Because preventative care can reduce expenditures and improve health outcomes, the GAO conducted a study examining actual preventative service use in relation to the U.S. Preventative Services Task Force (USPSTF) and Advisory Committee on Immunization Practices (ACIP) by Medicare fee-for-service (FFS) beneficiaries. This study also examined whether or not the Welcome to Medicare (WTM) exam effected preventative service use, the relation between Medicare Advantage (MA) and Medicare FFS preventative care, and preventative service use in Medicare Advantage plans given the efforts made by high-performing Medicare HMO-type health plans in encouraging prevention.

In Use of Preventive Services Could Be Better Aligned with Clinical Recommendations, a 74-page report to Congress, GAO found that:

  1. FFS beneficiary use of certain preventative services did align with clinical recommendations including cardiovascular disease and cervical cancer screening.
  2. FFS beneficiary use of other cancer screening for certain age groups did not align with clinical recommendations including osteoporosis screenings and immunizations.
  3. Of those FFS beneficiaries who became eligible in 2008 for the WTM exam, fewer than seven percent actually received it.
  4. A correlation was found between FFS beneficiaries receiving the WTM exam in 2006 and increased preventative service use.
  5. A greater number of MA plan beneficiaries partook in cholesterol testing and immunizations than did FFS beneficiaries, yet this was not true for cancer screening.
  6. No significant difference was found in preventative care use among FFS and MA non-HMO beneficiaries.

Results also indicated that those Medicare beneficiaries opting out of certain preventative care services had concerns about discomfort, side effects, or efficacy; reported having limited information on preventative care; and were not advised to acquire preventative care by their physician. To encourage preventative care use, higher-performing HMOs cited the use of several tools including newsletters, phone messages, financial incentives for physicians promoting preventative services, performance tracking, and feedback collection.

GAO recommended that Congress consider a cost-sharing mandate for those services discouraged by the USPSTF for certain beneficiaries. GAO also recommended Medicare coverage for services recommended by the USPSTF.

To read or download the full brief, click here (PDF).