 25 | Business Group on Health. Webinar Presentation: A conversation about the Impact of the expanding field of genetic testing on employers and key considerations for coverage. February 4, 2020.
- 26 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement: BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing. August 20, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing. Accessed July 8, 2020.
IntroductionEmployers' Guide to Preventive Care
Part 1Preventive Care: Regulatory Framework
Part 2Preventive Care: "Annual" Visits and Preventive Screening Considerations
Part 3Preventive Care: Role of Preventive Screenings in Managing Chronic Conditions
Part 4Preventive Care: Cancer Screening Guidelines
Part 5Preventive Care: Emerging Preventive Care Coverage Considerations
Part 6Preventive Care: Opportunities for Employers