Moderator and Discussant

Recently, preventive services stepped into the limelight when an Affordable Care Act provision required non-grandfathered group health plans and health insurance issuers to provide coverage for certain preventive services without imposing cost sharing requirements on patients. In theory, provision of preventive services without cost-sharing means that covered individuals will be able to access recommended services, when appropriate, without having to pay for the service. Although this is undoubtedly a boon to prevention, many challenges remain. Service providers face time and resource constraints, and, in a vista crowded with recommendations, the recommended services themselves face fierce internal competition. Also creating a sticking point in the transition from recommendation to implementation is the genesis of the recommending bodies – the United States Preventive Services Task Force (USPSTF), the Advisory Council on Immunization Practices, and the Health Resources and Services Administration – none of which were initially charged with developing recommendations with the intention that they would one day be used to determine coverage of services.

To better understand where preventive services stand today, this session will trace the recent history of recommendation development to align with the ACA’s stated priorities; examine existing tensions between what is likely needed for optimal sexual health, the strengths and limitations of the evidence base, and the real world concerns of return on investment and prioritization; and look for opportunities to strengthen and better integrate preventive services moving forward. Insights from a recent Institute of Medicine review of gaps in existing preventive services for women will set the stage for a discussion of the way forward in the integration and promulgation of preventive services aimed at improving sexual health. Discussion of findings from a comparative ranking process of USPSTF recommended preventive services conducted by the National Commission on Prevention Priorities will put the value of STD preventive services in context. Finally, despite the promising future for preventive services, the U.S. lacks a health system geared to the needs of young men, with an evidence base that is lacking to appropriately inform recommendations for this population. Rounding out this session will be a look at the impact, or lack thereof, of this legislation on the receipt of preventive services for STDs among these young men.

Prevention is a core component of public health, and the ACA provides a number of opportunities for strengthening prevention through clinical care. Although much progress has been made, questions remain. How do we reconcile ideal prevention goals with the existing evidence base, demands on clinicians, and the business model of providing coverage for services? How can we advance improved sexual health for all in a research and practice environment often stratified by gender and age? And, finally, for preventive services to achieve the greatest impact, least harm, and lowest cost, how should recommendations be modified to address periodicity, priority target populations, and the integration of services?