Employer-sponsored health plans should reflect national benchmarks for cancer screening

A study of over 1.3 million women in the U.K. has shown that the frequency of cervical cancer screening can safely be moved from once a year to every five years for women 25 to 49 years of age who have a negative genetic test for HPV (human papilloma virus). This genetic test replaces the traditional “Pap” smear, which requires a pathologist to microscopically review cells removed from the cervix. HPV testing is associated with fewer cancers diagnosed over the five years following a negative test compared to those diagnosed in the three years after a negative pap smear. Both require a pelvic examination when performed in a medical setting, although in the future women will be able to test themselves for HPV at home.

The U.S. Preventive Services Task Force (USPSTF) currently recommends cervical cancer screening every three years from ages 21 to 29 with pap smears alone. For women ages 30 to 65 years, the USPSTF recommends screening every three years with cervical cytology alone or every five years with high-risk HPV testing.

A study last year demonstrated that administering HPV vaccines between ages 12 to 13 lowered cervical cancer rates by 87%, showing us that vaccination could make cervical cancer incredibly rare, so it’s possible that the need for screening will decrease in subsequent years.

Implications for employers:

• Employers should update any reminder or incentive program to avoid prompting cancer screening more often than recommended. For instance, programs should not prompt cervical cancer screening more than every three years. (Similarly, mammograms are only recommended every two years from ages 50 to 74, so employer programs should not encourage screening mammography for those who are at average risk under age 50 or annual mammography for those over age 50.)
• More frequent repeats of cytology or HPV testing are medically indicated for some people with initial positive tests or at high risk for cervical cancer, so health plans should not implement caps on the frequency of these tests.
• Employers should encourage health plans to update any quality reporting or gaps in care programs to reflect current evidence-based guidance.

Employers can use the National Committee for Quality Assurance benchmarks for cervical cancer screening rates as targets for performance guarantees.

Medical encounters for COVID-19 appear to drop off a few months after initial diagnosis

Long COVID has been estimated to affect as many as 10% to 30% of those who are infected, and projections of the amount of disability this could cause are daunting. The National Institutes of Health has a budget of over $1 billion for long COVID research, and there are comprehensive long COVID evaluation and treatment centers across the country. Nonetheless, treatment at this point is mostly training to overcome the symptoms as there are currently no well researched approved therapies.

Epic, the large electronic medical record company, published data showing the percentage of those who have a medical claim related to COVID-19 diminished sharply a month after the initial diagnosis. Researchers reviewed medical claims of 264,000 people who had a single episode of COVID-19 from March to July 2020. They found, for instance, that among those age 50 to 64, about 25% had a COVID-19-related claim in the first 30 days after diagnosis, while under 2% had a COVID-19 claim between days 300 and 360.

Implications for employers:

• Many employers will have employees or members with long-term symptoms after recovery from COVID-19. This claims analysis could understate the problem as some with long COVID don’t seek medical care when it is not helping them.
• Members suffering from long COVID symptoms can find multidisciplinary post-COVID care centers. Unfortunately, many of these programs have substantial waitlists.

Higher hospital concentration leads to higher prices without better quality

High costs in the U.S. are largely due to high unit prices, as utilization of most services is lower than in most comparable countries. Many economists believe that increasing consolidation of health care providers is a major cause of high prices. A group of researchers showed that patients who were taken by ambulance to high cost hospitals paid higher prices regardless of the level of hospital concentration in the community. However, the higher price was associated with lower mortality in the communities with more hospital competition and was associated with no improvement in mortality in the highly concentrated markets. The researchers conclude that higher prices purchase better outcomes when there is competition, but not when there is little competition.

Implications for employers:

• This demonstrates that competition can actually improve quality, supporting public policy efforts to maintain continued competition in markets that do not already have highly concentrated hospital systems.

COVID-19 updates

• Cases have plateaued in the U.S., as Omicron variant BA.2.12.1 has become the dominant strain. About 71% of counties are at currently low risk, 21% are at medium risk and 8% are at high risk of community transmission. Indoor masks are recommended for those communities with moderate or high risk of community transmission.
• Although it might seem like many of our up-to-date vaccinated family members, friends and colleagues have recently had COVID-19, the risk of infection is twice as high for those who are unvaccinated. The unvaccinated have an eight times higher rate of death from COVID-19. Still, fewer than a third of U.S. adults under 65 years of age have had at least one booster shot.

The Food and Drug Administration (FDA) will review data for vaccination of children six months to five years on June 14 –15. This review will include both the Moderna two-dose vaccine and the Pfizer three-dose vaccine. This means that one or both of these vaccines is likely to be available for this age group by the end of the month, after the FDA decision is vetted by the CDC.

Author

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Jeff Levin-Scherz, MD

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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