For most people, the term “Preventive Care” suggests age appropriate cancer screenings, flu shots and childhood vaccinations.
What about appropriate regular monitoring of symptoms that prevents the worsening of a chronic illness?
Read on to see what we can learn by looking at this data.
The broader concept of preventive care includes (but not limited to) activities that lead to the overall reduction of adverse events (e.g. fewer life-threatening complications due to a chronic illness) and the promotion of overall health in the entire population.
The “Annual Wellness Exam” (aka Annual Physical, Annual check-up, Health Maintenance Visit, Preventive Care Visit, etc.) is perhaps one of the most underutilized benefits in a health plan even though it is available at no out-of-pocket cost to the covered individual (with most federal, state and commercial plans).
Getting an Annual Wellness Exam regularly offers two main advantages:
From a Payer (Employer, Health Plan, other) and Provider (individual Physician, Group Practice, Health System, other) standpoint, there is also a financial advantage in ensuring all members get a Wellness Exam every year as described below.
In looking at the Professional component of medical claims data for the last 3 years, HDMS saw an overwhelming trend among our customers. We classified members into two groups:
Adult members in both groups were then compared for ER Utilization, particularly for Avoidable ER usage using the NYU Emergent Status & AHRQ Prevention Quality Indicator (PQI) methodologies.
The results showed:
These reports show a clear pattern. Members who get an Annual Wellness Exam are less likely to use the ER for conditions that can be treated and/ or managed at a less expensive site of care. Hence, it is in the best interest of the organization to encourage and incent all their members to establish a relationship with a PCP and get regular Wellness exams.
Employers and health plans can demonstrate success through data analytics by determining the impact of preventative cancer screenings on access to treatment, risk and costs of care.
For example, a state health plan covering around 205,000 employees and dependents set out to identify the rate at which members were diagnosed with cancer after undergoing preventive screenings for breast, colorectal and cervical cancers.
For the overall state population, new cases of colorectal and cervical cancer have been decreasing while new cases of breast cancer are increasing. However, analysis of claims data for the state health plan differs for state employees:
By collaborating with HDMS experts, the state health plan created episode-based analysis groups, or cohorts, to assess compliance with preventive screenings compared to national guidelines and measure the impact of such screenings on early cancer detection and treatment.
Members in the episode-based analysis group included those who were newly diagnosed with breast, colorectal and cervical cancers as well as those who had been identified as having a recurring cancer diagnosis within two years of initial detection of the cancers. The results were enlightening:
Increased early diagnosis. The majority of new cases of breast, colorectal and cervical cancer were initially diagnosed following preventive screenings:
Decreased risk. The study showed early diagnosis of cancer through preventive screenings was associated with significantly reduced members’ risk scores. Members who were diagnosed earlier through preventive screening had significantly lower concurrent risk scores compared to other members with the same type of cancer. Higher risk scores are typically associated with members with later stages of cancer that require more complex treatment.
Specifically, members diagnosed with breast cancer through preventive screenings had an average risk score of less than 1.00 while members diagnosed outside of preventive screenings had average risk scores from 5.88 to 6.53. Similarly, members diagnosed with cervical cancer through preventive screenings had average risk scores of 1.00 while those diagnosed later exhibited risk scores of 3.31 to 4.22.
Reduced costs of care. Analysis also revealed the impact of preventive screenings in lower costs of care. The cost of treating breast and cervical cancer for women identified by preventive screening was lower on average.6