As the population ages, health care is becoming more complex in the United States. More than half of all Americans struggle with chronic health conditions, including heart disease, diabetes, or dementia.
Even more crucially, patients are presenting in clinics and hospitals with compounding health concerns and multiple comorbidities. This can result in higher test costs, longer courses of treatment, and difficulty in pinning down diagnoses.
One way providers can help reduce strain on health care systems is to offer preventive care services. In this article, we talk about different forms of preventive care, their pros and cons, and what you can do to make preventive health care a cornerstone of your practice.
Preventive care, also called preventative care, is a broad term, referring to actions patients or healthcare providers can undertake to help prevent or stabilize disease or chronic conditions.
Some forms of preventive care are medical interventions, while others focus on patient behavior. Screenings done by care providers can also go a long way toward contextualizing patient health.
Preventive health services fall into three main categories:
Primary prevention refers to services designed to prevent disease before it occurs. Vaccinations are prime examples of primary prevention, often slowing—sometimes almost stopping, as with polio in some parts of the world—the spread of a disease.
Secondary prevention refers to preventive services that might help catch a future health concern as early as possible. This often takes the form of screening tests: Mammograms, prostate checks, and colonoscopies are common—and memorable—examples of secondary prevention services.
Tertiary prevention refers to care that helps manage current, often chronic conditions. For example, a stroke patient might take a daily dose of aspirin to prevent the recurrence of blood clots. Tertiary prevention can also include education, such as on how patients can manage destructive drinking habits or quit smoking.
It can seem counterintuitive to invest resources against health problems that haven’t yet arisen. But as our population ages and health care systems become increasingly stressed, proactive care is one easy way to minimize healthcare costs—from both a financial and humanitarian perspective.
The fact is that preventive care saves lives. As an added bonus, it can also save money.
Though cost savings vary depending on the type of treatment—the prohibitive cost of scans and some drugs, for example, can make healthcare cost effectiveness relative—many primary, secondary, and tertiary preventions can save money by reducing hospitalizations and expensive treatments down the road.
We know that a patient who quits smoking may increase their lifespan by 5-7 years on average, but one Ontario study also found that the money spent on smoking cessation programs was recuperated in 95% of cases. Considerable health care savings accumulated quickly thereafter, and in many forms—from reduced health care costs due to fewer serious conditions down the road, to improved economic productivity resulting from fewer sick days.
Among the most effective prevention measures in both health and cost savings are immunizations. Not only did flu shots prevent an estimated 100,000 hospital visits in the US during the 2019–2020 flu season, flu shots for Canadian patients over 65 have been estimated to save $45 in health care costs for every $1 spent on immunization programs.
Savings are not the reality across all preventive services. Some more expensive proactive interventions, like prescriptions and scans, can increase health care costs overall. Even when they do seem necessary, there is the additional burden of convincing insurance providers they’re necessary—if they cover the service at all.
We’ll go more into the barriers to preventive healthcare later on. Despite obstacles, however, proactive care like prevention—when used in combination with reactive treatments—has the potential to improve patient quality of life, reduce certain costs, alleviate strain on the health care system, and help create a more holistic patient care structure.
Here are just a few ways preventive services can improve patient care:
Earlier detection. When it comes to chronic disease, little is more important to patient outcomes than early detection. It’s common knowledge that rates of cancer survival are substantially higher when the disease is caught early, but early detection of mild cognitive impairment can also significantly drive treatment in cognitive health.
Longer lifespan. Related to early detection, catching disease early—or preventing it altogether—has the potential to add years to patients’ lives.
Quality of life. Apart from the improved quality of life that comes with preventing disease before it starts, quality of life considerations can also factor into secondary and tertiary preventive care, like substance use counseling and mental health.
Prevention of comorbid conditions. Proactively addressing the development of chronic and complicated comorbidities can help reduce the growing strain on our healthcare system.
Expanded medical practice. Providers concerned with holistic patient care can turn to prevention as one solid way to expand their services. By making annual wellness checks part of regular health screenings, you can build patient trust—and develop a reputation as an attentive and thorough provider of care.
If applicable, ensure preventive services are covered by insurance before offering them to patients. Effective preventive care implementation may rely on cooperation with insurance providers, especially when it comes to more expensive screening tests like scans.
“Preventive care” covers such a broad array of potential services that it can be hard to know what qualifies. Here are some services that might qualify as effective preventive healthcare:
Physical assessments. The most basic elements of a physical exam count as preventative care. You’re already aware of the screening benefits of pressing a stethoscope to a patient’s chest and listening to their breathing. Cardiovascular screening is worthwhile—so is screening using a wider net. These regular health screenings allow to you detect signs of health problems early.
Blood tests. Use blood tests to check on much more than iron and glucose levels. Blood tests can feature in preventive measures like genetic screening, diagnostic tests, assessing risk of heart disease, and cancer detection.
Counselling. We’ve mentioned smoking cessation programs, but counseling can help inform patient behavior on any number of fronts, including substance use and vaccine intake. Behavioral counseling is also a great way to stress the importance of factors like appropriate exercise and living a healthier lifestyle, which can help to manage certain chronic conditions including mental illness and cognitive impairment.
Questionnaires. Questionnaires screen for mental health concerns, including depression, anxiety, and substance use disorders; neurological concerns like ADHD, autism, and concussion; and even for cognitive deficit. At worst, a questionnaire will provide information to you and your patients about what isn’t a concern; at best, it provides key information for mental health treatment and intervention.
Well-child visits are important preventive care opportunities for kids. Apart from monitoring children’s health and development, these appointments provide opportunities for clinical preventive services such as:
immunizations
treating lead exposure
vision and hearing tests
mental health screening for teens
STI screening for teens
and much more
Many health insurance plans cover comprehensive well-child visits. Check this complete list of covered clinical preventive services a provider might offer to children.
It’s easy for us to advise the implementation of preventive health care, but less easy to know when preventive care is the best option. Below, we discuss some of the barriers to clinical preventive services implementation.
Awareness of these concerns can help both health care providers and patients thoroughly understand their options when choosing a care plan.
Billing is a central concern for health care providers when recommending proactive treatment. While some screening methods like counseling and immunizations save money, more expensive preventive services like scans and certain prescriptions can result in higher costs than reactive treatment services.
Working with Medicaid and other insurance providers may put some preventive care options within reach that otherwise would not be possible. But given that reimbursement guidelines are constantly shifting, it can be difficult to know when a health screenings are worth the cost to insurance providers—or the patient themselves.
When it comes to screening tools like questionnaires and cognitive function tests, it can be hard to decide on a treatment plan based on vague, subjective, or incomplete data. This is especially true when data fatigue is a leading concern with healthcare providers. It’s one thing to implement screening tests, but another to parse the best treatment options based on endless metrics.
As with healthcare providers, cost is a leading barrier to preventive care with patients. Insurance providers may be reluctant to cover proactive procedures if they don’t appear medically necessary in the way reactive services are. Patients also may not possess the time, energy, skills, or knowledge required to appeal insurance decisions—or may not possess insurance at all.
Referral times for scans and specialists can range from weeks to months. Particularly when patients may not see preventive health care as medically necessary, the thought of waiting for so long just to be told there’s nothing wrong may seem like a waste of time, money, and energy.
Certain preventive screenings may pose socio-psychological barriers. Mental health, substance use, and cognitive function tests are at particular risk for associated stigma: a patient may react negatively to the very idea of susceptibility to these less-understood mental health and cognitive conditions.
Though never a one-size-fits-all solution—no amount of programming or conversation is likely to slow the spread of cancer—more accessible forms of preventive care like counselling may help bridge the gap posed by obstacles to providing preventive care.
In other words, holistic patient care may involve providing patients with information. This can include patient education and counselling to provide information and reduce stigma, or straightforward communication on possible preventive services; barriers to those services; possible alternatives; and what patients can do at home to improve their health outcomes.
Apart from education—both of yourself and your patients—there are certain factors that can help make preventive care a cornerstone of your practice. Qualities identified again and again in clinics that offered preventive care services include:
Value-based care. These care structures, where providers are compensated based on patient outcomes rather than fee-per-service, center diverse care methods, distributed care burden, and care transparency while devaluing profits. In other words: when patient outcomes are prioritized, patient outcomes improve!
Leadership. One way to influence care cultures toward preventive care is to champion preventative care values! Leadership toward a prevention-driven model can look like many things, but some important factors may include:
Clear vision: Working toward health care focused on patient outcomes.
Communication: With patients, insurance providers, and other health care practitioners.
Collaboration: Working with other care providers to influence care culture.
Education: Of yourself, your patients, and other care providers on preventive care options.
Fostering leadership in others: Encourage others to champion preventive care with you!
Measurement tools. Use of screening and measurement tools can give providers extensive information on their patients’ needs in many of the more obscure domains of holistic health care, like mental and cognitive health. If you need to start somewhere, collecting data may help you figure out where to start in holistic care planning.
Preventive care is a growing concern in health services—with good reason. As our population ages and chronic disease and comorbidities grow increasingly complex, proactive disease control may become a crucial way to reduce strain on our health care system.
Taking a proactive approach to improving holistic care not only improves patient outcomes but, in many cases, it may reduce costs in the long run. Whether focusing on physical screening like blood tests or applying measures like questionnaires, there’s no bad way to implement preventive care as part of holistic care provision.