Strategies for Using Preventive Care to Reduce Health Care Costs

Leading Contributors to Health Insurance Costs

Health conditions that require ongoing medical treatment or are likely to require expensive medical procedures can contribute to higher health insurance rates. Examples of such conditions include diabetes, cancer, and heart disease. In the U.S., many of these conditions are prevalent:

• 11.3% of the U.S. population has diabetes
• Approximately 39.5% of men and women will be diagnosed with cancer at some point during their lifetimes
• Heart disease is the leading cause of death for men and women in the U.S.

These conditions can be expensive to treat and manage, which can drive up the cost of health insurance for individuals who have them and their employers.

Certain lifestyle choices such as smoking and being overweight can also contribute to higher health insurance rates as they can increase an individual’s risk of developing certain health conditions.

How Much Are Employers Contributing?

According to ERC’s data, employers are contributing an average of 73% of health insurance premiums, while employees are contributing 27% on average. The minimum organizations were contributing was 20% of premiums, while some organizations covered 100% of their participants’ premiums.

How Are Employers Managing Health Insurance Costs?

As health insurance costs rise, employers are using a variety of strategies to manage premium increases:

• 66% of employers are sharing the costs of increases between themselves and their employees
• 12% of organizations are absorbing the entire cost of the increase
• Only 2% of organizations are shifting the entire cost increase to employees

What Can Be Included in Preventive Care?

Preventive care typically includes a range of services designed to help individuals maintain their health and prevent the onset of disease. These services may include things like:

• Regular check-ups
• Screenings
• Immunizations
• Health education

A preventive care visit may include a physical exam, blood pressure and cholesterol checks, and screenings for conditions like diabetes and cancer. Immunizations can help prevent the spread of diseases, while health education can provide individuals with the knowledge and tools they need to make healthy lifestyle choices.

Check-Ups and Health Screenings

By providing individuals with access to regular check-ups and health screenings, employers can help to lower the overall cost of health care, which can in turn reduce the cost of insurance for employers and individuals. A preventive care plan may include many of the following:

• Annual physical examination
• Blood pressure and cholesterol checks
• Screenings for diabetes, heart disease, and other chronic conditions
• Cancer screenings, such as mammograms and colonoscopies
• Tests for sexually transmitted infections
• Mental health screenings, such as assessments for depression and anxiety

Specific health screenings included in a preventive care plan will vary depending on the employer’s health plan and the individual’s age, gender, needs, and risk factors.

Immunizations

Many preventive care plans cover a range of immunizations, including those recommended by the Centers for Disease Control and Prevention (CDC) for children and adults. Some common immunizations covered by health insurance plans include:

• Influenza (flu) vaccine
• Pneumococcal vaccine
• Tetanus, diphtheria, and pertussis (Tdap) vaccine
• Measles, mumps, and rubella (MMR) vaccine
• Human papillomavirus (HPV) vaccine
• Hepatitis A and B vaccines
• Varicella (chickenpox) vaccine

Specific immunizations covered by any given health insurance plan will vary. Some immunizations may be covered for only certain participants, such as children or seniors.

Health Education

Providing participants with health education has the potential to reduce employer and employee health insurance costs. In fact, one study found that employees that participated in a health literacy program had 32% fewer hospitalizations, 14% fewer emergency room visits, and an 11% decline in overall costs.

How can employers leverage health education to produce better-informed health care consumers and lower health insurance costs? Here are a few examples:

• Educating participants about the importance of regular check-ups and screenings can help them identify potential health problems early on when they are most treatable and least expensive to manage. For example, a mammogram can help to detect breast cancer in its early stages, significantly increasing an individual’s chances of successful treatment.
• Teaching participants how to manage chronic conditions like diabetes and high blood pressure can help prevent the need for expensive medical procedures down the road. Individuals with diabetes can learn how to manage their blood sugar levels through diet, exercise, and medication, preventing the onset of more serious complications like heart disease and kidney failure.
• Providing participants with information about the importance of exercise and a healthy diet can help to prevent the onset of obesity and other chronic conditions. Individuals who are overweight are at an increased risk of developing conditions like heart disease and diabetes.