Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Value-Based Care News

Increase in Preventive Care Improves Health, Lowers Cost

By Ryan Mcaskill

Since the Affordable Care Act was implemented, there has been an increase in preventive care visit from patients.

- One of the biggest pushes of the Affordable Care Act and other healthcare reform initiatives is increasing the focus on the value of care instead of the number services that a practice performs for a patient. One of the main ways that healthcare providers can help this happen is through the use of preventative care visits. This will keep patient healthy and catch any potential problems early, preventing them from becoming worse and more costly to treat.

The Affordable Care Act expanded Medicare coverage in 2011 to fully cover preventative care visits. These include:

• Screenings for cancer including mammograms and colonoscopies

• Tests for blood pressure, diabetes and cholesterol

• Counseling in areas like weight loss, depression, alcohol use and quitting smoking

• Well-baby and well-child visits through age 21

• Vaccinations and shots

Recently, Health Affairs released a report that examined annual preventive care visits. The report looked at the impact of coverage expansion using data from 2007 through 2013 from primary care patents of Medicare-eligible age at the Palo Alto Medical Foundation.

“We compared trends in preventive visits and recommended preventive services among Medicare fee-for-service and Medicare health maintenance organization (HMO) patients as well as non-Medicare patients ages 65–75 who were covered by private fee-for-service and private HMO plans,” the report reads.

It was discovered that among Medicare fee-for-service patients, the annual use of preventive visits rose from 1.4 percent before the implementation of the Accountable Care Act to 27.5 percent after it started.

The rates of annual preventive care visits by Medicare fee-for-service patients was 10 to 20 percentage points lower than what was reported by individuals with private coverage (43-44 percent) or the those that are in a Medicare HMO (53 percent).

Patient-centered preventive care ‘underutilized’

Another study released by the American Journal of Managed Care focused on a pilot-program to provide personalized and patient-centered preventive care. It was tested in a busy, urban ambulatory clinic and was designed to be compatible with emerging care models.

“Evidence-based preventive care is vastly underutilized in the United States, but is necessary to decrease morbidity and mortality,” the article reads. “Personalization is essential for successful preventive care implementation.”

The report theorizes that limited time for clinicians and varying ideas of best practices for each patient, plus increasing healthcare complexity, have caused disparities when it comes to unequal distribution of preventive care. The program ran for 15 months from May 2012 through August 2013. It focused on making healthcare more personal, communicating information with risk communication literature, setting goals with patients for their next visit and constantly evaluating outcomes.

It was discovered that longer doctor visits and talk of risk factors and preventive care can be productive. By shifting tasks around – like clinical staff obtaining vital signs and utilizing routine questionnaires – hospitals can achieve positive results while also being cost effective. Furthermore, if the program achieves and sustains a life expectancy increase of at least 5.3 months, it would offer favorable value if the additional expenditures are lower than $44,000 per patient per year. That number exceeds the cost of the pilot program.


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