Benefits Strategy

Screening for Chronic Conditions

Primary care accounts for less than 10% of total health care expenditures: however, primary care providers (PCPs) are often seen by their patients as their most trusted health advisors.

May 09, 2023

Exploring Innovation in Preventive Care

A fresh look at updated screening guidelines and evolving testing methods to assist employers in evaluating ways to improve their members’ screening compliance and reduce hidden cost barriers to accessing preventive care.

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Abnormal Blood Glucose and Type 2 Diabetes

Uncontrolled diabetes can lead to blindness, limb amputation, kidney failure and vascular and heart disease. Screening patients before signs and symptoms develop leads to earlier diagnosis and treatment, but may not reduce rates of end-organ damage.¹⁰ While screening for type 1 diabetes is not recommended, the USPSTF recommends screening for abnormal blood glucose as part of a cardiovascular risk assessment for adults aged 35 to 70 who are overweight or obese.¹¹ The American Diabetes Association recommends screening for type 2 diabetes annually in patients 45 years and older, or in patients younger than 45 with major risk factors. Timely diabetes screenings can lead to early detection and enrollment in appropriate wellness and chronic disease management programs.

Cardiovascular Disease (CVD)

Cardiovascular disease (CVD), which encompasses conditions such as coronary heart disease, cerebrovascular disease and peripheral arterial disease, is the most common cause of death among adults in the United States.^12> Screening for high blood pressure and cholesterol should be part of the routine preventive visit and can also be offered on-site during health fairs or in on-site clinics. Statins are deemed preventive drugs for adults ages 40–75 years who have one or more cardiovascular risk factors and an estimated 10-year CVD risk of 10% or greater.¹³ HDHPs typically cover the prescription cost before employees satisfy their deductible and cannot require cost sharing of any kind. However, for patients outside of the 40-75 age window, the plan can require cost sharing.

Chronic Kidney Disease (CKD)

CKD is a common but underdiagnosed condition in which the kidneys have been damaged and have reduced function for at least 3 months.¹⁴ CKD patients also tend to suffer from diabetes, high blood pressure or both. Roughly 15% of the adult U.S. population has CKD, with the majority of those diagnosed at age 65 or older.¹⁵ Typically, CKD can be diagnosed using blood and/or urine tests. As many as 9 in 10 adults with CKD do not know they have the disease because it often has no symptoms in the early stages. Therefore, those at a higher risk (someone with a metabolic disorder like high cholesterol or a genetic predisposition) should be tested regularly.^15,16

At this point, the USPSTF has determined that there is not enough evidence to determine the potential benefits and harms of screening all adults for CKD. But it is important to note that their recommendations do not apply to those with diabetes or high blood pressure. For these populations, routine kidney function screening can lead to earlier CKD detection and more treatment options with respect to diet and lifestyle adjustments to slow the disease’s progression.

Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency virus (AIDs)

“For every HIV infection prevented, an estimated $360,000 is saved in the cost of providing lifetime HIV treatment,” according to the CDC.¹⁷ The USPSTF gave preexposure prophylaxis (PrEP) for the prevention of HIV infection an “A” rating for plan years beginning on or after June 11, 2020, in addition to annual screenings and risk assessments for HIV infection in adolescents and adults.¹⁸ In 2021, the Department of Labor (DOL) clarified that employers should cover the full cost of services associated with a PrEP prescription, including lab testing and doctors’ appointments.¹⁹ Following the USPSTF’s “A” rating, more generic PrEP medications have entered the market, lessening the cost burden. Currently, the cost of a monthly supply of PrEP is about $60 for generics and $2,000 for brand names, including Descovy and Truvada.²⁰

Reproductive Health as Preventive Care

In December 2022, HRSA updated its Women’s Preventive Services Guidelines²¹ to include expanded required services for plan years starting in 2024. These expanded services are focused on screening for gestational diabetes mellitus during and after pregnancy. More information about these recommendations and coverage considerations can be found on the HRSA website.

1 | Minemyer, P. Patients are likely to avoid preventive care should ACA coverage ruling stand, survey finds. March 8, 2023. https://www.fiercehealthcare.com/payers/patients-are-likely-avoid-preventive-care-should-aca-coverage-ruling-stand-survey-finds. Accessed April 24, 2023.
2 | Ugai, T., et al. Is early-onset cancer an emerging global epidemic? Current evidence and future implications. Nature Reviews Clinical Oncology. 2022; 19(10): 656-673.
3 | United States Preventive Services Task Force (USPSTF). Recommendation Topics. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics. Accessed March 9, 2023.
4 | Business Group on Health. ACA Preventive Services Chart. November 3, 2022. https://www.businessgrouphealth.org/resources/aca-preventive-services-chart. Accessed March 9, 2023.
5 | National Association of Community Health Centers. Closing the Primary Care Gap. February 2023. https://www.nachc.org/wp-content/uploads/2023/02/Closing-the-Primary-Care-Gap_Full-Report_2023_digital-final.pdf. Accessed April 24, 2023.
6 | Patient-Centered Primary Care Collaborative. Spending for Primary Care Fact Sheet. https://www.pcpcc.org/sites/default/files/resources/PCPCC%20Fact%20Sheet%20PC%20Spend%20Aug%202018.pdf. Accessed March 9, 2023.
7 | McAlearney AS, Gaughan AA, Shiu-Yee K, DePuccio MJ. Silver linings around the increased use of telehealth after the emergence of COVID-19: Perspectives from primary care physicians. J Prim Care Community Health. 2022 Jan-Dec;13:21501319221099485. doi: 10.1177/21501319221099485. PMID: 35588253; PMCID: PMC9130845.
8 | Elevance Health. Nearly four in five Americans who have used virtual primary care say it helped them take charge of their health. October 31, 2022. https://www.elevancehealth.com/newsroom/virtual-primary-care-helps-consumers-take-control-of-their-health.
9 | Whitehead DC, Mehrotra A. The growing phenomenon of “virtual-first” primary care. JAMA. 2021;326(23):2365–2366. doi:10.1001/jama.2021.21169
10 | Pippitt K, Li M, et al. Diabetes mellitus: Screening and diagnosis. Am Fam Physician. 2016 Jan 15;93(2):103-109.
11 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement- Prediabetes and Type 2 Diabetes: Screening. August 24, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes. Accessed April 24, 2023.
12 | United States Preventive Services Task Force. Screening for cardiovascular disease risk with electrocardiography: Recommendation statement. Am Fam Physician. 2018 Sep 15;98(6): online.
https://www.aafp.org/afp/2018/0915/od1.html. Accessed March 9, 2023.
13 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement: Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. August 23, 2022 https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication#:~:text=What%20does%20the%20USPSTF%20recommend,Initiate%20a%20statin. Accessed March 9, 2023.
14 | United States Preventive Services Task Force (USPSTF). Understanding Task Force Recommendations: Screening for Chronic Kidney Disease. August 2012. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/chronic-kidney-disease-ckd-screening. Accessed March 9, 2023.
15 | Centers for Disease Control and Prevention. Chronic Kidney Disease in the United States, 2021. July 12, 2022. https://www.cdc.gov/kidneydisease/publications-resources/ckd-national-facts.html#:~:text=CKD%20Is%20Common%20Among%20US%20Adults&text=More%20than%201%20in%207,are%20estimated%20to%20have%20CKD. Accessed April 24, 2023.
16 | United Kingdom National Health Service (NHS). Diagnosis: Chronic kidney disease. August 29, 2019. https://www.nhs.uk/conditions/kidney-disease/diagnosis/. March 9, 2023.
17 | Centers for Disease Control and Prevention. CDC’s HIV Prevention Progress in the United States. October 1, 2021. https://www.cdc.gov/hiv/dhap/progress/index.html. Accessed April 24, 2023.
18 | Business Group on Health. New ACA Preventive Service Coverage Requirement for HIV (PrEP). June 4, 2019. https://www.businessgrouphealth.org/resources/new-aca-preventive-service-coverage-requirement-for-hiv-prep. Accessed March 9, 2023.
19 | Department of Labor. FAQs About Affordable Care Act Implementation Part 47. July 19, 2021. https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-47.pdf. Accessed April 24, 2023.
20 | Varney, S. HIV Preventive Care is Supposed to Be Free in the U.S., So, Why Are Some Patients Still Paying? Kaiser Family Foundation Health news. March 3, 2022. https://khn.org/news/article/prep-hiv-prevention-costs-covered-problems-insurance/. Accessed April 24, 2023.
21 | Health Resources and Services Administration. Women’s Preventive Services Guidelines. December 2022. https://www.hrsa.gov/womens-guidelines. Accessed April 24, 2023.
22 | Fedewa SA, Star J, Bandi P, et al. Changes in cancer screening in the US during the COVID-19 pandemic. JAMA Netw Open. 2022;5(6):e2215490. doi:10.1001/jamanetworkopen.2022.15490
23 | Rodriguez S. Patient Engagement HIT. Preventive care takes a hit, cancer screenings drop 80% amid pandemic . June 6, 2022. https://patientengagementhit.com/news/preventive-care-takes-a-hit-cancer-screenings-drop-80-amid-pandemic. Accessed April 24, 2023.
24 | Meister, K. Prevent Cancer Foundation. Alarming new study shows pandemic is disrupting cancer screenings. February 25, 2022. https://www.preventcancer.org/2022/02/alarming-new-study-shows-pandemic-is-disrupting-cancer-screenings/. Accessed April 24, 2023.
25 | Callison K, et al. Cancer screening after the adoption of paid-sick-leave mandates. New England Journal of Medicine. 2023; 388.9: 824-832.
26 | Abul-Husn, N.S., Soper, E.R., Odgis, J.A, et al. Exome sequencing reveals a high prevalence of BRCA1 and BRCA2 founder variants in a diverse population-based biobank. Genome Med. 2020; 12 (2) . https://doi.org/10.1186/s13073-019-0691-1. Accessed March 9, 2023.
27 | United States Preventive Services Task Force (USPSTF). Final Recommendation Statement: BRCA-Related Cancer: Risk Assessment, Genetic Counseling, and Genetic Testing. August 20, 2019. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/brca-related-cancer-risk-assessment-genetic-counseling-and-genetic-testing. Accessed March 9, 2023.
28 | National Institute of Health. Biomarker Testing for Cancer Treatment. December 14, 2021. https://www.cancer.gov/about-cancer/treatment/types/biomarker-testing-cancer-treatment#:~:text=A%20biomarker%20test%20may%20be,those%20you%20are%20born%20with. Accessed April, 24, 2023.
29 | Business Group on Health. 2023 Large Employers’ Health Care Strategy and Plan Design Survey. August 2022. Available at:https://www.businessgrouphealth.org/%20resources/2023-large-employers-health-care-strategy-survey-intro. Accessed March 9, 2023.
30 | Klein E A, Richards D, Cohn A., Tummala M, Lapham R, Cosgrove D,. et al. . Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Annals of Oncology. 2021; 32(9), 1167-1177.
31 | United State Preventive Services Task Force. Draft Recommendation Statement Breast Cancer: Screening. May 9, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/breast-cancer-screening-adults#:~:text=Recommendation%20Summary&text=The%20USPSTF%20recommends%20biennial%20screening,ages%2040%20to%2074%20years.&text=The%20USPSTF%20concludes%20that%20the,age%2075%20years%20or%20older. Accessed May 10, 2023.
32 | American Cancer Society. American Cancer Society Recommendations for the Early Detection of Breast Cancer. https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html. Accessed May 10, 2023.
33 | Centers for Disease Control and Prevention. What Does It Mean to Have Dense Breasts? September 26, 2022. https://www.cdc.gov/cancer/breast/basic_info/dense-breasts.htm. Accessed April 24, 2023.
34 | National Institute of Health: National Cancer Institute. Dense Breasts: Answers to Commonly Asked Questions. https://www.cancer.gov/types/breast/breast-changes/dense-breasts. Accessed March 9, 2023.
35 | Food and Drug Administration. FDA Updates Mammography Regulations to Require Reporting of Breast Density Information and Enhance Facility Oversight. March 9, 2023. https://www.fda.gov/news-events/press-announcements/fda-updates-mammography-regulations-require-reporting-breast-density-information-and-enhance. Accessed April 24, 2023.
36 | Mayo Clinic. Virtual Colonoscopy. https://www.mayoclinic.org/tests-procedures/virtual-colonoscopy/about/pac-20385156. Accessed March 9, 2023.
37 | Centers for Disease Control and Prevention. Colorectal (Colon Cancer): Screening Tests. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm. Accessed March 9, 2023.
38 | ACS Medical Content and News Staff. Colorectal Cancer Screening: What Are My Options? American Cancer Society. March 2, 2020. https://www.cancer.org/latest-news/understanding-tests-that-screen-for-colon-cancer.html. Accessed March 9, 2023.
39 | Cavallo J. Solving the mystery of why colorectal cancer Is on the rise in young adults: A conversation with Kimmie Ng, MD, MPH. The ASCO Post. June 25, 2019. https://www.ascopost.com/issues/june-25-2019/solving-the-mystery-of-why-colorectal-cancer-is-on-the-rise-in-young-adults/. Accessed July 8, 2020.
40 | National Cancer Institute . Why Is Colorectal Cancer Rising Rapidly among Young Adults?. November 5, 2020. https://www.cancer.gov/news-events/cancer-currents-blog/2020/colorectal-cancer-rising-younger-adults. Accessed April 24, 2023.
41 | Centers for Disease Control and Prevention. Lung Cancer: Who Should Be Screened for Lung Cancer? https://www.cdc.gov/cancer/lung/basic_info/screening.htm. Accessed March 9, 2023.
42 | American Cancer Society. Can Lung Cancer Be Found Early?. January 8, 2023. https://www.cancer.org/content/cancer/en/cancer/lung-cancer/detection-diagnosis-staging/detection.html. Accessed March 9, 2023.
43 | Richards TB, Soman A, Thomas CC, et al. Screening for Lung Cancer — 10 States, 2017. MMWR Morb Mortal Wkly Rep 2020; 69:201–206. http://dx.doi.org/10.15585/mmwr.mm6908a1.
44 | U.S. Preventive Services Task Force. Cervical Cancer: Screening. August 21, 2018. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening . Accessed March 9, 2023.
45 | Centers for Disease Control and Prevention. HPV Vaccination Recommendations. November 16, 2023. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html. Accessed April 24, 2023.
46 | National Cancer Institute. Cervical Cancer Prognosis and Survival Rates. January 6, 2023. https://www.cancer.gov/types/cervical/survival#:~:text=When%20cervical%20cancer%20is%20diagnosed,relative%20survival%20rate%20is%2059%25. Accessed April 24, 2023.
47 | Rosenberg J. Cervical cancer screening rates" unacceptably low," researchers find. The American Journal of Managed Care. February 10, 2020. https://www.ajmc.com/view/cervical-cancer-screening-rates-unacceptably-low-researchers-find. Accessed April 24, 2023.
48 | Winer Rachel L, et al. Rationale and design of the HOME trial: A pragmatic randomized controlled trial of home-based human papillomavirus (HPV) self-sampling for increasing cervical cancer screening uptake and effectiveness in a US healthcare system. Contemporary Clinical Trials. 2018; 64 : 77-87.