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Secretary Sebelius Talks Prevention

On Tuesday, ITUP staff joined a discussion with HHS Secretary Kathleen Sebelius as she offered insight about the nation’s new investment in preventive care, “marking a fundamental shift from treatment to prevention.” On September 23rd, new health plans will be required to cover preventive services at no additional cost to individuals.

Here are some of the pertinent Q-and-A with Secretary Sebelius:

Disease and Prevention
Q: Will patients with chronic diseases be considered to be seeking preventive care or treatment for their illness?
A: That would not be preventive care; that would be considered medical management, and thus, left up to the health plans.

Q: In the area of colorectal screenings, in which there are at least three different screening options, is there anything that ensures that insurers won’t simply steer patients in one direction, but rather leave the decision to physicians and their patients? Is there any protection involved?
A: No, I don’t believe there is any protection involved. I know this might be an issue, but I’m not aware of any problems in this area.

Benefits of Prevention
Q: Which preventive benefits are included in the new provisions, and will there be a cap?
A: The regulation has tables that list vaccinations and benefits that are included. (See this list). There is no technical cap on the benefits.

Budget for Preventative Services
Q: What percentage of the overall legislation is being devoted to preventive care? I think this needs more priority.
A: The new law aims at ensuring a comprehensive approach in which prevention is an important part. We have allotted $15 billion over the next 10 years in a fund for prevention and public health.

Q: Will there be any financial incentives for plans to participate? Is this something that we should be encouraging, or is there a disconnect in this area?
A: I don’t think there is a disconnect. We are trying to give more Americans access to the preventive services that have usually been typical of large employer health plans.

Q: Many people have made reference to wellness; can you speak about grants that will be awarded to small businesses in terms of that?
A: That is an ongoing discussion with Congress, so we don’t currently have a timeline for when this will happen. However, for follow-up information, feel free to reference the newly-launched health reform website.

Q: We are looking to develop a community wellness program. We have seen many benefits in the modified behaviors treatment. Is there any care that specifically addresses this? Do you see anything coming that speaks specifically to modified behaviors?
A: Services have been recommended for body mass index consultations, nutritional counseling, etc. The preventive services page on the health reform website can provide a more comprehensive list for you.

Q: Pesticides have been documented as unhealthy; what will be the reimbursement for services in this area?
A: Part of the recommended services come from the “bright future” guidelines. So we will leave this discussion to doctors and their patients, but we are certain that environmental health will come up in their discussions.

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