Health care plan decisions regarding preventive services

Background: Medical decisions previously made by physicians and patients ar e increasingly influenced by health plans. It is important to understand ho w these decisions are made and who makes them. Objectives: To determine protocols used by health plans for recommending pr eventive services and to identify methods used to develop these protocols. Methods: An interviewer conducted semistructured telephone interviews with medical directors from 6 major types of health plans regarding coverage of certain procedural preventive services. Each medical director was asked: (1 ) Is this procedure Paid for by the health plan? (2) What is the frequency recommended for this procedure? (3) What age groups do you recommend for th is procedure! (4) Do you encourage patients to receive this procedure, and if so, how? (5) Who developed these preventive services recommendations? (6 ) Wow were these recommendations developed! Results: Ten interviews were completed representing 6 chosen types of healt h plans. While the different plans varied little regarding the preventive s ervices recommended, there was variation in efforts to promote recommended services to members. There were also differences among the plans in the dec ision-making process for developing preventive services recommendations, Conclusions: Managed care organizations promote certain preventive services to members. All health plans had at least 1 preventive medicine task force charged with making coverage decisions about preventive services. However, more could be done to rationalize development of preventive services recom mendations, primarily, implementation of evidence-based guidelines.