Does Preventive Care Save Money?

[somarco]

Some evidence does suggest that there are opportunities to save money and improve health through prevention.

Sweeping statements about the cost-saving potential of prevention, however, are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs.

Some preventive measures save money, while others do not, although they may still be worthwhile because they confer substantial health benefits relative to their cost. In contrast, some preventive measures are expensive given the health benefits they confer.

https://www.nejm.org/doi/full/10.1056/nejmp0708558

What we have is a conundrum.

The referenced article mimics studies from the early 90's at a time when managed care was expanding and politicians were promoting free and low cost health care.

Insurance carriers were also pursuing ways to improve their bottom line. Numerous actuarial studies concluded that, while SOME people may benefit from preventive managed care, the dollar savings for the carriers was negligible.

Even still, it gave them talking points that mirrored what politicians and MSM were discussing, and provided a way to differentiate themselves from what other carriers offered. Essentially, my plan is better than their plan because we cover more services.

 

[axeman462]

God bless the insurance industry! The only only industry out there that actually incentivices people to get and stay healthy.
There is no other industry in America that actually does this. We are literally saving lives here people!

 

[Fisher]

So to recap - sometimes it helps, sometimes it doesn't. I am now 0% smarter with this info.

 

[somarco]

sometimes it helps, sometimes it doesn't

Kind of . . .

Preventive care CAN help some folks as long as they follow doctors orders which may include lifestyle changes . . . which the majority shun.

A few Medicare carriers include gym memberships (SilverSneakers) while some of the other plans offer cash discounts for those who want to participate.

Less than 10% of my clients ask for SilverSneakers. I have no idea how many use it when it is included.

Carriers did actuarial studies in the 90's and possibly earlier, to determine how much to invest in covering preventive check ups and tests. The ROI was negligible and what worked for some folks didn't work for others.

They have tried different things over the years . . . premium discounts didn't pan out because a large number of insureds failed to take advantage of the "free" care.

Early on carriers tried targeted incentives that included covering mammograms for women. Before building that into the plan, a number of women were surveyed to determine how much they would be willing to pay for a covered mammogram. The bulk said they would pay $20 for a mammogram and no one would have a mammogram if they had to pay more than $50.


The EGH market also tried steep discounts only to discover the projected savings never materialized. So the carriers shifted the responsibility to the employer and encouraged employers to offer a combination of premium discounts for "wellness" and/or HRA incentives for compliance.

This worked better than blanket discounts because those who were motivated to stop smoking, participate in health coach programs and so forth were rewarded with lower premiums and/or extra HRA bucks to pay for OOP health care.

Another study found 70% of chronic disease could be prevented and, in many cases, reversed with lifestyle changes. But too many would prefer to take a pill rather than change their diet or add in moderate exercise such as walking 30 minutes per day.

30% of adults are overweight, 42% are classified as obese and 9% are morbidly obese.

There is helpful information available for those who are not cynical.

 

[straightnochaser]

February 14, 2008 <----- Date of the article.

He's digging deep in the archives..

 

[rmhaire]

He's digging deep in the archives..

Gotta know stuff before you can post stuff

 

[LeeV]

As most of you may know, I come from the carrier side of the business, spending significant amount of time within managed care organizations. We knew early on that much of the hype about prevention was window dressing. Prevention is a good thing, and at times it does help the insured. But we always thought that the true savings impact was minimal at best. Part of the problem was in the way the insured populations viewed preventive care and how effective the medical world could identify these risks.

The average insured tends to think of getting a yearly check-up or physical as the start of prevention, which it is. But unless the medical side runs a significant number of tests, it is difficult to find many of these risks. Then when confronted with potential risks, and what can be done to limit its impact, too many of these insureds ignore the advice anway.

The new advances being made in science/medical do make believe that much of this can be changed in the near future. Some of the things we can do thru DNA/Genetics appear to be able to identify many more risks at a much more affordable cost. Now whether people will act on that information is another story.

 

[somarco]

Prevention is a good thing, and at times it does help the insured. But we always thought that the true savings impact was minimal at best.

Thank you for your input! Always good to have an informed, sane comment in these threads.

When it comes to preventive care covered by insurance and Medicare, the numbers have not changed since at least the 80's when I was exposed to ROI carrier data on a granular level and began to realize that many of the so-called benefits were in fact window dressing.

And other structural changes, such as copays for medical and especially Rx had a negative impact on ROI. When treatment and medication was covered by a flat dollar amount vs deductible and coinsurance, utilization skyrocketed and had a negative impact on loss ratios.

It reminds me of folks who complain that health care is too confusing and would like to see transparent pricing like some auto repair places that post pricing for fluid changes, tire rotation and repair, etc.

While that sounds nice the human body is too complex to quote a flat rate for organ transplant and cancer surgery.

As one pointed out, the referenced article is a few years old. While the numbers have changed the underlying message is the same as it was in the 80's and 90's. The human factor, compliance or non-compliance, is the red herring that makes the "science" of predicting cost effectiveness unreliable.

 

[gregj]

Less than 10% of my clients ask for SilverSneakers. I

about 10% of mine do NOT ask about gym membership.

also, the whole "does x save money [that would presumably be spent on health treatment]?" is kind of a time-wasting red herring.

/soapbox