The U.S. healthcare system has been slowly moving from fee-for-service to a value-based payment. Preventive healthcare is a key component of this strategy in delivering high-quality, cost-efficient care that improves outcomes. New strategies for the 2020s aim to simplify value-based payment models with a road map that requires wider use of risk-bearing contracts and align incentives across different payers.
As discussed in “Why Quality Measures Matter”, quality measures promote early detection, better management of chronic conditions, and public health initiatives, all while boosting provider reimbursement through structured, evidence-based practices.
Quality reporting of preventive screenings is captured through structured data through CPT II codes and eCQMs. Accurate reporting of preventive screenings via certified EHRs allows healthcare organizations to capitalize on incentives in value-based or pay-for-performance models.
Just like regular maintenance for a car—getting routine oil changes, tire rotations, and brake checks, etc.—preventive health screenings and quality measures can help prevent costly downstream problems.
Naturally, these are win-win scenarios for health systems and payers. Health systems are rewarded immediately, and it costs less for payers in the long term. Why? Patient costs are lower in the future because they are not as sick. This leads to lower costs and better outcomes.
Furthermore, peer-reviewed evidence supports the importance of preventive measures for patients. This emphasizes how proper coding and quality measures contribute to both health improvements and financial incentives.
This is why organizations like the American Medical Association (AMA), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and U.S. Preventive Services Task Force (USPSTF) emphasize the role of these screenings in maintaining public health while enabling healthcare systems to improve patient care through value-based models like MIPS.
Below are examples of quality measures that focus on evidence-based screenings—powerful, incentivized prevention tools.
Cancer Screenings
Breast Cancer Screening:
In a 2024 JAMA systematic review and meta-analysis, breast cancer screenings significantly reduced cancer mortality. This is mainly through detecting cancer at earlier stages through regular screenings, facilitating more timely and effective treatments.
Cervical Cancer Screening:
Evidence reports from the USPSTF consistently demonstrate the effectiveness of screening. Particularly, HPV-based screening methods and co-testing can lead to earlier detection, treatment, and cure of cervical cancer.
Colorectal Cancer Screening:
A recently updated JAMA systematic review Affirmed the effectiveness of reducing both the incidence and mortality of colorectal cancer—regardless of the multiple USPSTF screening options.
Lung Cancer Screening:
High-quality evidence continues to support the benefits of screening for lung cancer in high-risk adults. Low-dose CT screening is associated with a reduction in lung cancer mortality and all-cause mortality, again, due to earlier detection of lung cancer at more treatable stages.
Chronic Disease Screenings
Diabetes:
Published studies in Diabetes Care demonstrate that early screening and lifestyle interventions reduce the incidence of Type 2 diabetes. Screening for diabetes and prediabetes is shown to reduce complications (like CKD) and improve management through early detection.
Hypertension:
Systematic reviews on hypertension screening reveal its effectiveness in reducing morbidity and mortality related to cardiovascular diseases.
Cholesterol:
Cholesterol screening is proven to reduce coronary events through early statin therapy and lifestyle interventions. This is why the USPSTF continues to recommend it.
Preventive screenings for cancer and chronic diseases are proven ways to improve patient health and public health efforts. When data is reported accurately, these screenings also help clinicians qualify for financial rewards under value-based models.
By optimizing the delivery of essential preventive care, health systems can report quality measures that prove their effectiveness—providing better care, keeping patients healthier, and benefiting from financial incentives.
For more information and guidelines on value-based payment and specific quality measures, check out these trusted sources:
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