Health Insurance Group Uses Task Force Recommendations to Inform Benefit Design and Prevention Options

Prevention and Care Management

2007

Members of America's Health Insurance Plans (AHIP) use the U.S. Preventive Services Task Force recommendations to help inform choices about benefit design and prevention programs. With more than 1,300 member companies providing health insurance coverage to over 200 million Americans, AHIP is the largest trade association of the nation's health insurers. The health insurance plan community is strongly committed to prevention as a foundation to improve the health of individuals and the nation's entire population.

"Health insurance plans need valid and reliable evaluations of the most current research to guide their policies, and the Task Force recommendations provide this guidance," says Carmella Bocchino, Executive Vice President, Clinical Affairs and Strategic Planning for AHIP. "The Task Force's work provides what health insurers and many in the medical community consider the gold standard in evidence-based reviews for clinical preventive services."

Carey Vinson, MD, Vice President, Quality and Medical Performance Management for Pittsburgh-based Highmark, also praised the work of the Task Force. "The Task Force provides balanced, systematic evidence reviews from more than one study. With the Task Force's recommendations, we are not dependent on consensus models, which may not be based on scientific evidence."

David Grossman, MD, Medical Director of Preventive Care for Group Health Cooperative, based in Seattle, provided insight into how health plans use the Task Force recommendations. "Building on these recommendations, we study the literature continually to see if there are any changes, and assess how the Task Force arrives at its decisions," he notes.

AHIP featured the Task Force in the January/February 2007 issue of AHIP Coverage: Health Care News, Views, Trends and Insights. AHIP's magazine is aimed toward executives and top-level managers in health care financing and health insurance, as well as other decision-makers in the medical community.

The AHIP magazine article covered the history of the Task Force and included a detailed explanation of the evaluation process undertaken prior to making formal recommendations. The article also featured invited commentary of the value of Task Force recommendations to insurance providers. Industry leaders, including medical leadership from HealthPartners, CIGNA, Aetna, and Harvard Pilgrim Health Care, highlighted how the work of the Task Force focuses on answering a fundamental question in health care: "Will this intervention benefit patients, and do the benefits outweigh the harms?"

The Task Force and AHIP have a long-standing relationship. Bob Rehm, Vice President of Public Health and Clinical Strategies, serves as AHIP's liaison to the Task Force. As liaison, he works with AHIP's Prevention and Public Health Workgroup and other health plan medical leaders to solicit reviews of Task Force draft recommendations, disseminate Task Force findings to AHIP's member health plans, and periodically solicit topic suggestions for future reviews.

"We value our partnership with the Task Force and AHRQ and appreciate their ongoing efforts to advance recommendations that help ensure patients receive evidence-based clinical preventive services," says Rehm.

Over the past six decades, AHIP and its predecessor organizations have sought to represent a "unified voice" for health insurance plans. Based in Washington, DC, AHIP advocates for affordable, high-quality health care coverage through its work on the legislative, regulatory, and policy issues facing the industry. AHIP also seeks consensus on the broader health care issues facing the nation, including the need to cover millions of uninsured Americans. More information about AHIP can be found at http://www.ahip.org.

Impact Case Study Identifier: CP3-08-02
AHRQ Product(s): U.S. Preventive Services Task Force (USPSTF)
Topic(s): Policy, Prevention
Geographic Location: National

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Current as of June 2012
Internet Citation: Health Insurance Group Uses Task Force Recommendations to Inform Benefit Design and Prevention Options. June 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/case-studies/cp30802.html