CH B AR THE LEONARD DAVIS INSTITUTE R ES E RI EF of HEALTH ECONOMICS Penn LDI 20 1 15 . - No ACA-Mandated Elimination of Cost Sharing for Preventive Screening Has Had Limited Early Impact Shivan Mehta, Dan Polsky, Jingsan Zhu, James Lewis, Jonathan Kolstad, George Loewenstein, Kevin Volpp American Journal of Managed Care, Volume 21, Number 7, July 2015 KEY FINDINGS: LDI RESEARCH BRIEF Did the Affordable Care Act’s elimination of cost sharing for preventive services increase rates of colonoscopy and mammography screening? Early results say no. THE QUESTION • Many physicians and patients may have been unaware of this policy change prior to having the To reduce financial barriers to receiving recommended procedure done; and preventive care, the Affordable Care Act (ACA) eliminated • The elimination of cost sharing may not be patient cost sharing for many preventive services. This a sufficient incentive for patients to undergo provision, rolled out between September 2010 and January invasive and unpleasant procedures, such as 2011, applies to all private insurance plans and exempts colonoscopy. ‘grandfathered plans’. In this study, LDI Senior Fellow Shivan Mehta and colleagues investigated whether this THE IMPLICATIONS ACA provision has its intended effect on colonoscopy and mammography rates. This study adds to the body of evidence evaluating whether the ACA is achieving its stated aims, and is the first to THE FINDINGS examine the impact of the ACA cost sharing provision on colonoscopy and mammography in an insured population. The authors find no significant change in the level of The results, although based on early data, suggest that colonoscopy and mammography utilization for beneficiaries the elimination of cost sharing for preventive services is in grandfathered vs. non-grandfathered plans. The authors not having the intended effect of increasing utilization, at stress that their study only looked at the first nine months least not for screening for certain cancers among privately- after the provision took effect, and that it may take longer for insured individuals. It could be that the impact of this intended effects to manifest. They also provision will vary by the type of service. There remains suggest possible explanations for their finding: plenty of room for improvement, as the insurer’s publicly reported rates in 2010 for colorectal cancer and breast cancer • Only colonoscopies coded as preventive screening were 63.7% and 76.9%, respectively. The authors were eligible for the policy change, so many suggest that eliminating cost sharing for all colonoscopies patients undergoing colonoscopies were still and mammograms in eligible populations, not just for tests subject to cost sharing; coded as preventive, may better support the policy’s goal. Research to Improve the Nation’s Health System. DATA DRIVEN. POLICY FOCUSED. ldi.upenn.edu THE STUDY LEAD AUTHOR : DR. SHIVAN MEHTA The authors used data from a national insurer for all Dr. Shivan Mehta is Director of beneficiaries aged 50 to 64 years who were enrolled in Operations at the Penn Medicine small business plans at any time between October 2008 Center for Innovation and Instructor and May 2012. There were 63,246 men and women eligible of Medicine at the Perelman School for colorectal cancer screening and 30,802 women eligible of Medicine. A gastroenterologist for breast cancer screening. In a retrospective analysis, the by training, Dr. Mehta works to authors compared colonoscopy and mammography rates for develop, test, and implement new beneficiaries still subject to cost sharing (in grandfathered health care delivery interventions across Penn Medicine’s plans), with those in plans that eliminated cost sharing health system. He also conducts health services research (intervention plans). looking at how health care systems can leverage behavioral LDI RESEARCH BRIEF economics, design thinking, and information technology to improve population health through medication adherence and cancer screening. Learn more about Dr. Mehta’s work Mehta SJ, Polsky D, Zhu J, Lewis JD, Kolstad JT, Loewenstein G, Volpp KG. ACA-Mandated Elimination of Cost Sharing for Preventive here. Screening Has Had Limited Early Impact. Am J Manag Care. 2015; 21(7):511-517. Connect With Us: ldi.upenn.edu Since 1967, the Leonard Davis Institute of Health Economics (LDI) has been the leading university institute dedicated to • ldi.upenn.edu/health-policysense data-driven, policy-focused research that improves our nation’s • @PennLDI health and health care. Originally founded to bridge the gap • www.youtube.com/user/LDIvideo between scholars in business (Wharton) and medicine at the University of Pennsylvania, LDI now connects all of Penn’s Colonial Penn Center schools and the Children’s Hospital of Philadelphia through its 3641 Locust Walk more than 200 Senior Fellows. Philadelphia, PA 19104-6218 P: 215-898-5611 F: 215-898-0229