Preventive Care: Role of Preventive Screenings in Managing Chronic Conditions

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.

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August 17, 2020

By taking a fresh look at some of the updated screening guidelines and evolving test methods, this guide will assist employers in evaluating ways to improve their members' compliance with preventive screening and remove cost barriers to accessing preventive care.

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

Typically, CKD can be diagnosed using blood and/or urine tests. Because CKD often has no symptoms in the early stages, some people at a higher risk should be tested regularly.

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.

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HIV/AIDS

For every HIV infection prevented, an estimated $355,000 is saved in the cost of providing lifetime HIV treatment.


Surgeon General Report

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

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TABLE OF CONTENTS

  1. Abnormal Blood Glucose and Type 2 Diabetes
  2. Cardiovascular Disease (CVD)
  3. Chronic Kidney Disease
  4. HIV/AIDS