What Congress Got Right on Prevention and Three Things To Consider in the Future

Based on what’s been written in its prior posts this week, readers may think the Disease Management Care Blog has, when it comes to prevention, dismissed the entire health reform package as woefully inadequate. Actually, outside of not doing enough to prevent diabetes and continuing to rely on one-on-one provider visits for prevention 'planning,' the DMCB thinks there is lots to be happy about in the legislation.

Medicare and Medicaid will now eliminate cost sharing and other forms of out of pocket expenses for many preventive services. In addition, States will be eligible to receive extra Federal funding to make this possible. In the area of tobacco, cessation drugs will now be included in State Medicaid formularies and cessation services will be available to women who are pregnant. Commercial insurers will also be largely prohibited from imposing any out of pocket costs related to immunizations as well as for preventive care for children and women and aspparently have to cover the "A" or "B" recommendations set by the U.S Preventive Services Task Force.*

Regular readers may also recall that Congress was being pressured to reset the cap on the percent of premium financial incentives that could be used by employers to promote wellness. The DMCB is happy to report that the original language has been preserved and that it is now set at 30%.

Last but not least, there are many grants, councils, task forces, demos and pilots that will include various initiatives to test approaches to and generally promote wellness and prevention. While it remains to be seen how much of an impact all of this will have, successes may breed additional successes and lead to additional changes in how government and commercial insurers pay for prevention.

Yet, is this enough? The DMCB isn't all too sure because much of the legislative language directs the Secretary of HHS to make all this happen using the "shall' verb. Between here and there is a lot of regulatory language and a large number of moving pieces that could mean delays and poor execution. That, to paraphrase our Vice President, is also a big deal. DMCB is rooting for the HHS Secretary and giving the taxpayers their money's worth.

In the meantime, here are some ideas for Congress to continue to consider in the inevitable fixes that will follow:

1. The next time Medicare beneficiaries are sent a rebate, why not send vouchers instead that can be used for a year's worth fitness training and/or nutritional counseling?

2. If randomized control trials show that case manager directed life-style interventions reduce the incidence of diabetes for persons at risk, why not cover this in Medicare and Medicaid?

3. And while this is a little different, while the Centers for Disease Control is charged with significant leadership responsibilities in the various working groups, why not ask it to lead the creation of a multi-faceted and state-of-the-art social media campaign in support of a national wellness agenda?

*though these are the folks who precipitated the mammography controversy