Covering preventive care is worthless if consumers don't know about it


It's pretty hard to take advantage of a deal allowing you to, say, get a free cancer screening if you don't know that said deal even exists. That's why covering preventive care is only as effective as consumers' knowledge of that coverage.

But a recent study has found that consumers don't know preventive care is covered, at least not people with high-deductible health plans. In fact, almost 20 percent of the 456 California-based healthcare consumers didn't know their high-deductible plans covered preventive office visits.

"This confusion appeared to create barriers to seeking preventive care, even when it was actually available for free or for a low out-of-pocket cost," Mary Reed, staff scientist at Kaiser Permanente Northern California, and colleagues wrote in the study published in Health Affairs.

Reed found that, based on this inaccurate understanding of their benefits, about one in five consumers delayed or avoided a preventive visit, test or screening because of cost. And it didn't matter what sociodemographic characteristics the consumers had; the lack of preventive care coverage was low across the board.

In this case, ignorance isn't bliss. It's a healthcare problem not addressed early, potentially leading to chronic pain and disease and unnecessary utilization of a very expensive healthcare system.

But the reform law aims to increase preventive care based on the general understanding, which has been demonstrated through research, that preventive healthcare helps consumers avoid more serious, and often chronic, health problems in the future.

In effect, covering preventive care actually saves insurers money because preventive screenings, tests, exams and the like cost less than the full-blown diseases and illnesses that otherwise could occur. The Institute of Medicine found that for every $1 invested in prevention, we save $6 in projected healthcare costs, so it's actually in insurers' financial best interest to educate their members about preventive benefits covered under high-deductible plans.

What's an insurer to do?

"Education and consumer decision support to increase awareness of the detailed benefit design features will be extremely important to truly remove the cost barrier for preventive care," Reed said in the study.

Taking a few extra steps to clearly outline benefits and state that preventive care is free or very low-cost could go a long way toward helping insurers save money. But since we all know consumers don't read the long and tedious health plan descriptions, insurers should be realistic about their communication efforts.

Perhaps customer service reps could quickly mention preventive care at the end of conversations with members. Or an extra line about preventive care could be included at the bottom of the explanation of benefits. A banner on the website, newsletter or email that insurers use to communicate with members could prove informative as well.

The point is it doesn't have to be a gigantic investment of time, money or resources. It just has to grab consumers' attention so they know to take advantage of all kinds of preventive care. Put the ball in members' court, let them take advantage of the health system and save the insurance industry some money along the way. - Dina (@HealthPayer)