IOM Recommends Coverage for More Women’s Preventive Services

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.

The Institute of Medicine recommended adding eight preventive health services, including birth control and emergency contraception, screening for gestational diabetes, and testing for human papillomavirus, to the list of preventive services that health plans must provide at no cost to patients under the health care reform law that will take full effect in 2014.

In a report released July 19, the IOM said that each of the eight services identified by IOM committee members is critical to ensure "women’s optimal health and well-being." Their recommendations are based on a review of existing guidelines and on an assessment of the evidence of the effectiveness of different preventive services.

"Every single one of the recommendations is a service we believe HHS [the Department of Health and Human Services] should consider covering without a copay," said panel chair Dr. Linda Rosenstock, dean of the University of California, Los Angeles.

In a press briefing, Dr. Rosenstock noted that the final decision on whether a woman should receive a particular service will remain between that woman and her physician. However, she said, "It is appropriate to decrease the barriers to what we have identified to be evidence-based, effective preventive measures."

According to the IOM, the eight preventive services for women that health plans should cover at no cost to patients include:

• Screening for gestational diabetes.

• Human papillomavirus testing as part of cervical cancer screening for women more than 30 years old.

• Counseling on sexually transmitted infections.

• Counseling and screening for HIV.

• Contraceptive methods and counseling to prevent unintended pregnancies.

• Lactation counseling and equipment to promote breastfeeding.

• Screening and counseling to detect and prevent interpersonal and domestic violence.

• Yearly well-woman preventive care visits to obtain recommended preventive services.

HHS Secretary Kathleen Sebelius will issue the final decision on which preventive services will be covered by insurance plans under health care reform. According to Dr. Rosenstock, Ms. Sebelius may decide by Aug. 1 which services on the IOM-recommended list to include.

Of course, many health care plans currently provide coverage for these services, Dr. Rosenstock noted, adding, "This is just a recommendation for first-dollar coverage."

The Patient Protection and Affordable Care Act of 2010 will require health plans to provide first-dollar coverage for the preventive services listed in HHS’ comprehensive list of preventive services beginning in 2014.

These include the services with Grade A and B recommendations made by the United States Preventive Services Task Force, the Bright Futures recommendations for adolescents from the American Academy of Pediatrics, and vaccinations specified by the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices. Services on the list include blood pressure measurement, diabetes and cholesterol tests, and mammography and colonoscopy screenings.

However, HHS officials, concerned that some preventive services key to women’s health were not included on those lists, asked the IOM to investigate and recommend additions to the coverage list that would be specific to women. At the request of HHS officials, an IOM committee made up of women’s health experts, headed by Dr. Rosenstock, identified critical gaps in preventive services for women as well as measures that will further ensure women’s health and well-being.

The committee identified diseases and conditions that are more common or more serious in women than in men, or for which women experience different outcomes or benefit from different interventions.

The panel considered only effectiveness, not any cost data or cost-effectiveness data, according to Dr. Rosenstock. The group’s charge also required members to consider only services provided in clinical settings, even though "preventive services can be effective when provided in settings outside the physician’s office," she said.

The report backs up each of the committee’s recommendations with the science behind it. For example, it notes that deaths from cervical cancer could be reduced by adding DNA testing for HPV to the Pap smears that are part of the current guidelines for women’s preventive services because HPV testing increases the chances of identifying women at risk for cervical cancer.

To reduce the overall rate of unintended pregnancies, which can lead to babies being born prematurely or at a low birth weight, the IOM report urges HHS to consider adding the full range of Food and Drug Administration–approved contraceptive methods as well as patient education and counseling for all women with reproductive capability. This would include emergency contraceptives such as levonorgestrel.

Lactation counseling already is part of the HHS guidelines that dictate what preventive services health plans must cover. However, the IOM report goes further, recommending coverage of breast pump rental fees along with counseling by trained providers to help women initiate and continue breastfeeding.