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NBGH guide emphasizes shift toward utilizing more preventive care

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The National Business Group on Health has released an extensive guide to help employers shift their health plans from emphasizing acute care and medications to focusing more on preventive care.

Under the traditional insurance model, preventive health services have been poorly supported in contrast to the coverage provided for acute care services, said Helen Darling, the NBGH's president in Washington.

Even today, some preventive measures known to be effective, such as obesity counseling, are not covered by all large employers or insured plans, Ms. Darling said.

Insurers, though, say they increasingly are investing in preventive services, and partnering with employers to promote good health practices and provide consumer-driven health plans that emphasize preventative measures.

But 52% of insureds currently do not receive prevention services that the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality know protect health, said CDC Director Dr. Julie Gerberding.

"So it isn't just an issue of having insurance," Dr. Gerberding said. "It's an issue of when you do have insurance, not having the right benefits or not accessing the right benefits that really are (scientifically determined) to promote better health protection."

The NBGH's roughly 500-page guide, "A Purchaser's Guide to Clinical Preventive Services: Moving Science into Coverage," aims to change that.

It provides detailed information on 46 clinical preventative services that medical evidence shows can prevent serious illness and premature death stemming from conditions such as obesity, diabetes and cancer.

It also addresses issues such as alcohol and tobacco use.

The "Purchaser's Guide" released last week translates scientific research on the most effective preventive care practices into benefits language to help employers adjust their summary plan descriptions, Ms. Darling said.

That way, employers can develop a "structured clinical services program," according to the NBGH.

The guide also establishes a business argument for funding screenings, immunizations, counseling and other care. It does so by detailing the cost effectiveness of recommended interventions.

For example, a section on alcohol abuse states that each $1 invested in screening and brief counseling saves about $4 in health care costs. It details the billions of dollars spent annually on alcohol-related health care, the cost to health plans, and the cost of alcohol abuse to employers in terms of absenteeism and lost productivity.

Some recommendations made by the guide, such as a call to cover immunization for the human papillomavirus associated with cervical cancer, could add "noticeable" cost to an employer's health plan spending, Ms. Darling said.

But the guide provides suggestions to prioritize coverages that might be most pressing for an employer to add to their plan offerings if they are not able to add them all at once.

While adding some of the 46 clinical preventative services to a health plan would increase immediate costs, it would reduce care expenses in the long term, the NBGH said.

Some increased costs can be offset by eliminating preventative services that some plans offer but have been found to be ineffective, Ms. Darling said.

For example, some plans continue to provide Pap smear tests annually to detect cervical cancer, Ms. Darling said.

But the guide points out that, although some health professional organizations recommend more frequent tests, the U.S. Preventative Service Task Force has not found evidence that annual screenings provide better outcomes than screening every three years.

Because doctors have limited time to spend with patients and employers have limited dollars to spend on care, it's critical that employers limit their investment only to services that provide the greatest health impact, said Dr. Carolyn M. Clancy, director of AHRQ.

"Not only is underuse of effective preventative services a concern to employers, but so, too, should utilization of ineffective or unproven clinical preventive services," Dr. Clancy said.

The "Purchaser's Guide" recommendations for coverage are largely based on the preventative task force's recommendations for people who have not yet shown signs of illness. The task force is a panel of primary care and prevention experts sponsored by the AHRQ, a unit of the U.S. Department of Health and Human Services.

The CDC provided funding to develop the guide.

Insurers also rely on preventative health data available from organizations such as the CDC and the AHRQ as well as their own claims data to develop their plan offerings, said Alan Spiro, chief medical officer of national accounts at WellPoint Inc. in Atlanta.

Still, part of the ongoing challenge for insurers and employers is in finding incentives that encourage consumers to take advantage of health screenings and risk reduction services, Mr. Spiro said.

The "Purchaser's Guide" is available for free on the NBGH's Web site at www.nbgh.com.