The Affordable Care Act is hotly debated, but it’s already delivering at least one new benefit to an estimated 54 million Americans. They now have access to preventive services, ranging from colonoscopies to mammograms, that previously had required co-payments. More than 1 million people in Missouri and another 2.3 million in Illinois are benefitting from this change in national health policy, according to the Department of Health and Human Services.
Preventive coverage for children up to age 17 includes screening for vision, hearing and obesity, regular pediatric visits, and immunizations. Among services to which women have access are mammograms, contraceptives, and screening for obesity, cholesterol and blood pressure. Services for men include colonoscopies, and screenings for cholesterol, blood pressure, obesity and HIV.
Although praising these benefits as unprecedented for millions of Americans, federal health officials concede it’s hardly a new policy among many major businesses and insurers whose wellness programs predate ACA. For example, UnitedHealthCare has espoused preventive health services for years, and some of its employer-clients in St. Louis and elsewhere provide such services for workers without requiring co-pays.
“It’s always better to fix things upfront,” says Dr. Robert Smith, market medical director for United Health Care of Missouri. He says ignoring prevention is akin to driving a car without changing the oil or the transmission fluid. In such instances, he says, the owner ends up having to replace the motor and the transmission.
“The human body works the same kind of way,” he says. “That’s why we focus on these wellness things. I think our health-care systems are learning that they have to do things differently.”
Data from the St. Louis Business Health Coalition show that 17 of its 49 member companies already offer employees preventive services without requiring a co-pay. Some of the area firms have found novel approaches to drive home their wellness messages.
Smith mentioned a St. Louis company whose workers take a form to their doctors and are expected to be proactive when discussing their health during the visit: “Doc, what’s my blood pressure? Is it good or bad? What do I need to do about it? What’s my cholesterol? What’s my blood sugar?” These are a few of the issues the patient is encouraged to squeeze into the conversation. After caring for the patient, the physician signs the form, which the patient takes back to the employer for a reward.
“The employer gives him 25 bucks,” Smith says.
A family practice physician by training, Smith likes to talk up the value of prevention while calling attention to the state’s health-care challenges. He’s pleased to see the United HealthCare Foundation partner with the American Public Health Association to rank states on health issues.
Prevention can trim costs
“Missouri has slipped from 39 to 40,” he says of the most recent rankings. “We have high smoking rates, a low immunization rate, a high rate of obesity. Diabetes is climbing, and we have a high rate of health disparities in some communities.”
The list of screenings embraced by UnitedHealthCare cover what’s in the federal law, including screening for cervical and prostate cancers, high blood pressure, diabetes and depression, as well as screenings for thyroid disease, autism, lead, tuberculosis and obesity among infants and children.
In addition, the insurer tries to educate patients through a website.
“Folks can go there and get material that has been passed through some health literacy screening,” he says. He adds that the company maintains websites for Latinos and African Americans “because health disparities occur in certain cultures, and we try hard to put the material out there.”
United Health Care’s positions on prevention are informed mainly by independent peer-reviewed, evidence-based information from the U.S. Preventive Services task force. It grades the evidence and decides whether a certain exam, technology or screening is useful in offering a short- or long-term benefit to the patient. The insurer’s decisions about which screenings to support also can be based on independent studies involving a consensus of doctors who might think a certain medical activity is effective even though there is no peer-reviewed evidence that it is.
Louise Probst, executive director of the St. Louis Business Health Coalition, also favors prevention, noting that some area employers have embraced the concept for decades. Still, she says, cost could now become a big issue because the zero co-pay mandate “means that the cost of these services may well go up.”
Smith adds that other challenges include covering services such as contraception that won’t be offered as part of health benefits through church groups and hospitals associated with Catholics and other religious institutions.
How these services are paid for in the cases of church groups refusing to cover the cost raises a “whole set of” issues, not the least of them being who is going to cover that cost. Smith says, “The reality is, yes, somebody is going to pay for it. My personal bias is that we all share in those costs.”
