Employer health plans have covered preventive care for more than 30 years, but prevention got a proverbial shot in the arm with the Affordable Care Act. Now more services are covered than ever before, and they come with no out-of-pocket costs to the majority of employees.
That’s good news for employers. Preventive care can provide a significant return on employers’ health care investment with lower health care costs, higher productivity and improved employee morale.
Preventive care (formerly called pre-ven-ta’- tive care — the extra syllable has been dropped) refers strictly to services intended to prevent illness or screen for health conditions. Once symptoms appear, the identical service becomes diagnostic and benefits are applied differently. A common example is a colonoscopy, which is preventive for colon cancer screening but diagnostic if there is bleeding or another digestive concern.
Preventive care by the numbers
$0 is amount insured people pay for preventive care (unless they’re in a grandfathered plan).
95 cents of every medical-care dollar is spent to treat disease after it has already occurred.
7 in 10 American deaths each year result from preventable chronic diseases like diabetes and heart disease.
$81 billion in national health care expenditures could be saved with prevention and disease-management programs according to a RAND study.
10% of large employers are fully aware of all of the preventive care services they’re required to cover at no cost.
60% of employees use preventive services when their employer offers incentives for participation, according to a Midwest Business Group on Health survey.
43% of Americans (less than half!) know that the Affordable Care Act eliminated out-of-pocket expenses for preventive care.
20% of women put off or postponed preventive services in the past year due to perceived cost according to the 2013 Kaiser Women’s Health Survey.
137 million Americans have received no-cost coverage for preventive services since the health reform went into effect.
4 categories of preventive services must be covered by private plans: screenings / counseling, routine immunizations, preventive services for children and youth, preventive services for women.
26% of health plans are grandfathered, and therefore are not subject to the no-cost rules about preventative coverage.
4 expert medical and scientific bodies develop the nation’s preventive care guidelines: U.S. Preventive Services Task Force, the Advisory Committee on Immunization Practices, the Health Resources and Services Administration’s Bright Futures Project and the Health Resources and Services Administration (HRSA) and Institute of Medicine committee on women’s clinical preventive services.
Engage employees with effective communications
The easiest way to get employee buy-in about preventive care is to highlight the advantages. Use these key messages for the best results:
“It’s free” Remind employees that your plan covers free preventive services based on the employees’ age and gender. Your carrier’s website will include a complete, easy-to-understand chart of services and explanations of the difference between preventive and diagnostic care.
“You’ll be your healthiest.” Immunizations can help employees avoid the dreaded flu each year, and screenings will help catch small problems before they develop into larger health issues.
“You’ll save money.” The cost of treating disease in the early stage generally leads to better health outcomes and lower costs. For example, catching colon cancer early with a free colonoscopy increases the chance of survival to 90 percent and reduces the cost of treatment, which could exceed $50,000 in the first year, according to the National Cancer Institute.