Prioritizing preventive care is becoming a key challenge and opportunity for hospital and health system trustees. "Boards should look to prevention as a means for their hospitals to improve the health of their communities and, ultimately, the bottom line," says Connie Curran, R.N., board member of Silver Cross Hospital, Joliet, Ill. She believes that successfully preparing for health reform implementation will require hospitals to emphasize community health and promote prevention.
By prioritizing clinical and community preventive services and using recommendations and tools in the field for this purpose, hospital boards can improve the delivery of care.
The USPSTF and ePSS
The Affordable Care Act creates opportunities for more adequately reimbursing providers for effective, high-quality preventive care. For example, under the ACA, Medicare will cover the full cost for preventive screenings and services receiving an A or B recommendation by the U.S. Preventive Services Task Force, an independent panel of primary care and prevention experts convened by the Agency for Healthcare Research and Quality, as directed by Congress.
The USPSTF systematically reviews evidence of effectiveness of such clinical preventive services as screenings, preventive medications and health behavior counseling, and develops recommendations. Recommendations are accessible at www.uspreventiveservicestaskforce.org and through the Electronic Preventive Services Selector at epss.ahrq.gov. At the ePSS site, clinicians can enter a patient's age, gender and other behavioral risk factors and receive a list of applicable recommendations. The ePSS also is available as a smart phone application and can be downloaded and installed on any website or Web-based application.
Recommendations for Boards
In 2009, AHRQ contracted with the Health Research & Educational Trust to take ePSS closer to the point of care. Working with a diverse group of providers integrating the ePSS into their electronic health records, we have learned that C-suite and trustee leadership are vital to prioritizing prevention within a hospital, health system or other provider group. Boards can make prevention a priority by holding their executive teams accountable for:
- Educating boards on the importance of prevention in the ACA.
- Ensuring that preventive care measures are incorporated into EHR acquisition, implementation and process upgrades in the move to meaningful use.
- Tying the appropriate provision of clinical and community preventive services to mission and strategic goals and including preventive measures in balanced scorecards, dashboards or other formats.
- Incorporating preventive care principles and guidelines into new care delivery structures, such as accountable care organizations.
- Incentivizing and supporting the provision of high-quality primary care with emphasis on data collection to support evidence-based preventive services.
- Working with physicians and other clinicians to incorporate the mind-set and practice of prevention into their work and the overall organizational culture.
- Educating clinicians on the value of preventive services, recommendations and tools.
Boards can do this by:
- Incorporating competencies related to prevention, primary care, population health and health information technology into board recruitment matrices.
- Ensuring that prevention and population health goals are reflected in board-level dashboards and strategic planning efforts.
- Including prevention metrics as a component of executive leadership evaluation and compensation processes.
The Way Forward
Using EHRs to promote evidence-based prevention, hospitals and health systems can reach their quality and safety goals. Boards must lead the way by ensuring executive leadership accountability for providing incentives and supporting high-quality, effective, efficient and patient-centered preventive services at the point of care.