How to Optimize Your Investments in Preventive Care

The following article was originally posted on the Mercer US Health News blog. You can find this article along with more health news content here.

By Patti Rittling, PhD, CHES?, CIC?, Principal; Prachi Nagda, MD, Partner, Health; Agnes Quiggle, Health & Benefits Consultant; and Brittany Webb, Principal, Mercer

Employers can play a critical role in improving the health and well-being of their employees. But – especially in this time of rising costs and high inflation – it’s important to carefully consider all investments in workforce health to ensure dollars are not wasted on low-value care. By low-value care, we mean services that provide little or no benefit to people, have potential to cause harm, incur unnecessary cost, or waste limited healthcare resources. Over time, research has shown that certain services that were once assumed to be beneficial – even essential – actually deliver little or no value. It’s time to take stock of your health and well-being programs to ensure they are designed for optimal value.

Healthy adults can chuck the annual check-up

Early detection of disease is important, but when it comes to preventive care, more is not always better. While annual physicals are a familiar part of the healthcare system, a growing body of evidence finds that for healthy people without any symptoms these yearly physician exams are a waste of time and money—and in some cases may do more harm than good. Numerous studies have failed to find a connection between periodic health evaluations in healthy people and reduced mortality or improved health outcomes. Groups including the American Medical Association and the United States Preventive Services Task Force have moved away from promoting the yearly head-to-toe exam in asymptomatic, healthy adults, and the Society of General Internal Medicine recently included annual exams in a list of medical exams that are often done unnecessarily as part of a campaign called Choosing Wisely, which aims to reduce wasteful and potentially harmful medical care. Given this shift, employers offering a wellness incentive plan that includes annual physicals should consider redesigning their program to include evidence-based practices. Modifying the incentive plan to include appropriate cancer screenings and dental cleanings or repurposing incentive dollars toward mental health support are ideas worth pursuing.

Rethink biometric screenings

Another area of low-value care includes annual biometric screenings. The need for biometric screening varies for each individual and it is unnecessary to test the entire population using the same measures for each individual. Employers should consider the following points when weighing the decision to offer biometric screenings to their employees:

• Only blood pressure screenings are recommended annually for the majority of healthy adults. Over-testing of other biometric measures may result in an inefficient use of dollars that could be redirected to other initiatives.
• Screening for prediabetes and type 2 diabetes is only recommended in adults aged 35 to 70 years who are overweight or obese.
• Cholesterol should be checked starting early in life but most healthy adults only need their cholesterol checked every 4 to 6 years. Some people, such as those who have heart disease, diabetes, or a family history of high cholesterol need to have their cholesterol checked more often.
• Employees with health conditions (such as hyperlipidemia) that need to be monitored should be tested under the supervision of their physician.
• All screenings have risks, including the possibility of false negatives or positives.

Move toward a more advanced primary care model

The third area of low-value care is simply poor quality primary care. Employers can save money and improve health outcomes by steering employees to high-quality, high-value primary care providers. Employees who have a relationship with a high-quality PCP receive evidence-based, individualized care and testing tailored to their unique needs. Establishing a patient-provider relationship is best done through a wellness visit that focuses less on a physical exam and more on a preventive care plan. This would include administering flu shots and other immunizations and referrals to a specialist for recommended cancer screenings such as pap tests, mammograms, and colonoscopies. The PCP can also screen for depression, obesity and tobacco use. Keep in mind that onsite screenings/coaching alone cannot guarantee that biometric problems will be diagnosed and treated by a physician. Steering employees to high-quality primary care will likely be more effective in ensuring employees with health risks get the treatment they need.

Consider the following ways to promote the use of quality primary care:

• Communicate the importance of establishing a relationship with a high-quality PCP who will provide personalized care.
• Eliminate barriers for preventive care visits, such as providing adequate PTO.
• Offer self-care, health literacy, and health consumerism programs and decision-support tools to educate employees on the best ways to care for themselves and the appropriate use of healthcare services.
• If offering biometric screenings onsite, communicate to employees they are not a substitute for a PCP relationship (unless screenings are offered through an onsite clinic with an advanced primary care model in which a provider works with the employee on follow up).

Reducing the overuse of healthcare resources is a critical part of improving the quality of healthcare in America. Employers can help – and make better use of limited resources – by moving away from mass testing to individualized care. Focusing efforts on establishing doctor-patient relationships is the better way to close care gaps and ensure that more pressing health needs are addressed.