Archives for 2014

Obamacare’s preventative services benefits are likely to continue to expand. Services are evaluating for no-cost share status by the US Preventive Services Task Force. This group is a leading collection of primary care providers and they evaluate treatments on a five mark scale. the highest two marks (A and B, like in school) are covered as no cost-share services under Obamacare. The current list of services is here

Recently preventative risk minimization breast cancer drug treatment have been declared a no-cost share service for some women:

The Department of Health and Human Services issued guidance Thursday saying that most insurance plans are required to cover the chemo-preventative drugs tamoxifen and raloxifene without co-pays or out-of-pocket expenses for women with an increased risk of developing breast cancer.

The Obama administration issued the clarification after questions arose about whether these medications count as preventative care, HHS Secretary Kathleen Sebelius and Florida Democratic Rep. Debbie Wasserman Schultz—a breast cancer survivor—wrote in a blog post Thursday.

The United States Preventive Services Task Force, an independent panel of experts selected by HHS, revised its recommendation in September to suggest the medications be available to women at high risk for the disease.

One of the likely targeted preventative service ad-ons is limited adult dental care to treat inflamation. Inflamation is an underlying issue with multiple and seemingly unrelated disease and condition clusters. US News had a good article on it a while ago:

“In recent years, we’ve come to accept that inflammation plays a role in many chronic diseases, but it’s about an imbalance—too many pro-inflammatory chemicals and not enough anti-inflammatory ones,” explains Moise Desvarieux, an inflammation researcher at Columbia University’s Mailman School of Public Health. Normally, hours after igniting the fires, the body shoots out anti-inflammatory substances to restore equilibrium.

There has been an interesting series of studies coming out of United Concordia, a dental insurer owned by a health insurance company, over the past couple of years that ties targeted dental care to significant health improvements and cost savings for people with heart disease, and diabetes. The study argues that untreated gum disease is a consistent source of background inflamation and that by treating gum disease, aggregate inflamation levels decrease and better health and thus lower costs follow. I would like to see an actual double blind study follow-up an interested party observational study, but this is an interesting first step on a question path.

There is one interesting side note on the United Concordia study, they were able to do a several hundred thousand person data dive because they are owned by a health insurance company. This ability to consolidate data and tease out unusual and perhaps less then fully intuitive links to save costs and improve only happens when the data sets are big and comprehensive. Medicare can do this, and some of the state Medicaid programs have big data sets that are clean enough to work with. But neither cover full dental/vision services, and have other limits, so there are public (and significant private) benefits to allowing some large scale vertical integration in the insurance market.

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