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Clinical Preventive Services Should be a Basic Benefit of Proposed Health Financing Reform. |
CONFLICTS IN PREVENTION POLICY AND SCIENCE
Just as we use scientific evidence to tell us which preventive services should be delivered widely, we should use science to ensure that we do not overuse preventive services and spend our limited resource inefficiently. For example, Medicare allows newly eligible beneficiaries to receive a variety of preventive services. In order to be reimbursed for this “Welcome to Medicare Visit,” physicians must, among other things, perform an electrocardiogram (EKG) to detect heart disease. Yet the U.S. Preventive Services Task Force, which conducts detailed scientific reviews to determine the effectiveness of preventive services, has not found sufficient evidence to recommend routine EKG screening to detect the presence of heart disease. |
- Financing mechanisms should make high-value clinical preventive services accessible to all who need them – This should be accomplished by ensuring that all Americans have access to quality, affordable health care and by increasing the capacity of community-based providers, such as community health centers, rural and migrant health centers, free clinics, and public health departments, to deliver these services to persons that are not adequately served by the traditional healthcare system.
- Financing mechanisms should encourage patients to use preventive services – Health insurers and healthcare purchasers should encourage individuals to use preventive services by avoiding financial disincentives such as applying high levels of cost-sharing to such services. Governments should also encourage consumer demand for high-value services by supporting public education efforts about preventive services.
- Financing mechanisms should offer incentives to healthcare providers to deliver clinical preventive services – Incentives such as tax benefits and preferential payments for healthcare delivery organizations can be used to encourage investments in systems and strategies that are proven to result in improved health outcomes. These might include such practices as: offering health risk assessments and behavioral counseling for diet and exercise, tobacco use, and alcohol and substance abuse; establishing linkages with community-based programs that provide preventive services; and having in place decision supports and patient advisories to ensure consistency in the delivery of preventive care and chronic disease management services. Another desired practice is the use of proactive “practice teams” that provide ongoing coaching for patients regarding preventive practices and management of their chronic conditions.
- Financing mechanisms should offer incentives to employers that reward their active engagement in employee health promotion – This can be accomplished by providing companies with incentives to, for example, establish evidence-based worksite health programs that promote health and screen for disease, adopt policies for maintaining a healthy workplace, provide health insurance coverage for preventive services, and require health plans and providers with whom they contract to use electronic health records.
LINKING HEALTHCARE DELIVERY ORGANIZATIONS WITH COMMUNITY PROVIDERS
Healthcare providers are, for a variety of reasons, often unable to deliver the preventive services that patients most need. Healthcare providers are often unaware that patients may be able to obtain these services through a variety of community-based and, thus, miss opportunities to refer patients to the resources. Physicians’ offices may not, for instance, have the capacity or the expertise to offer tobacco cessation counseling or weight management counseling to patients, but these services are often available in the community. Programs need to be put in place to facilitate easy referrals and information exchanges between healthcare professionals and community providers. |
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