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February 6, 2018

What’s the Deal with Preventive Care?

Artemis Health

We all know we should get that yearly physical, schedule that mammogram or colonoscopy, or finally visit the lab for annual blood work. These “preventive care” procedures are important for a few reasons:

  • They help your doctor catch serious illnesses, like cancer or heart disease, early
  • They give your doctor a chance to suggest preventive techniques, like weight loss or changes to your routine
  • They may lead to the discovery of an unrelated condition that you didn’t realize was affecting you

For these reasons and more, we wanted to dive deeper on preventive care. So what types of visits and procedures are in this category? Preventive care services are recommended procedures, tests and medications or shots that help keep you healthy and well. Most healthcare plans will cover these at no cost to the member because they may prevent future treatment that would be even more costly.

Preventive care services include blood pressure, cholesterol, or diabetes blood tests, many types of cancer screenings, immunizations, counseling on addiction or healthy eating, flu shots, pediatric checkups, and more. While all of these services are quite important for patients, they still come at a cost for payers.

We wanted to know: what’s the deal with preventive care?

For our Story (what we call an analysis on the Artemis Platform), we limited our data to folks 50 and older. These are the members most likely to need yearly checkups, blood work, or tests. A few highlights:

  • 357 members had preventive care claims during our analysis period (1 year). Our demo data is a population of about 12,000, so this is roughly 3% of members.
  • More women than men incurred preventive care claims, and more subscribers than spouses or dependents did, too.
  • Most of these claims were for members in 50 to 59 age bin.

We also looked at total employer paid costs for these procedures and correlated them with members’ home locations. Here’s what we found:

In addition to tracking costs, payers can also use this info to find out where these members are located. For example, if you had a large office in Dallas but saw relatively little engagement with preventive care there, you might target that location for a flu shot clinic.

We also broke down these claims by procedure.

Most preventive claims are for annual checkups, followed closely by allergy treatments and vaccines.

Finally, we wanted to look at the impact of preventive care on the health of these members. Assessing a patient’s overall health is complex and multifaceted, but one quick way to get a sense for this by looking at the average cost of claims per member. We set up two “cohorts” of members: those who had preventive care claims vs. those who didn’t.

We got a surprising result. Those in our preventive care cohort saw on average $7,642 in claims during the analysis period, while those outside the cohort cost on average $3,860. The trend was similar for the average number of claims: 35.4 for the preventive care folks, but just 7.36 for those not engaging in preventive care.

Why would this be the case? It could be for a number of reasons:

  • Maybe these members are sicker than the rest of the population, hence more claims
  • Possibly they’re diagnosed with serious conditions at a higher rate than others because they’re getting regularly tested
  • These members could be utilizing their benefits more often in general

Further analysis could reveal our preventive care cohorts most common illnesses, prescriptions, and more. Our population in this case is fairly small, and our analysis used sample data, so we can’t come to any firm conclusions. But we did find one silver lining in our preventive care group: they don’t miss as much work.

Those in the preventive care cohort miss on average 27 days of work, compared to 63.2 days for the rest of the population. Perhaps these folks are missing fewer days overall because they’re following doctor’s orders?

Are you looking for answers like these in your benefits data? We can help you find them.

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