Health Plan Implementation of U.S. Preventive Services Task Force A and B Recommendations

Colorado, 2010

Sara Russell Rodriguez, MSN, MPH; Deb Osborne, MPH; Jillian Jacobellis, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2011;60(39):1348-1350. 

In This Article

Editorial Note

Health-care reform advances individual and population prevention goals by requiring coverage of services supported by evidence. Variance in health plan interpretation of the USPSTF recommendations coupled with health-care provider uncertainty regarding coverage and coding and lack of clarity among consumers regarding benefits might affect their use of services and impinge on optimal health outcomes.

Although USPSTF provides clinical guidance on how to implement recommendations within health-care provider practices, it does not define the recommendations in language that can be applied readily to the delivery of health insurance benefits.[4] To ensure optimal consumer and health-care provider utilization of preventive benefits, implementation of these benefits must be consistent across health plans and understood by both health-care providers and consumers. The A and B recommendations should be translated clearly into health plan benefit language, and processes should be put in place for consistent implementation; public health agencies can assist in this effort. CDPHE has taken the lead in identifying gaps in preventive services and addressing these inconsistencies through collaboration with the major commercial and public health plans in Colorado.

Colorado has formed a prevention council, where health plan representatives can share best practices and come to agreement on minimum benefit standards for the A and B recommendations. Colorado has had previous success in working with health plans on tobacco cessation coverage and counseling and was able to gain agreement on minimum benefits. Creating constructive relationships with health plans will be critical to successful implementation of federal health-care reform. Public health agencies also can provide useful data regarding the return on investment from many public health initiatives and can connect health plans with population-based strategies to increase preventive service use.

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