Preventive Services— the Balance of Underuse and Overuse

1. Preventive Services— the Balance of Underuse and Overuse 2009 NQF Annual Spring Implementation Conference Eduardo Sanchez, MD,MPH,FAAFP Vice President and Chief Medical Officer BlueCross and BlueShield of Texas March 26, 2009

2. The Quality of Health Care Delivered to Adults in the United States(McGlynn, et al, NEJM 348:26,6/26/03) • Only 54.9% of recommended preventive care was provided. • 38 indicators McGlynn, et al, NEJM 348:26, 6/26/03. (McGlynn, et al, NEJM 348:26,6/26/03)

4. Overview The National Commission on Prevention Priorities, convened by Partnership for Prevention, guides an ongoing study that: That ranked clinical preventive services according to health benefit and cost effectiveness Demonstrated where improving the use of preventive services and eliminating disparities will save and improve the most lives

5. Which preventive services were considered? U.S. Preventive Services Task Force Advisory Committee on Immunization Practices

6. Which Preventive Services Are Most Valuable? NCPP ranks preventive services based on 2 measures: Health Impact Measured as QALYs Saved Cost Effectiveness (CE) CE = $s Spent – $s Saved QALYs Saved

7. Measuring Value NCPP uses a scoring system to indicate preventive services’ relative value: Health Impact Scores 5= Highest impact among these preventive services 1 = Lowest impact Cost Effectiveness Scores 5 = Most cost effective among these preventive services 1 = Least cost effective Total Scores Range from 10 to 2

9. Aspirin Use to Prevent Heart Disease Hispanics are 24% less likely and Asians are 40% less likely to use aspirin daily or every other day compared to non-Hispanic whites.

10. Smoking Cessation Advice and Help to Quit Hispanics are 55% less likely to have been offered assistance to quit smoking by a health professional compared to non-Hispanic whites.

11. Influenza Immunization in Adults 50+ Hispanic adults are 40% less likely to have had a flu shot in the previous 12 months compared to non-Hispanic whites; blacks are 35% less likely, and Asians are 21% less likely.

12. Colorectal Cancer Screening in Adults 50+

13. Breast Cancer Screening in Women 40+

14. Cervical Cancer Screening Among Women 18-64

15. Why Don’t More People Use Preventive Care? Barriers Facing Consumers: High out-of-pocket costs = low demand No regular source of health care or “medical home” Unaware of the preventive services they need; miscalculate their risk of disease; uncertain about preventive services’ effectiveness. Health Care System Barriers Providers lack or don’t use systems proven to increase delivery of preventive care Limited investment in a prevention-oriented health care workforce Reimbursement

16. What BCBSTX is doing. Consumers-focused solutions • Benefits redesign to lower out-of-pocket costs • Primary care medical home initiative • Blue Care Connection web-based/telephonic outreach Network-focused solutions • IT solutions (e-prescribing, EHR) • Primary care medical home initiative • Enhanced reimbursement

17. Let’s make sure we do what we know needs to get done. 2009 NQF Annual Spring Implementation Conference Eduardo Sanchez, MD,MPH,FAAFP Vice President and Chief Medical Officer BlueCross and BlueShield of Texas March 26, 2009