Preventive Care For All

Since the dawn of the Affordable Care Act more than a decade ago, receiving ‘preventive care’ without any out of pocket cost to individuals has become a cornerstone of the employer sponsored health market. But what exactly is preventive care, and who decides?

CMS states that “Chronic diseases, such as heart disease, cancer, and diabetes, are responsible for 7 of 10 deaths among Americans each year, and account for 75% of the nation’s health spending – and often are preventable.” In an effort to encourage individuals to be proactive about their health, the ACA’s mandate is intended to lower the overall costs associated with treating advanced stage disease and illness. If underlying health conditions are identified early, the treatment has a higher likelihood of success, and at a lower expense to both the individual and the health plan.

The Department of Health and Human Services (HHS) is largely responsible for dictating what services are considered ‘preventive’ within the meaning of the ACA’s mandate. The US Preventive Service Task Force (USPSTF) is an independent panel of national experts in the health field, who make recommendations to HHS using evidence-based data regarding what types of services should be covered as ‘preventive’. Though the constitutionality of the USPSTF’s authority to make these recommendations and bind employer health plans has been challenged in court, the ACA mandate still stands at the time of this writing.

Despite the removal of the cost barrier for individuals, the actual usage of preventive care is still low relative to expectation by the Departments. Employers can help with this statistic, if they engage with their workforce and benefit consultants to target specific behavior. For example, if a workforce has a higher than average incidence of heart disease, an employer might offer specific wellness initiatives designed to combat this disease. Workplace incentives might even include reduced medical premiums when offered as part of a wellness program. Office spaces designed to encourage movement through the day might also help address many common chronic conditions associated with sedentary day jobs.

In this growing area with potential for large scale cost savings, it's important for employers to have a seat at the table.

The complete list of preventive services is regularly updated, and can be viewed on the Health Care.gov website here.