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What is Preventive Care? Benefits, Examples, & Services

Chronic illnesses create a staggering financial burden for both patients and the American healthcare system. Because healthcare delivery has historically been reactive, many patients are only aware of developing chronic conditions once the disease significantly progresses and harms their health. This reactive approach leads to more emergencies, hospitalizations, and invasive medical procedures.

Preventive care, also known as proactive clinical engagement, offers a powerful solution to reducing high medical expenses and mitigating the severity of chronic diseases. It goes beyond just annual physicals and cancer screenings and encompasses a wide range of strategies, from vaccinations and lifestyle changes to early detection of health risks. By focusing on reducing the risk of illness, preventive care promotes healthier outcomes and brighter futures for patients.

Prioritizing prevention can alleviate the strain on resources and empower individuals to take control of their health and lead more fulfilling lives. Throughout this blog post, we will explore examples and benefits of preventive care. We will also dive into preventive care services, like Annual Wellness Visits, Chronic Care Management (CCM), and Behavioral Health Integration (BHI), that aid healthcare providers in delivering high-quality and proactive care to patients.

What is preventive care?

Preventive care is a proactive approach to healthcare that aims to identify and treat diseases early in their development. Preventive care emphasizes routine screenings informed by familial medical history, individual risk factors, regular immunizations, and healthy lifestyle alterations. 

When a disease is detected early, patients face improved clinical outcomes and a more robust quality of life. Early detection allows for less invasive healthcare interventions that are usually cheaper and less disruptive than later-stage treatment. 

For example, a prediabetic patient can reduce their risk of developing type 2 diabetes by implementing improved nutrition, weight loss, and regular exercise. If a patient misses the window to make these adjustments and develops diabetes, their medical expenditures will be 2.6 times higher than those of their non-diabetic counterparts. These patients also must learn more demanding and time-consuming methods of disease self-management. 

Preventive care facilitates optimal patient health by encouraging personalized care, tailor-made wellness plans, and activating and engaging patients in their healthcare journey. This patient-centered approach to healthcare creates better prospects for individual patients and aims to shift the broader healthcare industry’s position from reactive to proactive. 

Why is preventive care important?

Preventive care facilitates better outcomes for patients than reactive care. Reactive care focuses on curing disease and mitigating symptoms of established chronic illnesses rather than the prevention of disease progression and its affiliated symptoms. 

Reactive care places an enormous and avoidable strain on American healthcare resources. Hospital networks are flooded with patients facing emergencies due to undiagnosed underlying chronic conditions. These patients often face arduous recovery journeys, replete with rigorous medication schedules, dramatic lifestyle alterations, new limitations on mobility, and an array of new specialists to consult with about future treatment plans. The result for patients and providers is expensive, exhausting, and suboptimal. 

Preventive care aims to place patients in the strongest position possible to navigate their healthcare journey. Rather than waiting for a patient to fall ill to commence treatment, preventive care uses biometric data and familial background to target care gaps and proactively close them. It helps identify cancerous growths in their nascent stages, reduce blood pressure before it leads to coronary complications, and stave off illness that could result in lifelong debilitation or even death with immunizations. 

Providers cannot manage what is not detected, and many chronic illnesses don’t manifest symptoms until well into the disease's progression. Engaging with preventive care encourages high-quality care, reduces healthcare costs, and ultimately creates healthier patients. 

What are the benefits of preventive care?

• Aids healthcare providers in the early detection of chronic illnesses, diseases, and health complications
• Improves clinical outcomes by facilitating timely interventions
• Reduces healthcare costs for patients  
• Decreases hospitalizations and healthcare resource utilization  
• Engages and activates patients in their care journey 
• Encourages better quality of life for patients by mitigating the severity of symptoms

Learn more: How to Increase Preventive Cancer Screenings (And Why It Matters)

What are examples of preventive care?

Preventive care includes any screening, labwork, or immunization for an undiagnosed disease a patient may be at risk of developing. Preventive care also includes medication to reduce the risk of disease development, lifestyle changes, counseling to address risk factors, and screenings based on family history. 

Preventive care screenings 

• Breast cancer screening and mammograms
• Colorectal cancer screenings and colonoscopies
• Cervical cancer screenings and pap smears
• Diabetic eye exams and hemoglobin A1C control tests
• Counseling on lifestyle adjustments, including smoking cessation, weight loss, nutritional improvement, reduction of alcohol use, and mental health
• Screenings for diseases a patient has a hereditary risk of developing (like heart disease, diabetes, cancers, and osteoporosis)
• Dementia screenings
• Depression screenings and behavioral healthcare evaluations and interventions 
• Influenza immunizations
• Pneumonia vaccinations
• Routine vaccinations including measles, polio, and meningitis
• BMI (Body Mass Index) screenings and follow-up consultations
• High blood pressure testing and monitoring
• Cholesterol tests and monitoring
• Routine annual physicals and Annual Wellness Visits 

Preventive care services

As the healthcare industry increasingly recognizes the importance of preventive care, various services have emerged that facilitate value-based, preventative healthcare delivery. These programs often have the added benefit of being covered by Medicare, opening up recurring revenue streams for practices and encouraging higher levels of patient participation. 

Annual Wellness Visits 

Annual Wellness Visits (AWVs) are a preventive care service for eligible Medicare beneficiaries. They are designed to create individualized wellness plans for patients based on unique risk factors, personal medical history, and current health status. 

Unlike a traditional annual physical or a sick visit, the goal of an AWV is not to treat previously diagnosed illnesses, provide vaccinations, take bloodwork, or discuss new or worsening symptoms. Instead, AWVs are strategic planning sessions focusing on preventing future health problems. They encourage providers to take a holistic look at a patient’s healthcare journey, create lifestyle recommendations, schedule screenings and lab appointments for the future, and address outstanding gaps in care. 

AWVs aim to keep patients healthier by creating a care plan that catches chronic diseases early in development. These care plans help patients avoid dramatic, costly, and invasive medical interventions down the road.

Health Risk Assessments (HRAs) are the core of the Annual Wellness Visit. These self-guided questionnaires ask patients questions about their health history, lifestyle, and other pertinent medical and social issues. Providers then collate the information provided by the HRA and create individualized care plans. 

AWV software technology, like ChartSpan’s proprietary RapidAWV™, dynamically generates the questions and subsequent personalized recommendations for each patient and delivers the results to the attending provider. This simplifies and streamlines preventive care for seamless integration into any practice workflow. 

Once a patient has been enrolled in Medicare Part B for over a year, they can complete Annual Wellness Visits once every 12 months. 

Learn more: The Ultimate Annual Wellness Visit Checklist for Providers  

Chronic Care Management 

Chronic Care Management (CCM) is a preventive care service designed to support Medicare patients with multiple chronic conditions and help them navigate the complexities of their care. CCM services create an invaluable communication cadence between clinical visits for chronically ill patients. CCM provides patients with assistance, accountability, and emotional support through monthly calls from a care manager. 

During these monthly calls, care managers assist patients with medication refills and deliveries, address Social Determinants of Health (SDOHs) that impede care progress, and aid in care coordination. CCM care managers can also ensure that patients follow the care plans devised by their providers and address any complications or concerns about the care plans before they have the opportunity to derail patient progress. 

CCM care managers also serve patients by assisting in smooth coordination and communication between patients' specialists and primary care providers. When a patient visits a specialist to receive a preventive risk screening and close a gap in care, the care manager can follow up with the specialist and ensure that the results are efficiently transferred to the patient’s primary care practice. 

Care managers can also aid in closing care gaps by arranging transportation to and from appointments, connecting patients to community resources like food banks and senior groups, and providing patients with self-management tips for their conditions. They can detect missed screenings and, with the patient's permission, coordinate appointments. If care managers discover that patients have a fall,  a diet risk, or another emerging challenge, they can also provide them with recommendations. 

Dealing with multiple chronic illnesses is an already heavy burden for patients, and engaging in preventive care can result in added stress. Care managers help remind patients of the benefits of preventive care, offering encouragement and easing feelings of loneliness or frustration.

Integrated Behavioral Health

Patients and healthcare providers increasingly recognize that physical health is linked to mental and emotional well-being. However, many significant barriers to accessing behavioral healthcare exist for patients across the US. Integrated Behavioral Health (IBHC) services, also known as Behavioral Health Integration (BHI), were created to increase access to mental healthcare services by tying behavioral health with a patient’s primary care. 

BHI programs seamlessly intertwine physical and mental care under the roof of a single practice. Patients struggling with depression, anxiety, substance abuse, gambling addiction, or suicidal ideation can be referred to an in-house mental health professional by their primary care physician. This eliminates the lengthy waiting lists many patients seeking mental healthcare face. The convenience of access also encourages patients to take advantage of these services and can combat potential social stigmas surrounding the pursuit of mental healthcare. 

When patients can actively engage with professionals, they can learn how to address these feelings of fear, despair, and anxiety in healthy, productive ways. Patients are then better equipped to handle the difficulties of navigating chronic illnesses and ultimately face better clinical prospects. 

Learn more: 5 Reasons to Offer Integrated Behavioral Health Services.

What are the CPT codes for preventive care?

Medicare provides reimbursements for many preventive care services. Your practice can open up recurring revenue streams by identifying and appropriately billing CPT codes. 

Preventive care CPT codes

The CPT codes most commonly associated with preventive care are associated with their respective programs. 

AWVs

• G0402 (Welcome to Medicare / Initial Preventive Physical Exam (IPPE)): This service is a one-time, face-to-face offering for patients newly enrolled in Medicare Part B. Patients are only eligible to receive an IPPE within the first 12 months of enrollment.
• G0438 (Initial Annual Wellness Visit): After a patient has completed their IPPE or the window to receive one has expired, they are eligible to start receiving Annual Wellness Visits. Requirements to bill codes G0438 and G0439 include administration of an HRA, cognitive function assessment, functional ability and safety assessment, review of current providers involved in the patient’s care journey, personalized health advice, and more. 
• G0439 (Subsequent Annual Wellness Visits): G0439 is the standard billing code for all AWVs administered to patients after completing the IPPE and the initial AWV. Patients are eligible to receive one AWV every 12 months. 

Learn more: CPT codes for Annual Wellness Visits 

CCM

• 99490 (Standard 20 Minutes of CCM Services): CPT code 99490 is billed for a minimum of 20 minutes of non-face-to-face clinical staff time dedicated to a patient and directed by a physician or other qualified healthcare professional. This service is provided once per calendar month.
• 99439 (Additional 20 Minutes of CCM Services): Every additional 20 minutes of non-face-to-face clinical staff time provided to a patient per calendar month is billed under CPT code 99439.
• 99487 (60 Minutes of Complex CCM Services): Code 99487 was established for patients with complex chronic conditions who require more than 20 minutes of conversation with clinical staff. 99487 is used for billing 60 minutes of non-face-to-face clinical staff time as directed by a physician or healthcare professional. 
• 99489 (Additional 30 Minutes of Complex CCM Services): For every additional 30 minutes of clinical staff time provided to patients with complex chronic conditions, practices can bill Medicare under CPT code 99489. 
• G0511 (CCM and BHI Services for RHCs and FQHCs): When rural health clinics (RHCs) or federally qualified health centers (FQHCs) provide 20 minutes of clinical staff time as directed by a physician or healthcare professional, they can bill these services under CPT code G0511. This code is also used when these clinics and health centers provide their patients with 20 minutes of Behavioral Health Integration (BHI) services. 

Learn more: Chronic Care Management Billing Rules  

BHI

• 99492 (Initial Psychiatric Collaborative Care Management): Code 99492 is used to bill for the first 70 minutes of psychiatric care provided to a patient in a calendar month.
• 99493 (Follow-Up Psychiatric Collaborative Care Management): This code is used to bill the required monthly 60-minute BHI check-ins administered to patients after their initial 70-minute consultation.
• 99494 (Additional Time for Initial and Subsequent Psychiatric Collaborative Care Management): Every 30 minutes of additional behavioral healthcare services provided to a patient can be billed under CPT code 99494. 
• G2214 (Additional Time for Initial and Subsequent Psychiatric Collaborative Care Management): CPT code G2214 bills 30 minutes of initial or subsequent behavioral healthcare provided in a calendar month in consultation with a psychiatric consultant and directed by a physician or healthcare professional. 
• 99484 (General BHI Services): Code 99484 is used to bill at least 20 minutes of allocated behavioral health services per calendar month. This code is used to bill BHI models of care outside of the CoCM structure. 

Learn more: Behavioral Health Billing Guidelines for Providers

Partner with ChartSpan and deliver exceptional preventive care

ChartSpan is an industry-leading provider of preventive care services across the United States. From partnering with rural health clinics to provide CCM services to boosting quality scores with frictionless AWV software integration, we are eager to help practices deliver high-quality, proactive care to their patient populations. 

We offer a turnkey, fully managed CCM program, alleviating the often overwhelming workload that accompanies implementing an in-house CCM program. Our team of compassionate care managers is ready to engage your patients in a monthly communication cadence about their care while keeping the necessary documentation to ensure your practice can correctly bill CMS for services rendered. 

Our proprietary AWV software, RapidAWV™, offers real-time eligibility checks, flexible and customizable HRAs, and individualized wellness plan recommendations. All of these features facilitate a smooth integration into any practice workflow. 

Contact us to learn how we can help you elevate your practice’s preventive care offerings.

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