Barriers and facilitators to providing common preventive screening services in managed care settings

Despite increasing emphasis on disease prevention and health promotion, and ample evidence demonstrating the effectiveness of preventive services, suc h services are underutilized in the United States. The current trend of hea lth care toward health maintenance organizations and other managed care sys tems opens the door, perhaps to more effective control of heart disease, ca ncers and other chronic diseases through preventive care. This warrants att ention to the barriers/facilitators to the provision/utilization of prevent ive screening services in such settings. Overall goal of this study was to assess barriers/facilitators to the provision/utilization of preventive ser vices in managed care organizations (MCOs). This was accomplished by a) ide ntifying barriers/facilitators to the provision/utilization of three common preventive screening services (cholesterol screenings, mammograms, and Pap smears); and b) profiling typical MCO recipients of these three preventive screening services. A self-administered, mail questionnaire was used to ob tain information from a national sample of 1,200 Directors of MCOs associat ed with preventive care. A total of 175 usable responses were received resu lting in a 17.3 percent net response rate. The strongest barrier to the pro vision of all three screening services is the inability of them to generate short term savings for the MCO. Other barriers include high disenrollment rates, conflicting recommendations about effectiveness (for mammograms and cholesterol screenings), and patients' fears of getting a positive result ( for mammograms and Pap smears). The improved health status as a result of e arly intervention, high consumer awareness (for mammograms and Pap smears), and long term savings are important facilitators to the provision/utilizat ion of these screening services. Comparing barriers and facilitators across the three services shows the stronger barriers affecting the provision/uti lization of mammograms. For all three screening services, typical managed c are recipients are those in the high income groups with greater education l evels. However, with the increasing enrollment of Medicaid beneficiaries in to managed care, MCOs may fmd themselves selectively targeting these high r isk low income and less educated individuals to receive the preventive scre ening services. Study findings should be useful to health planners, policym akers and researchers at all levels in their efforts to encourage and promo te healthier lifestyle choices among U.S. residents. Future studies should address receipt of preventive services by Medicaid and Medicare beneficiari es in managed care settings.