HHS to require payors to cover CV-related preventive screenings

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Beginning on September 23, the Department of Health and Human Services (HHS), Labor and the Treasury will require new health plans to cover preventive services including blood pressure, diabetes and cholesterol test screenings to give patients better access to preventive care.

Under the new regulations, insurance plans will no longer be able to charge patients copayments, coinsurance or deductibles for evidence-based preventive services, routine vaccines, pediatric prevention and preventive care for women.

According to the HHS, Americans currently use preventive services at half the recommended rate. It is the hope of HHS that by cutting cost sharing to these types of services patients will utilize the recommended types of preventive care such as nutritional counseling to prevent obesity and aspirin usage to prevent MI, amongst others, more frequently.

In March 30, 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that men aged 45 to 79 and woman aged 55 to 79 use aspirin as a prevention method to thwart off future MIs and cardiovascular disease.

When utilized by 90 percent of the population this prevention tactic could save an estimated 45,000 lives per year, the agency said. Additionally, beginning cholesterol screening for men at age 35 and women at age 45 saved an estimated 2,450 lives per year when utilized by 90 percent of patients.

By expanding these types of services to cover more patients, HHS said the healthcare system will see benefits including: a reduction in illnesses and diseases; earlier treatment and a decline in mortality rates due to early screening; fewer sick days; and lower health costs.

Additionally, USPSTF has recommended that children over the age of six and adults be screened regularly for obesity and be referred to diet counseling to improve weight loss. Currently, it is estimated that the number of patients without weight loss coverage is 29 percent. And obese individuals incur significantly higher healthcare costs—39 percent—than those who are not obese, according to an analysis by the McKinsey Global Institute.

Providing patients access to diet counseling could significantly cut healthcare costs and prevent comorbities including hypertension, diabetes and coronary heart disease.

“These interim final regulations are expected to increase the take-up rate of preventive services and are likely, over time, to lead physicians to increase their use of these services knowing that they will be covered, and covered with zero copayment,” HHS stated.

HHS said that use of preventive services varies greatly between the insured and uninsured and coverage increases usage rates between three and 30 percentage points. The agency estimated that with coverage for these services these points could be raised by 5 or 10 percent for most patients.

The estimated annual increase for these services to be included in patient health plans would cost $4.