Preventitive Services and Screening (02-23-2005) 

Together with at risk behavior modification (i.e. stop smoking), preventive screening (i.e. checking your blood pressure) may allow us not only to take responsibility for our health but also to discover potential problems when they are in their initial stage, easier to resolve, and before they become big problems, more difficult, more expensive to handle and with less chances of cure or survival. Several employees have been asking about Preventive Services and Screenings. "What do you mean?", "What does make sense?", "Is it simple or complicated, expensive or covered by my plan?" We asked Dr. Alberto Colombi (Corporate Medical Director) to clarify some principles regarding this issue.

Based on the recommendations of the "Clinical Preventive Services" Report of the U.S. Preventive Services Task Force only screenings of proven impact are considered. Useful screenings must have predictive value avoiding false positives and false negatives, must improve favorable health outcomes, must be cost effective, non invasive, easily accepted and be confidential. Few proven screening procedures pass this rigorous set of criteria.
Preventive Services are divided in three categories:

  1. Screening Tests
  2. Counseling interventions
  3. Immunizations

Each category can be delivered in coordinated, complementary steps:

a. Basic: They can be provided by the company at each worksite to groups of employees
b. Major: They are provided by health plan(s) to subscribers

Below are examples of Basic and Major screening procedures:

BASIC: Could be provided at work MAJOR: To be provided by health plan
Blood Pressure Mammogram age 50 and higher
Body Mass Index Colonoscopy age 50 and higher
Blood Lipids (Cholesterol) Pap Test
Fasting Blood Glucose Osteoporosis
Depression Other

Basic Work site screening can be implemented through company resources or inducing Health Plan(s) to return as a work site service some of the premium paid to them by employers/employees and deliver work site services at no additional cost to them.

Major screening ought to be part of all health plans arrangement if their usefullness is based on universal consensus. There is also another key concept to consider.

Major screening procedures made accessible through HMO arrangements are subject to Quality monitoring through indicators called HEDIS Quality Indicators.

HEDIS stands for Health Employer Data Information Set (HEDIS) and is a set of performance indicators assembled by the National Committee for Quality Assurance (NCQA) to evaluate Health Plan(s) performance in providing adequate preventive services and screening procedures to those insured. About 50 indicators are available to assess effectiveness, availability of care, services utilization, etc.

Among these metrics the percentage (not the names obviously!) of Members having a Mammogram, a flu shot or a Colonoscopy, or appropriate Diabetes testing are also noted. The performance of an HMO is then deemed better if the proportion of those undergoing/utilizing the desired preventive service-screening procedure is higher.  If we want to teach employees to become move involved with consumer driven health plans, employees will have to become familiar with these quality indicators in order to make informed choices on the quality of preventive care they get.