PRIMARY CARE
Richard Wender, M.D.
Alumni Professor and Chair
Department of Family Medicine
Thomas Jefferson University
Immediate Past President, American Cancer Society (National)
Primary care clinicians care about prevention and devote a significant percentage of their clinical effort to preventive care. Patients frequently visit primary care offices for control of blood pressure and lipids, as well as glucose control for diabetics. Other common primary care prevention activities include some cancer screenings and counseling for adverse health behaviors like tobacco use. However, few clinicians are able to reach all their enrolled patients with the full range of evidence-based preventive care interventions.
One principle obstacle to prevention in primary care is the limited amount of time available to administer all the recommended services for a patient, especially given that many preventive encounters occur as part of an acute or chronic care visit. These time constraints are exacerbated by payment systems that typically provide incentive for primary care physicians to conduct a large number of visits in a relatively short time period (20 minutes or less on average).
A reformed payment system is needed to realign incentives to promote the delivery of preventive care. Such reform should include enhanced payment for primary care services to reverse the alarming decline in the number of new and existing primary care clinicians, to provide support for new technology, and to hire appropriate team members who can help provide preventive services. Perhaps most importantly, new payment systems must link financial incentives to the achievement of specific thresholds for evidence-based preventive care as opposed to the volume of delivered care.
INDUSTRY
F. Mark Gumz
President and Chief Operating Officer
Olympus America
Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States – a shocking statistic because these deaths could be prevented with routine screenings. When colon cancer is detected early and treated appropriately, it is curable nine out of 10 times. A national commitment to early detection of CRC would not only save lives, it would also save money. Yet health insurance plans offered by many U.S. employers do not cover routine colorectal cancer screenings.
According to a report commissioned by the American College of Gastroenterology, early detection of colorectal cancer results in an overall cost savings to society. Today, the cost to treat the 150,000 people estimated to be diagnosed this year alone is predicted to reach $2.4 billion for Medicare and $8.3 billion in the private sector, depending upon the pharmaceuticals used in treatment. That’s almost $11 billion.
Simply stated, we need to have coverage for colorectal screening in all employee health insurance plans. Since 2006, Olympus employees and family members participating in the United Healthcare plan the company offers have been eligible for 100 percent coverage of annual colonoscopy or sigmoidoscopy screenings, regardless of age.
We urge all employers to include coverage of colorectal cancer screening in their employee health insurance plans. Colorectal cancer screening coverage needs to be extended to the vast majority of the U.S. population who are covered by private health insurance plans. Doing so will not only save millions in health care costs, it will save thousands of lives.
HEALTH INSURANCE
Bill Fried, M.D.
Medical Director
MidAtlantic Region
Aetna
We can all agree that there are current problems with the health care system, and Aetna is committed to being part of the solution. We believe that coverage for preventive care, including colorectal cancer screening, is a vital element in any meaningful health care reform plan.
That is why we promote preventive care and wellness and strongly support better access to affordable, quality care. In fact, we cover routine preventive care and recommended cancer screenings at 100 percent under nearly all of our standard benefits plans.
To help improve cancer-screening rates, members receive periodic reminders to encourage them to seek services to prevent disease or detect and monitor conditions early on. Registered nurses are available by phone if members have questions about preventive care services. Our web-based cancer screening information and tools help members make better-informed decisions about their care.
We also work closely with physicians to increase adherence to colorectal cancer screening guidelines. Physicians are sent a list of their patients in need of recommended screening tests. Clinical resources and patient education materials are available to them as well.
Providing access to care that is proven effective and based on sound medical evidence produces quality outcomes, promotes health, eliminates waste, and is good for patients as well as the health care system. By doing so, health insurance companies can create the means to provide universal health care access for all Americans.
