Preventive care is a significant focus of healthcare reform in the United States, with good reason.
According to the Centers for Disease Control and Prevention, almost one out of every two adults has at least one chronic illness, many of which are preventable. Through policy, patient support, employee engagement, and more, players in the healthcare system are encouraging people to take preventive measures to ward off infectious diseases, unintentional injuries, and chronic diseases to stay healthy and avoid future medical problems.
What is preventive care?
Preventive care strategies are typically divided into three levels. Primary prevention methods are the easiest and least-costly: wearing a bicycle helmet, getting recommended immunizations, and steering clear of tobacco products, for example. Secondary prevention methods are used to detect and treat people with risk factors: receiving a screening to gestational diabetes, perhaps. Methods of tertiary prevention aim to reduce the impact or slow the progression of an established, symptomatic disease—surgery to remove suspicious tissue or rehabilitation to build a patients’ stamina.
Prevention goes hand-in-hand with wellness. The idea is that when people do their best to stay healthy and reduce their risks for future health problems, they can avoid incurring unnecessary medical costs—and ultimately, bring down the cost of insurance.
What’s the bottom-line?
To be sure, the bottom-line economic benefits of providing preventive care medical services are debatable and under constant scrutiny. Payors across the heathcare system have to pay for health and risk screenings, well visits and the like, even if the services don’t improve a person’s health or serve to prevent future disease (and their associated medical bills). For instance, most routine colon cancer screenings on asymptomatic people don’t yield abnormal results—yet they carry a price tag. The smaller percentage of colorectal screenings that detect early onset of illness, however, can help diagnose and address a serious condition before it progresses and make a significant impact on the patient’s course of treatment, lifespan, and healthcare costs.
While overall healthcare spending might not actually go down as a result of delivering preventive care, it will result in a healthier, more health-informed population—and this is the goal of the many programs and initiatives being created and promoted across the healthcare system. It’s empowering individuals and families to lead healthier lifestyles that reduce their risk for costly, chronic conditions. A price can’t be given to the peace of mind that comes with “clean” lab results, after all. So let’s take a look at how preventive medicine is being addressed across the healthcare system:
Affordable Care Act
Legislation has already been passed to give people access to affordable preventive care services. ACA-compliant healthcare plans are required to cover a wide range of evidence-based preventive care services for adults and children—at no cost to the insured. These services include blood pressure screening, colorectal cancer screening for adults over 50, diet counseling for adults at a higher risk for chronic disease, various immunization vaccines, obesity screening and counseling, well-woman visits for women under 65, hearing screenings for newborns, and oral health risk assessments for young children. For a comprehensive list, visit healthcare.gov’s preventive care benefits section.
Employer-Sponsored Wellness Programs
Workplace wellness programs are an increasing popular way for employers to ensure a healthier, more engaged workforce. They encourage healthy fitness and nutrition choices and help employees learn about, reduce and manage risk factors such as obesity and tobacco use in the spirit of feeling great and preventing chronic disease. In addition to promoting various incentive-based initiatives, many wellness programs provide secondary preventive care services such as health coaching, in which a health care professional works with individual employees to help them manage lifestyle-related risk factors and learn healthier behaviors resulting in more positive outcomes.
Medical Case Management and Chronic Care Programs
Sometimes offered as part of a wellness program, but often offered as a benefit through a person’s insurance carrier, medical case management provides clinical support to a patient with a chronic condition, injury, or a complex treatment plan. These programs are designed to reduce hospital re-admissions (especially to the emergency room) and keep people aligned with their treatment plans. A medical professional works with a patient and his or her care team to coordinate their care, assuring compliance with medications and helping to control conditions.
Aside from providing coverage for a wide range of preventive care services and offering case management services, insurers play a critical role in providing people with resources to proactively stay healthy. Healthier policyholders incur less claims, after all, and people are looking to their insurance providers to help them make more informed healthcare choices. Health plans offer members different tools to help them manage their health—online and offline through personal support, via audio/visual libraries, education materials, and tips for healthy living—on topics ranging from fighting germs and flossing teeth to immunizations and lifestyle-based healthcare recommendations.
Public Health Programs
Additionally, there are numerous public health programs at the national, state, and community levels that address preventive care. Many of these focus on communication—getting the word out to people about the importance of prevention and wellness—as well as providing services and activities to keep community members and their families “in the system” and taking steps toward a healthy future.