Preventive services: An underutilized resource

Substantial evidence supports the position that preventive health screenings and other preventive services are indispensable parts of the U.S. healthcare system. Yet despite clear benefits, from detecting cancer at early stages to preventing disease through vaccination, rates of preventive services are lagging behind where they should be.

Fewer than half of adults ages 65 or older are up to date with core preventive services, despite regular checkups and coverage by nearly all insurance plans, according to a 2010 report by the Department of Health and Human Services. In addition, fewer than 30% of adults ages 50 to 64 are up to date with core clinical preventive services, according to a 2011 Centers for Disease Control and Prevention (CDC) report. 

Research going back about a decade suggests that ethnic and racial minorities, the socioeconomically disadvantaged, and rural populations are less likely to receive preventive services, such as vaccinations. According to the 2011 CDC report, 44% of blacks reported not receiving influenza vaccinations, compared to 29% of whites.

ShensonThough definitions vary, clinical preventive services generally encompass immunizations, screening tests and counseling “to prevent the onset or progression of disease and disability,” according to CDC. Such services can include influenza and pneumococcal vaccinations; screenings for breast cancer, colorectal cancer, diabetes, lipid disorders and osteoporosis; and counseling for smoking cessation. 

“Clinical preventive services can be important in three stages of disease development,” says Douglas Shenson, MD, MPH, associate clinical professor of epidemiology and public health at Yale School of Medicine. These are before disease occurs (such as vaccinations), before disease is clinically evident (for example, breast cancer screening) and once disease is established, but before it has made its maximum impact (such as vision screening in individuals with diabetes).

Next: A prevention gap

A prevention gap

Cost barriers (or perceived cost barriers) may be a key driver of low utilization of preventive services, according to 2013 data from the Kaiser Family Foundation. According to the data 20% of women and 16% of men surveyed said that they had postponed preventive services within the previous year because of cost. Even among the insured, the respective figures were 13% and 9%.

KottkeThe Affordable Care Act mandated free preventive services, notes Tom Kottke, MD, medical director for population health for HealthPartners, Minneapolis. But patients don’t necessarily know that; therefore HealthPartners tries to educate its members, Kottke says, and “That has required some marketing.” In addition, a clinic visit might technically be “free,” yet still entail lost wages, childcare costs, transportation costs and so forth, he says.

Another reason for poor prevention delivery is “a mismatch between the system and the mission,” says Shenson, who is a founder and the executive director of the Sickness Prevention Achieved through Regional Collaboration initiative. People usually go into the system only when they’re sick, so the focus is on the illness, not on preventive measures, he says. One way of mitigating this, says Shenson, is to involve resources other than just physicians, such as pharmacists who can encourage flu shots.

Next: Driving stronger engagement

Driving stronger engagement

“There is not a one-size-fits-all approach” to increasing preventive services, so health systems' screening programs should aim at their specific populations, says Clare Krusing, spokesperson for America’s Health Insurance Plans.

The types of screenings to emphasize will depend on location, because health risk factors vary, says Donna Lee Gardner, RN, MA, MBA, senior principal of the National Association of Occupational Health Professionals. Local public health departments can assist by providing information on common risk factors in your area, she says.

Gardner likes patient portals at physician practices, which enable secure messaging between physicians and patients, calling them “a wonderful opportunity to educate patients.” For example, a practice might post information about the importance of annual physicals on its patient portal. 

It’s important to make it easier to incorporate an “action-oriented step” when discussing preventive services with patients, says Kottke, adding that health systems should consider, “How can we make it easier for the patient to take action?”

Along those lines, HealthPartners offers same-day mammography, which has increased the mammography rate by 20% in women turning 50, he says.

Adept use of technology can help in some areas, too. HealthPartners had been finding it challenging to encourage younger women to come in for chlamydia screening, so it tried ads on Facebook, which upped the screening rate by 15% to 20%, says Kottke.

HealthPartners also adopted fecal immune testing (in place of the traditional fecal occult blood testing) for colon cancer screening. The test, which looks for abnormal DNA shed by tumor cells, Kottke explains, can be completed by patients by mail so that they don't need to come into the office. Testing is done annually and if results are positive, the next recommended step is a colonoscopy.

The key to preventive screenings, Krusing sums up, is to make health an easy part of the patient’s day.