Improving the Delivery of Preventive Services to Medicare Beneficiaries

Abstract

CENTRAL TO US CONGRESSIONAL AND ADMINISTRAtion efforts to reform health care is a renewed focus on “investment in prevention and wellness.” Translating that commitment to investing in preventive care into improved health will require a strategy for separating effective prevention from that which is ineffective or even harmful, and aligning payment strategies with practices supported by the best evidence. However, existing federal and private insurance coverage does not adequately support the delivery of clinical preventive services associated with improved quality of life and reduced premature mortality. Medicare is both the largest US payer for adult health services and the standard by which many other payers model their coverage. It is thus a logical place to effect optimal coverage for preventive services. In this Commentary, we propose 3 steps by which Medicare could expand preventive care: by expanding preventive coverage, adopting payment reform to pay for the coordination of preventive care, and passing legislation allowing the Centers for Medicare & Medicaid Services (CMS) to discontinue coverage of nonbeneficial and potentially harmful preventive services.