How employers can remove the barriers to preventive care

The benefits of regular screening for many types of cancer and other serious health conditions are clear: Early detection enables conditions to be managed, often heading off invasive and expensive treatments. Toward that end, preventive care is meant to be free under the Affordable Care Act (ACA). And yet, shockingly, few people undergo all the screenings they need.

Barriers to preventive care

Increasing access to preventive care services was a major goal of the ACA, which mandated that health plans cover annual physicals and a host of screening procedures approved by an independent panel. While the usage of some screening procedures has increased, overall adoption remains very low: In 2015, only 8.5% of adults over 35 received all the recommended high-priority preventive services, and the number dropped to only 5% in 2020, a government survey found. Additional findings show that the percentage of adults who take advantage of preventive screenings and wellness visits is still lower than before the pandemic. It’s not surprising then, that a recent study found one out of three people covered by employee health plans is likely to have an undetected chronic condition.

Why aren’t more people taking advantage of free screenings?

People may put off seeking healthcare for a number of reasons, but it’s often because of socioeconomic factors such as where they live, their level of education, and how much money they make. Those in rural areas and those dealing with chronic conditions tend to have lower rates of preventive care, possibly because of limited understanding of health issues and limited access to healthcare providers.

Another reason is that often preventive care visits aren’t really free. A Boston University study found that one out of four people with employer-sponsored health insurance get a bill for preventive services that should have been provided without charge. A 2022 survey found that four in 10 adults skipped or postponed such care for that reason.

Under the ACA, insurance companies determine which charges are fully covered as preventive services, but some providers add extra fees that may get passed on to patients. For example, patients undergoing colonoscopies have been charged a $250 fee for “surgical trays”, which was applied to their deductibles.

There are also many cases where patients are responsible for follow-up procedures resulting from covered screenings. For instance, one study found that in 2019 women who had abnormal pap smears or cervical exams faced follow-up procedures with out-of-pocket costs between $112 and $702.

Patients may also have to pay copays and deductibles if a preventive service includes diagnostic or treatment elements. This means that discussing conditions like depression or gastroesophageal reflux during an annual checkup could result in additional charges for diagnostic services. Because it is important for patients to address these concerns during their visits, we need to consider how we mitigate these financial barriers.

The benefit to employers: lower long-term costs

For employers, few initiatives can have a bigger impact on the company’s long-term costs than encouraging members to be diligent about routine screenings—delays in obtaining preventive care can raise a company’s long-term health costs significantly. For example, a patient whose chronic kidney disease is identified early can often be treated with simple lifestyle changes. Patients whose condition progressed to stage 3 of a five-step scale incur annual healthcare costs averaging $26,843, according to a 2019 study. Those at stage 5 have costs that can approach $200,000 a year. The high prevalence of late-stage cancers and chronic conditions significantly impacts medical plan trends, making it crucial for employers to prioritize prevention and primary care.

How employers can encourage preventive care

Nearly every company can benefit from increasing its members’ utilization of preventive care services, but the best tools to achieve these goals depend on circumstances, plan design, and member population. Here are seven actions for companies to consider:

1. Communicate regularly about the importance of preventive care

Employers can reinforce the value of preventive care in educational material sent to members and their families. Explain the free and low-cost services provided by the company benefit plan and address employees’ concerns about surprise billing, medical privacy, and other issues. Don’t forget to include information about screening, wellness visits, and vaccinations for children of members.

2. Look for subgroups that underutilize preventive services

At some companies, there are segments of employees—such as non-English speakers, lower-income workers, and those at certain locations—that are less likely to use preventive screenings. These non-medical factors, known as social determinants of health (SDOH), influence health outcomes, greatly impact preventive care utilization rates, and create health disparities. Understandably, many individuals impacted by socioeconomic factors prioritize paying for food or rent over seeking healthcare. Additionally, this population may not have the same opportunities as high-wage earners to take paid time off work to seek healthcare. Providing health equity is key, for example, by expanding your provider network to ensure everyone has equal access to seeking healthcare (virtual, onsite, etc.).

Identify whether your company includes these populations and find ways to understand the barriers that prevent them from getting preventive care, then build a targeted communication program that addresses their concerns.

3. Look carefully at high-deductible plans

In addition to the factors mentioned earlier, the initial out-of-pocket costs associated with a high deductible plan can discourage members from seeking care. Note that federal regulations restrict employers from expanding the range of fully covered services in these plans. As an alternative, it may be beneficial to consider contributing to the health savings account that is allowed with a qualified HDHP, especially for lower-income workers. It’s important to clearly and consistently communicate that these accounts are intended to cover unexpected healthcare costs, including follow-ups to preventive services.

4. Encourage members to build a relationship with a primary care provider

People who have regular access to quality primary care are healthier, live longer, and spend less on healthcare. That’s in large part because primary care providers focus on preventive care. They also encourage their patients to get the necessary screening procedures.

5. Work with your insurance company to reduce surprise charges for preventive services

Ask your carrier how it treats cases in which providers add additional charges to covered services. Encourage the carrier to push back on inappropriate add-on fees and to use a broad definition of what constitutes a fully covered preventive service.

6. Increase coverage for follow-on testing and procedures

Consider adjusting your plan design so any additional diagnostic testing that follows a covered preventive screening is also covered without a copay or deductible. If possible, keep the terms of the plan easy to understand so participants can feel secure that they won’t be hit with surprise out-of-pocket expenses.

7. Consider onsite health screenings, ideally with follow-up care

Onsite biometric screening programs can be helpful but shouldn’t be seen as a replacement for an annual visit with a primary care provider. Instead, the screenings can help motivate members who discover they have a health condition to find a primary care provider. Employers may also consider a screening program that also provides access to a professional, such as a nurse practitioner who can help members interpret test results and start appropriate treatment.

Promoting member engagement with preventive care is crucial to help ward off chronic disease, disability, and death. Moreover, preventive care is fundamental for creating a strong relationship with primary care, which is essential for ongoing health management. This two-prong approach is critical for employers looking to manage their healthcare costs long-term.

How Alliant can help

Alliant helps clients provide better care outcomes and reduce the total cost of healthcare by integrating proven data-driven interventions. Our data analytics, health & productivity, and clinical services teams work jointly to build solutions that impact preventable healthcare spend.