Preventive care is the core of the health system and a vital part of everyday health. It is the most basic care that a person should receive regularly. U. S. law requires health insurance plans to cover preventative services, making them available to those who need them. It is beneficial not only for patients but also for insurance companies: they spend less on preventative care, such as annual check-ups and screenings, than on disease management.
The key point behind preventative care is to actually prevent the onset of a new disease or the complication of an existing chronic condition. Regular check-ups reduce risks that an illness may go unnoticed, and allow doctors to manage it at the earliest stage. Immunization aims to prevent the most common viral or infectious diseases.
What’s more important, regular health monitoring is most effective when it comes to chronic disease management, particularly, when there are several diseases. According to the Centers for Disease Control and Prevention (CDC), cancer and such chronic conditions as diabetes and cardiovascular diseases are the reason for 70 percent of deaths among Americans. In other words, 70 percent of all deaths in the U.S. are caused by preventable diseases. For example, the most common type of cancer is lung cancer, which is primarily associated with smoking. Heart diseases and diabetes are often caused by poor nutrition and obesity.
Managing chronic conditions accounts for more than 70 percent of the U.S. health spending. 5 times more is spent on someone with a chronic condition than on a healthy person. The government reports that 25 percent of adults and 75 percent of seniors in the U.S. have several chronic conditions.The CDC claims that if every American received the recommended preventive care, 100,000 lives could be saved each year.
Besides basic annual check-ups, preventive services include immunizations for all ages, blood pressure screenings (and screenings for type 2 diabetes for those who have high blood pressure), cervical and breast cancer screenings, HIV screenings, obesity screenings, and counseling, diet counseling, etc.
Preventative care provisions under the Affordable Care Act (ACA) also include:
- Maternity care, including well-women visits, support for contraception and breastfeeding, domestic violence screening, as well as nutrition, and alcohol counseling.
- Treatment of mental health, such as depression screenings, and substance abuse prevention.
- Disabilities coverage, such as special equipment and services to maintain living standards in case of temporary injuries (e.g. broken bones) or chronic conditions.
- Pediatric care, including dental care, and vision tests, etc.
Covered preventive services are provided in the guidelines and recommendations by various authorities, such as the CDC, U. S. Preventive Services Task Force (USPSTF), and others. However, these guidelines are likely to change over time. For example, vitamin D screening is currently not on the list of covered services, but it is highly likely to appear soon.
Distinguishing preventive services can be tricky sometimes. It requires the patient to know what is covered by his insurance and what is not. For example, a cholesterol test and the CBC (a complete blood count) may be performed during one visit to the doctor, but only the cholesterol test will be covered, while the CBC coverage will depend on the rules of the health plan. Depending on the situation, the same test may be preventive (and free of charge) or diagnostic (which should be paid by the patient). For example, a mammogram is covered, but if a doctor finds a lump or has a particular concern, the mammogram will be considered as a diagnostic service.
One should also bear in mind that, for the patient to be fully covered, the doctor should be an in-network provider. The doctor’s office may also make mistakes, and a patient may receive bills for preventive services instead of the insurance company. Preventive services may increase the administrative burden on both providers and patients, creating a mess in billing and documentation. All of these factors compel providers and insurance companies to search for methods to organize the current system more effectively, often through new technologies, special software and platforms developed to mediate interactions between all involved.
Solve.Care provides an effective solution for all parties involved, by utilizing advanced blockchain technologies and best standards of data encryption. Solve.Care offers software addressing the most common problems associated with preventive care services.
Dr. David Hanekom, the Chief Medical Officer and Regional President, North America of Solve.Care, said: “We are using digital payments and administrative simplification through Care.Networks to redirect more resources towards improving health outcomes for every patient. Solve.Care is creating value for both patients and clinicians. Our platform helps direct money away from covering administrative costs and towards directly helping patients through preventative care, which leads to lower premiums, better benefits, and greater satisfaction … The future of the global healthcare system looks bright, and I am proud to be in the vanguard of this innovation”.
Preventive health care is the central pillar of the healthcare system. Not only does it reduce health care spending, but it also increases self-awareness and engagement among patients. The preventive services list is expected to become longer over time, and no doubt that will mean utilizing advanced technologies to eliminate existing organizational problems.