Tag Archives: preventive care

S.C. adults may gain dental benefits as part of Medicaid plan

Image by sunnyviewdental via flickr.

Image by sunnyviewdental via flickr.

Adult dental benefits would be added to South Carolina’s Medicaid program under a plan being considered by the state legislature.

Preventive and restorative dental benefits for poor adults are part of a package of proposed Medicaid enhancements that also includes health screenings and weight-loss help, Seanna Adcox reported in a Feb. 5 story for The Associated Press.

The new benefits were part of state Medicaid Director Tony Keck’s budget presentation before a House Ways and Means panel, Adcox wrote. The initiatives would cost $15.3 million from state taxes and $52 million total when including federal money.

Currently, the state Medicaid program covers only emergency tooth extractions in specific cases of medical necessity. Continue reading

For wellness programs, more employers using rewards and penalties

Here’s a trend to watch: More employers are using both financial incentives (the carrot) and penalties (the stick) in wellness programs. A number of publications have covered the issue of employers using penalties, perhaps because the penalties are a relatively new development.

For many years, employers have used incentive payments and other inducements to encourage workers to participate in wellness programs. But a rising number of employers are using financial penalties to encourage participation.

In July, Pennsylvania State University told its employees and their spouses that they would face a $100 monthly surcharge unless they completed a biometric screening and an online wellness profile and certified that they have had or will have a physical exam. Penn State added that it would not have access to the health screening results.

Dena Bunis, managing editor at CQ HealthBeat, covered this story and reports (via the Commonwealth Fund) that as part of the biometric testing, employees and spouses have to get blood pressure and fasting blood tests and height and weight measurements. In emails, faculty and staff have raised questions about why the university decided to encourage participation with a penalty rather than a financial incentive, Bunis wrote. Continue reading

HHS unveils ‘National Prevention Strategy’

Today, in a live webinar and a companion piece in the New England Journal of Medicine, the Department of Health and Human Services released its “National Prevention Strategy,” a broad effort to realize the preventive care goals set forth in the Affordable Care Act. The specifics of implementation are still taking shape, but the release centered around four primary talking points:

  • The ACA seeks to “remove cost as a barrier” to “clinical preventive services,” by requiring new private plans to cover preventive services in the “strongly recommended” and “recommended” categories (examples include certain vaccines and screening procedures) with no cost to the beneficiary. Medicare will take a similar approach, and state Medicaid plans will be incentivized to do the same.
  • It promotes workplace wellness initiatives through new grants and a re-evaluation of existing programs.
  • It seeks to involve communities and local governments through community-based efforts. “Community Transformation Grants,” for example, “promise to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.”
  • It makes preventative health a federal priority through “a newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies,” which “will develop a prevention and health promotion strategy for the country.” It also promises a “national strategy to improve the quality of health care,” and “improved data collection on health disparities.”

In addition to the four big messages, HHS officials pointed to initiatives designed to address specific, salient concerns such as smoking, obesity and the looming shortage of primary caregivers.

ECRI reviews prostate cancer research

The ECRI Institute’s new review of recent research on the utility of off-label prescription of Finasteride in the prevention of prostate cancer (PDF) presents research and clinical guidelines. Its bibliography and research review may be useful for anyone considering a follow-up to Gina Kolata’s recent New York Times piece on cancer prevention. Finasteride blocks an enzyme that aids the proliferation of prostate cancer cells. It’s used to reduce the size of enlarged prostates and, under the name Propecia, to treat male pattern baldness.

A large trial on finasteride, known as the Prostate Cancer Prevention Trial (PCPT), was published in 2003. The 18,882 men (asymptomatic, with normal PSA levels, 55 years of age or older) enrolled in the trial were randomly assigned to receive either finasteride or placebo for 7 years. … The authors of the trial reported that finasteride reduced the incidence of prostate cancer from 24.4% to 18.4%; however, the incidence of high-grade prostate cancers was 25.6% higher in the finasteride group than the placebo group. The clinical significance of these findings is unclear and has been widely debated.

The impact of prophylactic finasteride on long-term mortality and quality of life was not reported by the PCPT. Two models forecasting the impact of finasteride on mortality in participants in the PCPT were published. Grover et al. predicted that for every 1,000 men treated with finasteride, a total of 20 life-years (0.02 years per individual) would be saved, and Lotan et al. predicted that men treated with finasteride would, on average, gain 1.7 months of life.

The ECRI release was prompted by Kolata’s piece in The New York Times which questions why drugs that have been proven to prevent cancer are not being taken while many potentially harmful (and useless) supplements are. Kolata mentioned the Finasteride case in addition to similar examples involving breast cancer prevention drugs.

According to its Web site, the nonprofit ECRI Institute “dedicates itself to bringing the discipline of applied scientific research to healthcare to discover which medical procedures, devices, drugs, and processes are best to enable improved patient care.” The acronym ECRI has been adopted as the organization’s full name, but used to stand for “Emergency Care Research Institute.”

An ounce of prevention will cost you

Prevention is no panacea. If the country expects to keep people well by catching and treating disease early, better health won’t come cheap.

Stanford med school prof Abraham Verghese explains in a critique of Obama’s health plan in The Wall Street Journal. The gist: health reform won’t pay for itself.

apples-for-prevention

Photo by digicla via Flickr

“Counting on the ‘savings’ that will come as a result of investing in preventive care and investing in the electronic medical record among other things,” he writes, is “a dangerous and probably an incorrect projection.”

Sure, losing weight and exercising more don’t cost much. But Verghese says screening, testing and treating patients early is expensive. “Prevention is a good thing to do,” he says, “but why equate it with saving money when it won’t?”

The bottom line, Verghese writes, is that fundamental reform and an expansion of coverage can’t happen without cutting costs. That means drug prices, doctors’ fees and hospital charges are all in line to get whacked.

Related

In the Columbia Journalism Review, Trudy Lieberman, president of AHCJ’s board of directors, interviewed Rutgers researcher Louise Russell about the potential for preventive care to curb health care costs. Russell (bio page) said that, in many cases, preventive care may actually add to overall health care costs because, for such care to be effective, it needs to be employed on a large scale.

Russell says studies that claim savings based on prevention are not only calculating medical expense, but also figuring in potential future earnings of those whose lives are saved by prevention. She also encourages a stronger focus on more cost-effective preventive measures, like flu shots, over more expensive options like annual pap smears.

In the final third of the interview, Russell specifically addresses reporting on preventive care and provides guidance and recommendations.