As preventative care recommendations like hepatitis B screenings are updated, health plans need tools to help them design policies that are current, support members, and reduce provider friction.
For payers grappling with a rapidly changing healthcare landscape, policy design adjustments need to keep pace, all while building in administrative efficiencies to reduce costs and support members, clients, and provider networks. This is a challenging proposition, but one that can be managed with the right focus and partners.
One area of particular interest in payer medical management is designing policies that promote preventative care. When payers encourage members to take advantage of preventative care services, they can see improved health status for their members as health issues are caught and treated earlier, often leading to more appropriate utilization rates and costs.
Barriers to preventative care and screenings
One challenge is that members may not actively take steps for preventative care. A study estimates that only 8% of Americans undergo routine preventative screenings, and only 15 states have above-average preventative healthcare metrics. Among females, nearly half skip preventative care services for routine check-ups, vaccines, and screenings. Without these screenings and services, potential health risks go undetected, leading to more urgent and costly procedures later on.
In some cases, the lack of preventative care is due to social or economic barriers, especially among populations that are low-income, diverse, mobility-challenged, or rurally located. These barriers can include:
- Family or work responsibilities
- Childcare availability
- Perceived discrimination
- Transportation barriers
Additionally, some barriers are specific to members’ health coverage:
- Coverage barriers - not understanding what their plan covers or if they will maintain their plan.
- Financial barriers - worrying that their health insurance won’t cover care or they will have to pay more than they expect or can afford.
During care, providers inevitably bring up routine or newer recommendations like vaccines, screenings, and other services, and this can lead members to wonder about coverage and finances. Health plans can help reassure members by clearly incorporating preventative care into policies, benefit-at-a-glance materials, and member portals.
