Immunizations and Screenings on upswing
Blue Cross Blue Shield of Nebraska has tracked changes in utilization rates for preventive services since passage of Obamacare in 2010. Its findings:
» Colorectal cancer screenings increased by nearly 7 percent between June 2011 and May 2013.
» Vaccinations and immunizations increased by 6.1 percent between June 2011 and May 2013.
» The rate of new preventive office visits increased 2.2 percent between June 2011 and May 2013. That compares with the 15.7 percent increase that occurred between June 2010 and May 2012.
» Cervical cancer screening rates decreased by nearly 9.8 percent between June 2011 and May 2013.
» The proportion of insured receiving at least one preventive service from June 2012 through May 2013 increased 1 percent over the prior 12 months.
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The Affordable Care Act aims to increase the number of people taking advantage of preventive services such as immunizations and screening tests. These services no longer cost patients out-of-pocket money, but that isn't the only thing that keeps people from using them.
The U.S. Department of Health and Human Services estimates that 71 million Americans received expanded coverage of one or more preventive services in 2011 and 2012 because of the federal health insurance law known as Obamacare. That number includes 477,000 Nebraskans and 801,000 Iowans.
Covered preventive services include immunizations, diet counseling, colorectal screenings for people older than 50, mammograms, Pap tests and help quitting smoking.
Yet many people simply don't know there no longer is a fee for such services, said Dr. Richard O'Brien, professor emeritus at Creighton University and the former dean of Creighton's medical school.
“The efforts to educate the public about what's available and what they can get from the Affordable Care Act have been expanding,” O'Brien said. “The polls still don't show that a lot of people are highly knowledgeable about it, sad to say.”
AARP's Public Policy Institute reported late last month that fewer than a third of people ages 50 to 64 were up to date with certain recommended preventive services. The report was based on two years of Behavioral Risk Factor Surveillance Survey data for each indicator, usually from 2010 and 2011 data combined, but sometimes using 2009 and 2010 numbers. That means some of the data reflect the period when co-pays still were needed for certain preventive services.
“This is good baseline data,” said Megan Multack, the study's author.
People in the 50-to-64 age group who receive recommended preventive services and engage in healthy behaviors are more likely to stay healthy and function independently in old age, Multack wrote. But costly chronic conditions and poor health start to become more prevalent among that age group: More than 70 percent of them have at least one chronic health condition, compared with 35 percent of adults ages 18 to 45, Multack wrote.
“Oftentimes, people (in the 50-to-64 group) may not think of themselves at risk,” Multack said in an interview, “but this is the time when they should be starting to get these preventive services regularly.”
The percentage of Nebraskans and Iowans in that group who have had cholesterol screenings in the last five years is below the national average, according to Multack's report, as is the percentage who have gotten colorectal screenings.
Also below average: the percentages of Nebraska women who have had a Pap test within the past three years and a mammogram within the past two years. Iowa's numbers for those two tests are just above the national averages, which is 78 percent for each.
Nebraska and Iowa are among the top 10 states for people ages 50 to 64 who get flu shots: Iowa is fifth with nearly 50 percent and Nebraska is ninth with about 48 percent.
Underuse of preventive services is an even greater problem for uninsured Americans, racial and ethnic minorities and those of low socioeconomic status, Multack wrote, noting that those groups also are more likely to report risk factors for poor health.
Besides eliminating the cost, which Multack said had been the No. 1 barrier to accessing preventive services, providing reminders could help. “This could be an immunization registry or something as simple as sending a patient an email or calling them.”
Dr. Jim Medder, an associate professor at the University of Nebraska Medical Center, said he teaches his students that simply telling a patient to stop smoking or to start exercising more isn't enough. Physicians “need to try to find out why the patient does this or why they do that. Get at their motivation. Help them work through changing behaviors.”
If time for such counseling is an issue, Medder recommends that doctors enlist the help of other health-care providers such as physicians' assistants, nurse practitioners and nutritionists.
He added that restaurants, grocery stores, employers and local governments can help promote healthy lifestyles and wellness.