May 09, 2023

Exploring Innovation in Preventive Care

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.

Full Series

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.

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Articles & Guides Plan Design & Administration Preventive Services Primary Care