HC Policy Power Players Series: United States Preventive Services Task Force

The Members

The United States Preventive Services Task Force, or USPSTF, is made up of 16 members from a number of organizations and institutions outside of the federal government. They are doctors, nurses and epidemiologists with vast expertise in numerous medical fields including pediatrics internal medicine, geriatrics, women’s health, behavioral medicine, and family care.

The task force is responsible for making preventive care recommendations, and deeming which services are unnecessary. The task force is funded, staffed, and appointed by the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality. The USPSTF meets in Washington several times a year to produce the best preventive care recommendations.

What USPSTF Does

The USPSTF ranks its recommendations using a three letter grading scale. An “A” recommendation indicates that there is a “high certainty” that the net benefit of the preventive service is substantial. A “B” recommendation means either the net benefit, or the certainty of the benefit is moderate. A “C” recommendation means the service is selectively recommended, and that only a small group of patients is likely to achieve any benefit. “D” ratings indicate that the service is not recommended, and that the harms of the service likely outweigh any benefit. “I” ratings indicate there is insufficient evidence to make any judgment on the service.

Making the Recommendations

The USPSTF has influence in a couple of major areas. The recommendations of the USPSTF are often the standards by which insurance providers make their coverage policies.  When the Affordable Care Act (ACA) was passed, it included language that formalized their influence over the new marketplace plans by mandating the USPSTF recommendations be “essential benefits.” Under ACA, close to 90 million Americans with employer and individual health policies will no longer have to pay a co-payment or deductible for recommended preventive screenings with an A or B grade.

The Impact
Why Preventive Care Matters

Chronic illness is one of the biggest drivers of increased health care costs in the United States.  Nearly three trillion dollars is spent on health care annually, and treating chronic illness accounts for 75 percent of this spending. This phenomenon will only get worse as America continues to age. While Americans are typically living longer, many of them live with chronic illness that affects their quality of life and productivity.

There are sorted opinions on how preventive care will affect overall health care costs. Consider this: A 2008 study in Circulation estimated the total cost of preventive care for heart disease and diabetes over 30 years to be $8.5 trillion, but would only save $900 billion in treatment costs over 30 years. The net effect of this is an additional $7.6 trillion in spending over this 30 year period. In other words, attempting to prevent the disease is far more costly than incurring the already high cost of treating heart disease and diabetes. Additionally, the Congressional Budget Office concluded in 2009 that preventive care would likely improve people’s health but wouldn’t generally reduce health care spending, largely because people would be living longer. While many preventative services do improve health and wellbeing for millions of people, many of these recommendations may increase health care costs. However, the USPSTF does not factor in cost whatsoever when making recommendations.

What to Watch for in 2014

Health care reform will continue to be a hot topic as the ACA continues its rollout. Some interesting recommendations in the process of being evaluated include aspirin use to prevent cancer and cardiovascular events, as well as screenings for dementia, and for suicide risk. The USPSTF will remain in the background influencing how the ACA and other public health initiatives, both public and private, will determine what preventive care services should be a part of American health care.