Prevention and wellness care are widely recognized as means to reduce health costs and spending, while also improving outcomes for patients. Preventive services typically include screenings for diseases, such as cancer, or harmful conditions, such as obesity. They also include immunizations. For example: someone gets a flu shot costing $20 and avoids becoming victims of the early 2013 flu season. The person not only will be healthier, but will not need to get anti-flu prescription drugs or to visit a physician or hospital for care, all of which would be much more expensive than the $20 flu prevention.

Examples like that have made preventive care a hot topic. It will become even more important after 2014, when the Affordable Care Act (ACA) begins to require health plans to cover preventive services as part of the health reform law’s essential health benefits (EHB). Qualified health plans (QHP) on health insurance exchanges (HIX), Medicaid health plans (for the ACA expansion population), state Basic Health Programs (BHP), and most other private health insurers all will need to offer policies that cover the essential health benefits.  Under the ACA, federally-endorsed preventive services must be covered, without co-pays, and without applying a deductable.

AHRQ Study on Rural vs. Urban Preventive Care Use:

Preventive care use is a frequent study topic for the Agency for Healthcare Research and Quality (AHRQ). One recent AHRQ report looked at preventive service use among people living in rural areas, those that are not in Metropolitan Statistical Areas (MSA) defined by the White House Office of Management and Budget (OMB).

The short report, which draws data from AHRQ’s Medical Expenditure Panel Survey (MEPS), has some interesting findings:

  • Compared to MSA (urban) residents, non-MSA (rural) residents were less likely to see a physician for a check-up, have a cholesterol screening, and visit a dental provider in 2009.
  • Non-Hispanic black people in rural areas were less likely to have seen a physician for a routine preventive visit, compared to non-Hispanic blacks in urban areas.
  • The difference between routine preventive care visits among urban and rural residents was larger for non-Hispanic blacks than for non-Hispanic whites.
  • Forty-one percent of non-Hispanic blacks who lived in a rural area had seen the dentist in the past year, compared to 56 percent of non-Hispanic blacks who live in an urban area.
Health IT and Preventive Care:

In addition to the ACA’s push for preventive care, health information technology initiatives have the potential to help patients manage their own health and preventive care. Interactive Preventive Health Records (IPHR) are one good example of that.
IPHRs are online web-based tools that allows patients access to electronic health records (EHR), that collects patient information, gives personalized health recommendations, helps explain lab results and other clinical information, and that reminds or prepares patients for visits. Primary care physicians can use an interactive preventive health record system to meet Medicare annual wellness requirements, and to facilitate reporting, benchmarking, and patient tracking.

The AHRQ has published a handbook for primary care physicians interested in using interactive preventive health records, and the handbook is also a good resource for anyone who wants to learn more about the tool.

There might be limits to how much health IT (HIT) such as IPHRs can improve preventive care use for rural residents, who typically do not have as fast or extensive internet access as urban residents do. Nonetheless, IPHRs and other electronic patient communication tools have the potential to do a lot to improve primary care.