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Cardiovascular Screenings Increase After the ACA, Study in The American Journal of Managed Care® Finds


Physicians’ response to policy changes in the Affordable Care Act show that changing cost-sharing formulas can make a difference, according to results reported by Drs. Joseph Ladapo and Dave Chokshi.

CRANBURY, N.J.—More physicians screened patients for diabetes and hypertension and especially for tobacco use in the years after 2010, when the Affordable Care Act (ACA) required that payers cover preventive screenings without out-of-pocket costs to patients, according to a new study in the current issue of The American Journal of Managed Care®.

Joseph A. Ladapo, MD, PhD, and Dave A. Chokshi, MD, MSc, examined the impact of the ACA policy change on physicians’ approach to preventive care by evaluating two sets of national health statistics over a period from 2006 to 2013. They found that the ACA’s policy of eliminating cost sharing for preventive services did change physician behavior.

“Our study supports the argument that the ACA’s cost-sharing provisions are an effective way to increase uptake of clinical preventive services, although overall levels of service provision were still lower than those recommended,” they wrote.

Under the ACA, certain screenings must be covered at no cost to the insured consumer under criteria established by the US Preventive Services Task Force; services that receive ratings of “A” or “B” should be covered. Criteria can include a person’s age or certain clinical indicators. The authors measured differences in screening rates between patients who met the criteria for having tests without a copayment and those who might have had them but were not insured, or were just shy of the age threshold.

Ladapo and Chokshi evaluated 11 preventive cardiovascular services for adults that received “A” or “B” ratings. The target populations were privately insured and the study found that the policy change under the ACA was associated with:

  • An increase of 3.5 tests per 100 visits for diabetes screening from 2006-2010 to 2010-2013
  • An increase of 11.6 tests per 100 visits for tobacco use screening from 2006-2010 to 2010-2013
  • An increase of 9.9 tests per 100 visits for hypertension screening from 2006-2010 to 2010-2013.

There was also an increase in prescriptions for aspirin therapy in men only (up 2.9 tests per 100 visits).

While the authors did find greater use of preventive services, they cautioned that “absolute effects of the ACA’s preventive cardiovascular care provisions were often modest,” and other factors may be in play. They noted that as of March 2014, only 43 percent of the US adult population were aware that the ACA called for free preventive screenings.


Ladapo JA, Choksi DA. Changes in cardiovascular care provision after the affordable care act. Am J Manag Care. 2017;23(11):e366-e373.

About The American Journal of Managed Care®:

The American Journal of Managed Care® (AJMC®) is a peer-reviewed, MEDLINE-indexed journal that keeps readers on the forefront of health policy by publishing research relevant to industry decision makers as they work to promote the efficient delivery of high-quality care. AJMC.com is the essential website for managed care professionals, distributing industry updates daily to leading stakeholders. Other titles in the AJMC® family include The American Journal of Accountable Care®, and two evidence-based series, Evidence-Based Oncology™ and Evidence-Based Diabetes Management™. These comprehensive offerings bring together stakeholder views from payers, providers, policymakers and other industry leaders in managed care. To order reprints of articles appearing in AJMC® publications, please contact Jeff Prescott at 609-716-7777, ext. 331.

Contacts:AJMC® Media:

Theresa Burek, 609-716-7777



Surabhi Verma


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