Preventive Care Outreach: Partnering to Improve Health Outcomes, Lower Costs and Increase CMS Scores

Three-quarters of health care spending in the United States is due to avoidable chronic disease.[1] Preventive care is one of the best ways to address this challenge; however, millions of Americans avoid preventive care every year. 

Why? They may be unaware of available services or concerned about the associated costs.[2] Access to care is also a challenge, with as many as 25% of Americans lacking a primary care provider.[3] 

Proactive patient outreach is an important step health plans can take to help members get the preventive care they need. eviCore’s preventive care outreach program can improve patient well-being, lower treatment costs and may increase a health plan’s performance score with Star Ratings and Healthcare Effectiveness Data and Information Set (HEDIS) metrics. 

Why is Preventive Care Important? 

Preventive health care can help identify potentially serious health problems earlier when they are easier and less costly to treat. Preventive care includes annual wellness exams, dental visits and counseling, as well as routine health screenings and tests, such as:

• Annual flu vaccines
• Immunizations
• Breast, cervical and colorectal cancer screenings

These regular visits and practices matter. They’ve been shown to significantly affect disease detection and treatment success rates. For example:

• Regular colonoscopies combined with stool tests reduce colorectal cancer mortality by 52% [4]
• Regular mammograms and breast cancer early detection reduces the risk of patient death from breast cancer by 49% [5]

In addition to improving patients’ long-term health, preventive care also reduces costs for both patients and health plans. 

The Role of Preventive Care Outreach 

Preventive care outreach enhances patient health by identifying and resolving any gaps in care. When eviCore partners with health plans to conduct preventive care outreach, the impact is significant. 

When Medicare Advantage patients were contacted about missing their recommended cancer screenings:

• Nearly 70% scheduled a cervical cancer screening [6]
• More than 50% scheduled a breast cancer screening [7]

A preventive care outreach team can also work with patients to help identify a high-quality, high-value site for their check-up or screening, alleviating any concerns about costs they might have and creating a better overall member experience. 

Potential Impact on Star Ratings and HEDIS Performance

When health plans offer proactive preventive care outreach to their members, their Medicare and Medicaid ratings may improve. 

Star Ratings are now more heavily weighted than ever before to member experience, including any contact from a health plan to a member inquiring about their necessary wellness visits and screenings.[8] For Medicaid, 90% of health plans rely on HEDIS measures to compare performance. [9]  

Because many Medicare and Medicaid beneficiaries use Star and HEDIS ratings when deciding between plans, this emphasis on member experience makes it even more important to provide a robust program supporting preventive care outreach.

How Preventive Care Outreach Works

When it comes to preventive care outreach, eviCore partners with health plans to make the process as smooth and easy as possible. Once a year, a health plan sends their member and provider files to eviCore, and eviCore manages all the administrative and record-keeping responsibilities.   

Based on the data provided, concierge agents reach out to members through mail, phone calls, and text messages to discuss necessary preventive care and increase awareness about its importance.

Agents help to reduce the barriers to preventive care for members in several ways, including:

• Working with patients to schedule appointments
• Helping members find a primary care provider
• Sending appointment reminders
• Updating a member’s health plan files to indicate that care has been received
• Sharing test results with providers (if approved by the patient) to ensure continuity of care

eviCore can also create materials for provider offices to inform patients that preventive care outreach is part of their health plan, and why this outreach is important for their health. 

Learn More about eviCore’s Preventive Care Outreach Program

eviCore’s preventive care outreach program operates as a seamless extension of our partner health plans to benefit their members and deliver an exceptional experience.

If you’re a health plan administrator and you’d like to learn more about eviCore’s preventive care outreach, reach out to your primary contact at eviCore or sales@evicore.com.

Sources:

[1] Beaton, T How Preventive Healthcare Services Reduce Spending For Payers, Aug. 29 2017.HealthPayer Intelligence,

[2] Syed, S.T., et al (2014). Traveling Towards Disease: Transportation Barriers to Health Care Access. Journal of Community Health, 38(5), 976-993. Beaton, T How Preventive Healthcare Services Reduce Spending For Payers, HealthPayer Intelligence, Aug. 29 2017.

[3]Levine DM, et al. Characteristics of Americans with primary care and changes over time, 2002-2015. JAMA Intern Med. 2019 December 16.

[4] Zorzi M, et al. Non-compliance with colonoscopy after a positive faecal immunochemical test doubles the risk of dying from colorectal cancer. Gut. February 8, 2022.

[5] Otto, Suzie et al. Mammography Screening and Risk of Breast Cancer Death: A Population-Based Case–Control Study. Cancer Epidemiology Biomarkers & Prevention. (2012) 21 (1): 66–73.

[6] eviCore book of business data, 2019.

[7] eviCore book of business data, 2021.

[8] Gill, A. 3 Things to Act on for 2023 Star Ratings. Managed Healthcare Executive. April 25, 2022.

[9] U.S. Dept. of Health and Human Services. Office of Disease Prevention and Health Promotion. Healthcare Effectiveness Data and Information Set (HEDIS). Healthy People 2030.