Under the leadership of First Lady Casey DeSantis and Governor DeSantis, Florida is already becoming a shining beacon on the healthcare hill with the Cancer Connect Collaborative, which will analyze Florida’s approach to cancer diagnosis, research and treatments. Now could be the right time to take this momentum to the next level and create a further impact on American healthcare, starting here in Florida, with a legislative change that will put healthcare on a steep trajectory of progress few of us can imagine today.
Everyone knows that American healthcare has big problems. Steadily increasing costs threaten federal and state budgets like nothing else, while Americans are sicker than ever. Health access is compromised for millions of people. Cancer, diabetes and cardiovascular diseases kill millions every year.
What most of us are less aware of is that America’s healthcare problem is a preventive care problem. Did you know that between 30-50 percent of all cancer cases are preventable? Did you know that 80 percent of premature heart disease and strokes can be avoided? That the vast majority of diabetes cases never had to happen?
The medical evidence is crystal clear; nearly one million deaths, and $2T in annual costs, could be avoided by simply doing one thing; having everyone follow the preventive care recommendations that already exist – ones that medical authorities and institutions have already agreed upon. Preventive guidelines are in place; they are budgeted; and we all know they should be followed.
Yet, the preventive care situation remains dire: only 8 percent of Americans get all of the recommended preventive care they need. 92 percent of us are not up-to-date on the screenings and checkups that are proven to save lives. The reason for this massive failure in our healthcare system is simple: getting preventive care is far too complicated. This complexity is a function of two big problems:
First, there are no systems in place that inform us it is time for screenings. Since personalized screening guidelines are complex and continuously in flux, such systems would need to be far more adaptive and intelligent than just having your doctor tell you to get your physical. They need to understand your full family history in real-time, understand changes in guidelines and create personalized risk profiles. They also need to be very easily accessible and usable.
Second, even if these systems were in place and everyone would know what preventive care they need to be fully medically protected, people would have difficulty accessing preventive care. Unless you have a doctor you like and trust, one who is also connected to these new medical intelligence systems, you still have a problem; which providers are in your network? When are they available? How do you schedule an appointment? What if you don’t like your doctor? While these obstacles may sound trivial, the friction created through the in- and out-of-network mechanics on preventive care adherence is massive.
We founded Prevention for America, a not-for-profit coalition designed to bring preventive care to all Americans and begin to solve these problems. Our approach is not to demand more government spending and higher budgets, but to activate the most powerful and time-proven American instruments of progress: technology and free market dynamics.
To solve problem #1 – a medical intelligence layer that allows all Americans to quickly and easily understand their care gaps – we developed a free digital platform accessible to everyone. It’s called “Can These 20 Questions Save Your Life?” and will be available this month at www.20questions.life
This tool prompts you to answer 20 questions and reveals to you the preventive care screenings and checkups you currently need, are late for and will need in the near future. It also provides tools through partners that help you close your care gaps and become medically protected. These additional services are either completely free or offer very affordable personal care coordination.
We believe the “20 Questions” is a game-changer for preventive care in America, because it allows everyone to know at any point in time how to be 100 percent medically protected, according to official medical guidelines and based on their highly personalized risk profile.
But there is still problem #2. As long as we, as patients, can’t get easy and efficient access to preventive care services - including annual screening exams, A1C tests, FIT colon cancer screening tests, lipid panels, mammograms and pap smears - and maybe, more importantly, a system that quickly organizes these screenings for us, major preventive care gaps will remain. And, as long as we have these major gaps, there will be billions of dollars and millions of lives lost in downstream healthcare.
At the core of this problem stands the fact that health insurance plans can reject payment to providers that are not in their network. With that, the innovation forces of the free market are stopped in their tracks: new medical solutions and innovative providers who can deliver better, faster and more affordable preventive care cannot acquire new patients, because they are dependent on being approved by hundreds of local insurance plans across the country. That can take many years, if not decades - a nail in the coffin of any medical technology startup.
This “walled garden” approach is killing off much innovation in preventive care - and with that, is partially responsible for millions of deaths and trillions of dollars in healthcare costs.
While fully-licensed medical providers can be rejected or dragged through multi-year approval processes by insurance plans before being able to enter the market, we will not be able to solve preventive care in America.
If, on the other hand, every American had access to any licensed medical provider for the small, fixed set of preventive care measures, rapid and widespread innovation would transform access and coverage across the nation.
We believe that Florida’s preventive care gap could be dramatically reduced in a short period of time through a simple and lean legislative provision and make Florida the nation’s best-performing healthcare region by a wide distance.
The proposed legislation would require ALL health insurance plans to pay for a small set of clearly specified preventive care measures, as defined by US guidelines, for their members - regardless of the chosen provider. To protect health plans, this simple and broad legislation caps billing at 125 percent of Medicare rates for the medical services provided. Since existing federal law already defines preventative services and requires health plans to pay for those services with no copays for in-network providers, the legislation would use those definitions to build on existing law.
By tying the reimbursement rates for preventive care to Medicare rates, health plans are protected from being overcharged for these services by out-of-network providers.
The mid-and-long-term effects of this legislation would be dramatic:
1. Reduction in cancer, diabetes, and cardiovascular costs for healthcare plans
2. Improvement for access to preventive care services for all patients
3. Increase in innovation and competition between preventive care providers including new providers that can enter the market to cover remote and low-access patient populations that currently have little to no access
4. More patients for existing providers and less hassle with insurance reimbursements
This unique combination of more patients for existing providers, better coverage for access-challenged populations and lower overall healthcare costs in the mid-term is a function of the power of preventive care. By providing everyone with better access to medically proven preventive care, everyone will win, because everyone becomes healthier.
We stand ready to work with Florida and the Cancer Connect Collaborative to make Florida the first state to use new technologies to better protect its citizens from cancers and other diseases. It’s time to give Americans the preventive care they are owed, and we will do everything we can to make that happen.