Promote preventive care to save money, improve health

Things just don’t work in perpetuity without a little help.

“Equipment of all kinds needs routine maintenance,” said Mark T. Jansen, MD, chief medical officer for Arkansas Blue Cross and Blue Shield. “If we drive a gasoline or diesel-powered vehicle, we take it into the shop for oil changes so that the motor continues to run for a long time. It prevents the equipment from breaking down, so we don’t need to replace an expensive engine. Preventive medical care keeps people’s bodies from breaking down. So, why is it that when we’re thinking about our human bodies, we’re so resistant to doing the recommended maintenance?”

Jansen said promoting preventive care for employees is a win-win for businesses. “It helps prevent high-cost claims for your business, loss of productivity for your workforce and serious disease for your employees and their families. It’s good for everyone, and costs virtually nothing to promote inside your organization.”

And preventive services are sorely needed. Nearly half of all the nation’s health costs are attributable to 84 modifiable risk factors, while globally at least a quarter of all deaths are from preventable causes. In the U.S., 27% of healthcare spending is on preventable illnesses.

What constitutes preventive healthcare?

Preventive healthcare measures detect, intervene and manage potentially serious conditions before they become advanced and more difficult to treat, Jansen said. Promoting preventive care within organizations can help keep healthy employees “low-risk” while targeting the “high-risk” employees for effective interventions and treatment before their conditions escalate. Sometimes, the conversations physicians start because of risk assessments and other preventive care can wholly stop disease from occurring in the first place.

Together, these services, many of which the Affordable Care Act (ACA) mandated that private insurers cover for members, boost the health of Americans, prolong life and lower the healthcare costs they and their employer-sponsored plan faces.

“Unchecked, someone with high blood pressure could end up with advanced coronary disease,” he said. “Besides the suffering and risk to the patient, open heart surgery costs them and their employer astronomically more than getting them on blood pressure medication and working with them on lifestyle changes years before the cardiovascular disease develops.”

Underutilization = wasted savings opportunities

Jansen said the potential for savings and benefits creates a powerful incentive for employers to promote preventive healthcare among their workforces, particularly since the mandated ACA coverage removed a major financial barrier to care. The Centers for Disease Control and Prevention (CDC) has shown that workplace prevention promotions can lead to a 25% savings each in absenteeism, healthcare costs, workers’ compensation and disability management claims costs.

Yet, Jansen said Americans have been historically reluctant to seek preventive services such as cancer and cardiovascular screenings, behavioral health assessments and immunizations, even after the ACA required coverage. While the national uninsured rate hit an all-time low in 2023, the insured are still hesitant to pursue preventive care.

“During the pandemic, people got into the habit of not going to the doctor for their screening studies with the then-quite-valid excuse, ‘I might catch Covid if I do that,’” Jansen said. “Of course, Covid is still around and even ramping up this summer, but the deadly Covid has pretty much come and gone for most people who aren’t immunocompromised. Yet, utilization of preventive services—particularly cervical cancer screenings, colonoscopies, mammograms and vaccinations—is still low now even though for most people Covid is no longer a deadly threat.”

Another underutilized, covered preventive service is using low-dose CT scans to screen annually for lung cancer in smokers at high risk of the disease. “It costs a lot of money to take care of someone with advanced lung cancer, and the probability of dying from it is high,” Jansen said. “If people who were eligible were more regularly screened, we could lower costs and avoid a lot of pain and suffering from advanced cancer, extending many lives.”

Conversely, he said, “The absence of preventive care leads to more high-cost claimants with advanced or catastrophic illnesses. That’s avoidable harm for costs and organizations’ productivity, and it’s certainly bad for the individuals and families hit by the disease.”

How to know your preventive coverage

Sometimes the experts disagree on what screenings should be done and at what frequency.

The United States Preventive Services Task Force (USPSTF) is an independent, national body that makes evidence-based recommendations on effective ways to prevent disease and prolong life. The recommendations the USPSTF publishes include clinical guidelines for assessing risks through early detection screenings, changing behavior through interventional counseling and managing risk and disease progression through preventive medications and immunizations.

While different institutions such as the American Cancer Society or specialty-specific medical associations may have differing guidelines on screening schedules and other preventive care eligibility, Jansen said Arkansas Blue Cross medical policy is directly informed by the USPSTF’s recommendations. “Because the USPSTF is the official government entity, they are the authority we recognize. We use their recommendations to determine what tests should be offered to whom at what periodicity with no cost share.”

Arkansas Blue Cross members can always contact customer service through Blueprint Portal or by calling the number on their medical ID cards to verify their preventive services coverage. “Our customer service team can access the details of everyone’s plan to help members understand what screenings and services are available without a charge to them,” Jansen said.  Arkansas Blue Cross also has preventive care recommendations online.

Promoting prevention at work

Jansen highly recommended that employers promote and incentivize preventive care among their employees. That can be through:

• communications about preventive care in company newsletters and intranets;
• talking about covered preventive coverage at staff meetings;
• hosting screenings such as blood pressure checks at the worksite;
• inviting speakers to give talks and webinars about preventive care; or
• crafting wellness programs that encourage participation in preventive care and healthy lifestyle choices.

Some wellness programs financially incentivize preventive visits through premium credits or rewards programs. Arkansas Blue Cross has wellness consultation services that can help get employers get started, as well as communications materials for members about wellness offerings.

Another valuable tool the USPSTF recommends sharing with employees and their families is the MyHealthfinder tool on health.gov from the U.S. Office of Disease Prevention and Health Promotion. Americans can use the simple tool to enter their or their children’s age, gender and risk factors to see which covered preventive services are recommended for their demographics. Myhealthfinder provides clear, actionable health information on about 100 prevention and wellness topics. For instance, a person at risk for diabetes can learn ways to help prevent, detect and manage the disease.

“It’s a useful, evidence-based tool that’s easy to read and available in English and Spanish. Employers can even add free MyHealthfinder content to their websites to directly promote clinical preventive services to their workforce,” Jansen said.

“Promoting regular preventive healthcare visits among your employees and plan participants is even more important than getting that oil change,” he continued. “Because unlike a car engine, a human body is irreplaceable. We have to care for it proactively our whole life long.”