Little Evidence Thus Far of Increased Preventive Screenings, Despite ACA Rule to End Cost Sharing, AJMC Study Finds

FOR IMMEDIATE RELEASEJuly 17, 2015

PLAINSBORO, N.J.—Cost-sharing has ended for preventive mammograms and colonoscopies due to the Affordable Care Act (ACA), but the change hasn’t created a groundswell of patients seeking these services, according to a new study in The American Journal of Managed Care.

Shivan J. Mehta, MD, MBA, assistant professor of Medicine at the Perelman School of Medicine, University of Pennsylvania, and co-authors examined data from Humana for beneficiaries aged 50 to 64; these enrollees were in small-business employer plans both before and after this policy change took effect in September 2010. Those in plans that required to end cost-sharing for these preventive screenings were compared with beneficiaries in “grandfathered” plans that did not have to make the change yet.

Researchers did not find any substantial difference in use of preventive colonoscopies and mammograms between the two groups, although researchers acknowledged that their data covered just nine months after the change. The full study can be found here.

It is possible, they said, that patients and doctors were still unaware of that co-payments were eliminated for many plans, which may have affected uptake of these screenings.

Also, cost-sharing is only eliminated for those screenings coded as “preventive.” A colonoscopy scheduled after a patient had symptoms or a polyp removed would be coded as a “diagnostic” and “therapeutic” screening, and thus subject to cost-sharing. Still, they wrote, “even among the subset of colonoscopies coded as preventive, for which the policy is specifically directed, we did not find a significant increase in colonoscopy utilization.”

Researchers also noted that many plans had reduced or eliminated cost-sharing for mammograms before the ACA requirement took effect.

What can be done to increase screening? Spreading the word about the end of cost-sharing may not be enough, the researchers said. “Consideration should be given to waiving cost-sharing for all colonoscopies and mammograms in the eligible population, as opposed to just those that are coded as preventive,” they wrote. Steps to eliminate the amount of time and inconvenience required or increase the salience of the procedure may also encourage more people to be screened, since some will avoid colonoscopies in particular because they are “invasive and unpleasant.”

About the Journals

The American Journal of Managed Care celebrates its 20^th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on new healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s news publications, the Evidence-Based series, bring together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.

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