Promoting Employee Utilization of Preventative Care

What is preventative care?                                                                                     

Preventative care is a subset of services offered through health plans with the intention of detecting or preventing serious diseases and medical issues. Treatment and other forms of medical intervention are most effective when conditions are identified early (or prevented altogether), so sound preventative care can result in both better outcomes and more cost-effective care. In most cases, certain preventative care services are offered with no cost-sharing to employees and 100% coverage by group insurance plans. The annual deductible does not need to be satisfied and there is no coinsurance or copay associated with using these benefits.

Covered preventative care includes:

• Annual Physicals
• Well Woman Exams and Screenings
• Well-Child Visits
• Immunizations
• Contraception
• Allergy screenings
• Colorectal cancer screening, mammograms, and certain other cancer screenings (subject to age and risk factors)

For more on what’s covered - click here

Why is it important that your employees utilize their preventative care benefits?

Effective use of preventative care can help lower health spend for employers and employees by treating diseases and illnesses before they become severe. When employees postpone the care they need, it can lead to higher long-term costs, absences, or compromised work performance down the line. Similarly, when covered dependents keep up with their preventative care, it can also reduce long-term costs and mitigate risks to employee well-being.

Family Health History:

It is important to encourage your employees to learn and discuss their family health history with their providers. If your employee has a family history of chronic diseases, like cancer, heart disease, or osteoporosis, it is more likely that your employee will contract this disease themselves. Once the provider is aware of specific family medical history, they are more likely to be able to help the individual or the family member take steps to prevent certain health conditions or catch them early, when they are easier to treat.

Barriers/reasons why not everyone uses their preventative care:

• Not understanding their plan, what’s included, and how to use it
• Not having a primary care physician
• Lack of awareness of the importance and recommended preventative services
• Don’t like going to the doctor or dentist
• Don’t want to take the time off to go

What can employers do to encourage employees to use preventative care:

• Discuss specific options with your insurance broker.
• Keep educational materials and plan descriptions easily accessible and up to date.
• Consider allowing employees flexibility in their workday to go to preventative care appointments. Approaches can include dedicated time off, allowing for a longer lunch period, or offering flex hours for personal medical care.
• Run awareness campaigns to highlight common conditions, emphasize the importance of well visits for both employees and their dependents, and promote important screenings.

What should you advise if the healthcare provider feels the employee should have further testing or screenings performed outside of their preventative care visit?

• Encourage employees to ask their healthcare provider for verification of benefits. This will allow the employee to see what their out-of-pocket cost will be for extra screenings or testing.
• Remind employees of their plan’s out-of-pocket maximum so that they are aware that no matter how much associated next steps in care may cost, the plan will begin to pay 100% after their out-of-pocket maximum is met for the plan year.
• If the cost of services is prohibitive, an employee may speak with their providers about payment plans. Employees can also look to stand-alone facilities (ie. MRI centers) rather than using services at a hospital for certain types of tests.
• Other options if covered by the employer:
  • Flexible Spending Accounts
  • Health Savings Accounts (HSA)
  • Health Reimbursement Account

When employees don’t utilize preventative care services, they often overpay for their healthcare and so do their employers. At RBN People & Benefits, we are here to assist and advise employer groups on how to navigate employee education and engagement.