Medicare Benefits Good Step Towards Prevention

In the midst of a continuing dialogue about the critical role prevention and wellness measures should play in any health reform effort, the Centers for Medicare & Medicaid Services (CMS) is promoting a new Medicare benefit which provides coverage for an Initial Preventative Physical Examination (IPPE)and an Annual Wellness Visit (AWV). This measure, introduced as part of the Affordable Care Act, is another step in the direction of improving the health of Americans. Offering annual preventive visits is a critical component of a comprehensive preventive care system, and by supplementing these new annual Medicare benefits with existing notable programs, chronic diseases can be largely preventable and highly manageable.

While encouraging, this Medicare offering also needs to be augmented by a more robust concentration on prevention if we are to have any shot at curbing the rising costs of chronic disease. Largely preventable and highly manageable chronic diseases account for more than 90 cents of every dollar spent on Medicare and Medicaid. In contrast, we spend less than 5 cents on prevention. With these numbers in mind, if we fail to take the appropriate measures now to set up and support long-term prevention and disease management solutions, chronic diseases such as diabetes, cancer and heart disease will continue to be the leading cause of death, disability and rising healthcare costs in our country.

What can’t be overlooked is a much-needed emphasis on both prevention and care coordination. The IPPE and AWV do address a Medicare recipient’s health history and presenting risk factors, but to measurably make a difference in the reduction of chronic disease we must also focus on the follow up, including self-management skills and care coordination needed to provide long-term health solutions and, ideally, to head off risk factors and eliminate unhealthy behavior identified during the visits.

With the Medicare population primed to double by the year 2030, our window of opportunity to affect healthy change for the better in this population is now. Taking advantage of IPPE/AWV benefits and re-aligning the system to promote health can help to delay and even prevent the onset of chronic disease which will improve the health of seniors and reduce health care spending.