Affordable Care Act Driving Use of Preventive Services

A prevention model of health is weaving its way into the fabric of traditional models of care.  The Affordable Care Act is expanding the use of preventive services in the US health care delivery system.  Preventive health care services avert diseases and illnesses from happening in the first place rather than treating them after they happen.

The United States Preventive Services Task Force analyzes the evidence base and cost effectiveness of various preventive services.  They publish a running list of “Category A & B” preventive services that are evidence based best practices that have a positive return on investment.  Category A & B Preventive Health Services are covered at no cost to consumers in the Qualified Health Plans offered on the Marketplace. In addition, many employer-based and government-sponsored health plans include Category A & B Preventive Services in the health insurance plans they offer to their members.

The United States Preventive Services Task Force recommends more than 50 preventive health services for clinicians to use in their practice.  They include various screening tests, counseling, immunizations, and preventive medications for adults, adolescents, and kids.  Their most recent recommendation is to screen for obesity in kids 6 years and older and offer or refer them to comprehensive, behavioral interventions to promote improvements in weight status.

The Task Force operates within the Agency for Healthcare Research and Quality (AHRQ) and consists of a panel of experts representing public health, primary care, family medicine, and academia.  They update the list of recommended services by reviewing best practices research conducted across a wide range of disciplines.

The AHRQ & Team Force use a systematic evidence review to develop the recommendations and follow a rubric for assigning grades based on the magnitude of net benefit and costs anticipated for the preventive service (basically the return on investment).

The overarching mission of the AHRQ, including their administration of the Preventive Services Task Force, is to reduce healthcare costs by analyzing data and making recommendations to clinicians and the health care system and guiding systems toward services and interventions that have a positive return on investment.   In other words, they find ways of preventing bad health outcomes and examine the evidence to identify interventions and prevention services that have a positive ROI.

AHRQ's research has become more important in recent years as value-based reimbursement arrangements tie payment to clinical quality.  Clearly, AHRQ is one of our country’s beacons of evidence based decision making.