USPSTF Recommendations Guide Payers on Preventive Care Screenings

The US Preventive Services Task Force (USPSTF) has made a few preventive care screenings recommendations in recent months that payers should take note of for their preventive care and value-based care strategies.

Value-based care relies heavily on preventive care services to stem higher healthcare spending. Payers can reward providers for conducting screenings in accordance with established standards in order to promote high value healthcare spending, instead of perpetuating low value care spending patterns.

For many payers and healthcare professionals, this means staying on top of USPSTF recommendations.

The USPSTF’s most recent analysis found that individuals between the ages of 50 to 75 years would benefit from colorectal cancer screenings and for individuals between 45 to 49 years of age. But members between 76 and 85 years old may not benefit from the screening as much.

In 2018, over three in ten adults who were eligible for the colorectal cancer screening were not up to date with their screening. The disease has continued to grow in prevalence, even among younger age groups.

This is particularly important for payers and healthcare professionals to communicate to the Black community. Colorectal cancer deaths between 2014 and 2018 were highest in the Black community, with 18 colorectal cancer deaths for every 100,000 adults.

“The causes for these health disparities are complex; recent evidence points to inequities in the access to and utilization and quality of colorectal cancer screening and treatment as the primary driver for this health disparity rather than genetic differences,” the report explained.

“The USPSTF encourages the development of systems of care to ensure adults receive high-quality care across the continuum of screening and treatment, with special attention to Black communities, which historically experience worse colorectal cancer health outcomes.”

Hypertension was another condition that the USPSTF addressed.

This condition impacts around 45 percent of adults in the US and is a comorbidity for some of the most deadly and most expensive diseases in the US including heart failure, stroke, and chronic kidney disease.

Screening for hypertension was already considered a highly recommended practice but the USPSTF has reaffirmed that conclusion in its recent recommendation, yielding substantial health benefits to members.

USPSTF recommended not only using an office blood pressure measurement according to normal practice, but also following up that screening with a validated ambulatory blood pressure monitor or home blood pressure monitor to confirm the presence of hypertension prior to initiating treatment.

The recommendation emphasized that ambulatory blood pressure monitoring can more accurately predict cardiovascular events, as opposed to home blood pressure monitoring.

Screenings should be annual for adults who are 40 years of age and older or for those with risk factors. Otherwise, screenings should occur every three to five years.

Some experts responded negatively to the USPSTF’s hypertension recommendations, expressing that they could exacerbate racial care disparities due to the limited use of ambulatory blood pressure monitoring. Reimbursement for this practice has been poor and many insurers do not cover it, thus limiting access.

This underscored, to some extent, the importance of payers in providing equitable access to these preventive care services.

One preventive care screening that payers might decide not to reward in value-based contracts due to USPSTF’s recommendations is the vitamin D deficiency screening for individuals who live in community, are not pregnant, and are not exhibiting the symptoms of vitamin D deficiency.

“The US Preventive Services Task Force (USPSTF) concludes that the overall evidence on the benefits of screening for vitamin D deficiency is lacking,” USPSTF stated. “Therefore, the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults cannot be determined.”

USPSTF found that screenings may incorrectly identify members as vitamin D deficient, leading to an overdiagnosis. This, in turn, would result in payers having to cover unnecessary vitamin D treatments. It could also result in underdiagnosis.

Thus, the current recommendation upholds the previous recommendation from 2014 which found that the data was insufficient to assess vitamin D deficiency screenings.

Although the data has not been heavily evaluated, the need for this recommendation is clear. Between 2000 and 2010, Medicare reimbursement volumes for vitamin D testing skyrocketed. The test experienced an 80-fold increase in utilization.

This does not necessarily mean that payers should discourage screenings altogether. In fact, there simply is not enough research to determine the worth of these screenings. However, USPSTF did draw a connection between vitamin D screenings and misclassification.

Earlier in the year, USPSTF also released recommendations on hearing loss screenings for seniors and lung cancer screenings.