A consistent pattern shows that early detection of cancers and chronic conditions can lead to better management and reduce the need for more invasive treatments. Despite the Affordable Care Act (ACA) ensuring that preventive care services are free, many employees still skip these screenings.
Dave Zieg, MD, Alliant’s national director of clinical services, highlights the issue: "We know preventive care saves lives and reduces morbidity and mortality, but preventive care rates in the US are abysmal."
According to Zieg (pictured), few Americans complete all recommended screenings, even though access to preventive care was a core goal of the ACA.
“Preventive care rates in the US are abysmal. We should be doing way, way better,” he said.
While some preventive services have seen increased use since the ACA was implemented, overall adoption remains low. Data from 2015 indicates that only 8.5% of adults over 35 received all high-priority preventive services.
That number further declined to 5% by 2020. Other studies suggest that preventive care rates remain lower than pre-pandemic levels, and a recent study revealed that one in three individuals covered by employer health plans may have undetected chronic conditions.
Socioeconomic factors like location, income, and education often prevent people from seeking preventive services. Rural residents and individuals with chronic illnesses generally show lower rates of preventive care, possibly due to limited access to healthcare providers and health literacy gaps.
Zieg said that hidden fees are another significant barrier. Many patients with employer-sponsored insurance encounter charges for services that should be fully covered under the ACA.
A Boston University study reports that one in four individuals receives a bill for preventive care. Additionally, a 2022 survey found that 40% of adults delayed or avoided preventive care to avoid potential costs. Under the ACA, insurers have discretion over what services are fully covered as preventive, yet some providers add fees that may reach patients, such as a $250 “surgical tray” fee for a colonoscopy.
Patients may also face charges for follow-up procedures from screenings. In 2019, women needing follow-up after an abnormal Pap smear incurred out-of-pocket expenses between $112 and $702.
Copays and deductibles may apply if a preventive visit includes diagnostic discussions, making it challenging for patients to address their health concerns without financial impact.
For employers, encouraging preventive care utilization can mitigate rising healthcare costs over time. Zieg pointed out that when conditions like chronic kidney disease are detected early, treatment may only require lifestyle changes.
However, by the time a patient’s condition progresses to stage 3, annual healthcare costs average $26,843, while stage 5 can reach $200,000 annually. Employers, therefore, stand to benefit by promoting preventive and primary care, potentially reducing costs linked to late-stage cancer and chronic illness.
For many employers, raising preventive care engagement can yield substantial benefits. Strategies vary, but Zieg suggests several approaches companies might consider to address these issues effectively.
First, employers can share consistent information about the services covered in company benefits plans, addressing employee concerns around unexpected charges, privacy, and other factors.
Companies can also use data to target communication toward groups less likely to seek preventive care, particularly non-English speakers, low-income workers, or those at remote locations.
Reviewing high-deductible plans is another option, as high out-of-pocket costs discourage preventive service utilization. Employers might consider contributing to employees’ health savings accounts to help mitigate these costs.
Additionally, encouraging primary care relationships is important, as regular access to primary care is linked to better health outcomes and lower healthcare spending. Employers can also collaborate with insurance providers to address inappropriate add-on charges and ensure comprehensive definitions of preventive care are applied.
Another option is to design plans that cover additional testing related to preventive screenings, helping members avoid surprise out-of-pocket costs.
Finally, providing onsite screenings along with follow-up care options can motivate employees to engage in preventive services, potentially encouraging longer-term primary care relationships.
Fostering preventive care utilization is a key step in managing chronic disease risk within employee populations. For employers, aligning preventive care initiatives with primary care can play a critical role in supporting healthier, more proactive healthcare engagement among members, potentially reducing long-term costs and contributing to overall workforce health stability.
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