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.
Vendor Partnerships and Reimbursement
- Engage your partners in steerage of members to appropriate testing: Ensure navigators and patient advocacy teams are equipped to steer members to the appropriate tests and testing site. Also, empower your navigator to educate patients about what tests they can expect to receive and the forecasted cost for the visit, including what is covered and the expected out- of- pocket cost.
- Conduct preventive screening communications campaigns: Employers in partnership with navigators, engagement programs, health plans and other partners should conduct periodic simple but targeted communication campaigns based on claims data to drive appropriate and timely preventive screening utilization. Consider incorporating these communication campaigns into your existing well-being incentive program as an additional layer of health promotion.
- Consider implementing bundles for common preventive services: The risk of surprise or balance bills increases for screening tests that require ancillary services, such as anesthesia for colonoscopies. Work with health plans to implement payment bundles for these services to lower the likelihood of employees deferring preventive services due to out-of-pocket cost concerns.
Employee Empowerment
- Bring screenings directly to your employee populations: For highly dispersed populations, consider supplementing care available in the community by offering mobile screening facilities. Mobile clinics provide a convenient solution that allows patients better access to preventive health services across more diverse geographies.
- Incentivize the use of primary care and screening: Evaluate if employee incentives promote better compliance with screenings and prevention. If so, consider implementing incentives that connect patients with primary care providers and basic screening schedules.
- Encourage shared decision-making between members and their providers: If a screening test is recommended by the United States Preventive Services Taskforce (USPSTF), Health Resources and Service Administration (HRSA), the Centers for Disease Control and Prevention (CDC) or another federal agency only for specific patient populations, patients who do not meet the screening criteria will have to pay their share of out-of-pocket costs if they choose to receive the screening. Members should discuss with their providers which screenings are recommended for them, and patients as well as providers should be able to access information about the out-of-pocket cost implications easily.
- Target populations at high risk for common comorbidities in screening outreach: Many employers have implemented initiatives targeting employee subpopulations with common chronic diseases, which can serve as additional touchpoints for patient education on preventive screenings. For example, advocating for kidney disease screenings for those enrolled in a diabetes management program with health plans and other vendor partners can lead to better coordination of care and ultimately better chances of early detection.
Vision for the Future
- Monitor the rapidly evolving biomarker and genetic testing landscape: Appropriate utilization of biomarker and genetic tests may identify elevated disease risks that can lead to appropriate modification of screening frequency and improve patient outcomes. It is important that in cases of increased genetic risk, personalized shared decision-making is deployed, as the course of action depends on the level of risk, treatment available and the patient’s set of circumstances and preferences.
- Take advantage of telehealth-enabled prevention: As virtual health programs have risen to prominence during the pandemic, employers can consider how virtual preventive care can best serve their employees. Virtual primary care can assist in lessening the preventive visit gaps for patients who have barriers like transportation, accessibility concerns or other SDOH.
- Consider new, less invasive screenings: Consider adjusting coverage to include new, less invasive forms of screening, such as home tests for colorectal and cervical cancers as well as biomarker and genetic testing for populations with the appropriate risk profile.
- Provide continuous screening support for cancer survivors: Ensure that cancer survivors in your employee population are still engaging in screenings and have the ongoing support needed as part of a comprehensive oncology solution.
Measuring Your Success
- Include preventive screening compliance in vendor performance measures: For vendors who can directly influence and drive patients’ compliance with preventive screening guidelines, consider implementing a vendor performance metric that is tied to improving the rates of screening within your employee population.
- Consider potential impacts of SDOH in Evaluating Screening Compliance: Analyze your population’s screening compliance through the lens of SDOH to understand which populations may need additional help to access care. Consider adjusting paid leave policies if the hourly population is at risk of forgoing appropriate care due to concerns about lost wages.
- 1 | Minemyer, P. Patients are likely to avoid preventive care should ACA coverage ruling stand, survey finds. March 8, 2023. https://www.fiercehealthcare.com/payers/patients-are-likely-avoid-preventive-care-should-aca-coverage-ruling-stand-survey-finds. Accessed April 24, 2023.
- 2 | Ugai, T., et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nature Reviews Clinical Oncology. 2022; 19(10): 656-673.
- 3 | United States Preventive Services Task Force (USPSTF). Recommendation Topics. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics. Accessed March 9, 2023.
- 4 | Business Group on Health. ACA Preventive Services Chart. November 3, 2022. https://www.businessgrouphealth.org/resources/aca-preventive-services-chart. Accessed March 9, 2023.
- 5 | National Association of Community Health Centers. Closing the Primary Care Gap. February 2023. https://www.nachc.org/wp-content/uploads/2023/02/Closing-the-Primary-Care-Gap_Full-Report_2023_digital-final.pdf. Accessed April 24, 2023.
- 6 | Patient-Centered 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 March 9, 2023.
- 7 | McAlearney AS, Gaughan AA, Shiu-Yee K, DePuccio MJ. Silver linings around the increased use of telehealth after the emergence of COVID-19: Perspectives from primary care physicians. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221099485. doi: 10.1177/21501319221099485. PMID: 35588253; PMCID: PMC9130845.
- 8 | Elevance Health. Nearly four in five Americans who have used virtual primary care say it helped them take charge of their health. October 31, 2022. https://www.elevancehealth.com/newsroom/virtual-primary-care-helps-consumers-take-control-of-their-health.
- 9 | Whitehead DC, Mehrotra A. The growing phenomenon of “virtual-first” primary care. JAMA. 2021;326(23):2365–2366. doi:10.1001/jama.2021.21169
- 10 | Pippitt K, Li M, et al. Diabetes mellitus: Screening and diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-109.
- 11 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement- Prediabetes and Type 2 Diabetes: Screening. August 24, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes. Accessed April 24, 2023.
-
12 | United States Preventive Services Task Force. Screening
for cardiovascular disease risk with electrocardiography: Recommendation statement. Am Fam Physician. 2018 Sep 15;98(6): online.
https://www.aafp.org/afp/2018/0915/od1.html. Accessed March 9, 2023. - 13 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. August 23, 2022 https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication#:~:text=What%20does%20the%20USPSTF%20recommend,Initiate%20a%20statin. Accessed March 9, 2023.
- 14 | United States Preventive Services Task Force (USPSTF). Understanding Task Force Recommendations: Screening for Chronic Kidney Disease. August 2012. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chronic-kidney-disease-ckd-screening. Accessed March 9, 2023.
- 15 | Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. July 12, 2022. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html#:~:text=CKD%20Is%20Common%20Among%20US%20Adults&text=More%20than%201%20in%207,are%20estimated%20to%20have%20CKD. Accessed April 24, 2023.
- 16 | United Kingdom National Health Service (NHS). Diagnosis: Chronic kidney disease. August 29, 2019. https://www.nhs.uk/conditions/kidney-disease/diagnosis/. March 9, 2023.
- 17 | Centers for Disease Control and Prevention. CDC’s HIV Prevention Progress in the United States. October 1, 2021. https://www.cdc.gov/hiv/dhap/progress/index.html. Accessed April 24, 2023.
- 18 | Business Group on Health. New ACA Preventive Service Coverage Requirement for HIV (PrEP). June 4, 2019. https://www.businessgrouphealth.org/resources/new-aca-preventive-service-coverage-requirement-for-hiv-prep. Accessed March 9, 2023.
- 19 | Department of Labor. FAQs About Affordable Care Act Implementation Part 47. July 19, 2021. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-47.pdf. Accessed April 24, 2023.
- 20 | Varney, S. HIV Preventive Care is Supposed to Be Free in the U.S., So, Why Are Some Patients Still Paying? Kaiser Family Foundation Health news. March 3, 2022. https://khn.org/news/article/prep-hiv-prevention-costs-covered-problems-insurance/. Accessed April 24, 2023.
- 21 | Health Resources and Services Administration. Women’s Preventive Services Guidelines. December 2022. https://www.hrsa.gov/womens-guidelines. Accessed April 24, 2023.
- 22 | Fedewa SA, Star J, Bandi P, et al. Changes in cancer screening in the US during the COVID-19 pandemic. JAMA Netw Open. 2022;5(6):e2215490. doi:10.1001/jamanetworkopen.2022.15490
- 23 | Rodriguez S. Patient Engagement HIT. Preventive care takes a hit, cancer screenings drop 80% amid pandemic . June 6, 2022. https://patientengagementhit.com/news/preventive-care-takes-a-hit-cancer-screenings-drop-80-amid-pandemic. Accessed April 24, 2023.
- 24 | Meister, K. Prevent Cancer Foundation. Alarming new study shows pandemic is disrupting cancer screenings. February 25, 2022. https://www.preventcancer.org/2022/02/alarming-new-study-shows-pandemic-is-disrupting-cancer-screenings/. Accessed April 24, 2023.
- 25 | Callison K, et al. Cancer screening after the adoption of paid-sick-leave mandates. New England Journal of Medicine. 2023; 388.9: 824-832.
- 26 | Abul-Husn, N.S., Soper, E.R., Odgis, J.A, et al. Exome sequencing reveals a high prevalence of BRCA1 and BRCA2 founder variants in a diverse population-based biobank. Genome Med. 2020; 12 (2) . https://doi.org/10.1186/s13073-019-0691-1. Accessed March 9, 2023.
- 27 | 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 March 9, 2023.
- 28 | National Institute of Health. Biomarker Testing for Cancer Treatment. December 14, 2021. https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment#:~:text=A%20biomarker%20test%20may%20be,those%20you%20are%20born%20with. Accessed April, 24, 2023.
- 29 | Business Group on Health. 2023 Large Employers’ Health Care Strategy and Plan Design Survey. August 2022. Available at:https://www.businessgrouphealth.org/%20resources/2023-large-employers-health-care-strategy-survey-intro. Accessed March 9, 2023.
- 30 | Klein E A, Richards D, Cohn A., Tummala M, Lapham R, Cosgrove D,. et al. . Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Annals of Oncology. 2021; 32(9), 1167-1177.
- 31 | United State Preventive Services Task Force. Draft Recommendation Statement Breast Cancer: Screening. May 9, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults#:~:text=Recommendation%20Summary&text=The%20USPSTF%20recommends%20biennial%20screening,ages%2040%20to%2074%20years.&text=The%20USPSTF%20concludes%20that%20the,age%2075%20years%20or%20older. Accessed May 10, 2023.
- 32 | American Cancer Society. American Cancer Society Recommendations for the Early Detection of Breast Cancer. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed May 10, 2023.
- 33 | Centers for Disease Control and Prevention. What Does It Mean to Have Dense Breasts? September 26, 2022. https://www.cdc.gov/cancer/breast/basic_info/dense-breasts.htm. Accessed April 24, 2023.
- 34 | 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 March 9, 2023.
- 35 | Food and Drug Administration. FDA Updates Mammography Regulations to Require Reporting of Breast Density Information and Enhance Facility Oversight. March 9, 2023. https://www.fda.gov/news-events/press-announcements/fda-updates-mammography-regulations-require-reporting-breast-density-information-and-enhance. Accessed April 24, 2023.
- 36 | Mayo Clinic. Virtual Colonoscopy. https://www.mayoclinic.org/tests-procedures/virtual-colonoscopy/about/pac-20385156. Accessed March 9, 2023.
- 37 | Centers for Disease Control and Prevention. Colorectal (Colon Cancer): Screening Tests. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm. Accessed March 9, 2023.
- 38 | ACS Medical Content and News Staff. 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 March 9, 2023.
- 39 | 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. June 25, 2019. 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.
- 40 | National Cancer Institute . Why Is Colorectal Cancer Rising Rapidly among Young Adults?. November 5, 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults. Accessed April 24, 2023.
- 41 | 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 March 9, 2023.
- 42 | American Cancer Society. Can Lung Cancer Be Found Early?. January 8, 2023. https://www.cancer.org/content/cancer/en/cancer/lung-cancer/detection-diagnosis-staging/detection.html. Accessed March 9, 2023.
- 43 | Richards TB, Soman A, Thomas CC, et al. Screening for Lung Cancer — 10 States, 2017. MMWR Morb Mortal Wkly Rep 2020; 69:201–206. http://dx.doi.org/10.15585/mmwr.mm6908a1.
- 44 | U.S. Preventive Services Task Force. Cervical Cancer: Screening. August 21, 2018. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening . Accessed March 9, 2023.
- 45 | Centers for Disease Control and Prevention. HPV Vaccination Recommendations. November 16, 2023. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html. Accessed April 24, 2023.
- 46 | National Cancer Institute. Cervical Cancer Prognosis and Survival Rates. January 6, 2023. https://www.cancer.gov/types/cervical/survival#:~:text=When%20cervical%20cancer%20is%20diagnosed,relative%20survival%20rate%20is%2059%25. Accessed April 24, 2023.
- 47 | Rosenberg J. Cervical cancer screening rates" unacceptably low," researchers find. The American Journal of Managed Care. February 10, 2020. https://www.ajmc.com/view/cervical-cancer-screening-rates-unacceptably-low-researchers-find. Accessed April 24, 2023.
- 48 | Winer Rachel L, et al. Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a US healthcare system. Contemporary Clinical Trials. 2018; 64 : 77-87.
Exploring Innovation in Preventive Care
More Topics
Articles & Guides





This content is for members only. Already a member?
Login
Join today to gain access to member-only resources!
Learn More
More in Benefits Strategy