Preventive care significantly improves health outcomes—cancer screening alone has added as many as 16 million years to people’s collective lifespans. Yet only about 5% of adults receive the screenings recommended for their risk factors.
That isn’t a gap. It’s a chasm.
Preventive care detects serious illnesses early, when treatment is most effective. With 90% of the nation’s $4.5 trillion in annual health care spending going to treatment for chronic conditions, the disconnect between preventive care’s potential and its current use represents a tremendous opportunity to improve health outcomes and reduce the burden of chronic disease.
Understanding the barriers
Recent research reveals that 94% of Americans face barriers to accessing preventive care. These barriers fall into several interconnected categories:
Emotional hesitation: Fear of receiving bad news, embarrassment about health conditions, or discomfort discussing personal issues can lead people to avoid screenings. This is particularly true for young women—one in four have avoided screenings for these reasons. Trust can also be an issue, with some people lacking faith in the health care system due to prior experiences or cultural norms.
Logistical challenges: Scheduling appointments, taking time off work, long wait times, and transportation issues can be major deterrents to getting preventive care. According to a survey by the American Association of Nurse Practitioners, nearly 40% of Americans travel more than 10 miles to access care, and those traveling over 10 miles were much more likely to report access challenges. In rural or underserved areas, the challenges multiply.
Cost and coverage concerns: Four in ten adults have delayed or skipped care due to cost concerns, and 72% of people cite cost as the biggest factor in whether or not they would pursue screening services. Even if members have health insurance, there can be confusion about what is covered and what out-of-pocket costs they might incur.
Lack of health literacy: Health literacy—being able to find, understand and use health information to make informed decisions—is limited for about 88% of adults. In the context of preventive care, members may not know what screenings they need or how to access them. They also may not understand the terminology used by providers or know what questions to ask.
Disconnection from primary care: Members with a primary care provider are more likely to receive recommended preventive services. However, nearly one-third of Americans don’t have one or go regularly. That means they’re missing annual wellness exams and other opportunities to learn about needed preventive care.
What’s at stake
The preventive care gap creates cascading consequences. Members who miss screenings are more likely to present with advanced-stage illnesses that are harder to treat and may require complex interventions. This gap can also impact Healthcare Effectiveness Data and Information Set (HEDIS) measures—particularly with regard to cervical, breast and colorectal screening—which feed into Star Ratings.
However, preventive care is also an area where health plans can make meaningful, measurable improvements in population health within a relatively short timeframe. Unlike many chronic disease interventions that require years to show results, preventive care outreach can start to make an impact right away.
Closing the gap
Targeted outreach strategies can help members overcome obstacles and access the preventive care they need.
Rather than waiting for members to realize they are overdue for screenings, data-driven identification can be used to reach out to members directly and proactively. This approach eliminates the awareness gap and provides education about coverage and costs. It also reduces logistical friction by helping members schedule appointments, while encouraging them to build an ongoing relationship with a primary care provider.
The most effective outreach programs use multiple communication channels—including mail, phone calls, and text messages—to reach members where they are. Concierge-style support helps members identify convenient appointment times and locations, understand their coverage, and address concerns about cost or the screening process.
Data from recent programs demonstrate the effectiveness of this approach. For example, researchers tested a phone-based program to help a largely underserved population access preventive care services. Participants received either a simple referral or more in-depth concierge-style support. Both approaches increased the use of preventive services, but referrals paired with navigation led to significantly higher completion of needed care.
The preventive care gap represents one of health care’s most significant and solvable challenges. It’s clear that proactive strategies, supported by multi-channel communications and personalized navigation, work. The question isn’t whether to act—it’s how quickly health plans can seize an opportunity that delivers measurable results for members and the health care system alike.
