August 17, 2020
- 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. Determining a payment bundle for these services can lower the likelihood of employees deferring preventive services due to the concern of receiving these types of bills.
- Conducting preventive screening communications campaigns: Employers in partnership with navigators, engagement programs, health plans and other partners should conduct periodic communication campaigns or deploy targeted messaging to drive appropriate and timely preventive screening utilization.
- Ensure populations at high risk for common comorbidities are completing every applicable screening test: 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.
- Encourage shared decision making between members and their providers: If a screening test is recommended by USPSTF, HRSA 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 check with the health plan about the out-of-pocket cost implications. Services for which there is unknown or limited efficacy for early detection or disease prevention as well as those that have been deemed exploratory may not be covered as preventive by their health plan.
- Monitor the rapidly evolving genetic testing landscape: Appropriate utilization of genetic tests may identify 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 individual set of circumstances and preferences.
- Promote use of vaccines: Much can be achieved through appropriate education and facilitating access to adult vaccines such as flu shots.With public health concerns being top of mind now more than ever, the importance of controlling the rate of flu infections to ease the burden on the health care system and curb the spread of respiratory illnesses should be a priority. Employers can play a role in increasing the rates of flu vaccinations and laying the groundwork for large-scale adoption when a COVID-19 vaccine becomes widely available.
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- 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.
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- 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.
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- 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.
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- 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.
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- 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.
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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