We identified screening programs for the case study by conducting a literature review and talking with knowledgeable individuals about prevention programs and managed care. We then selected seven programs that illustrated key points of interest and yielded a mix of managed care plans. We made no attempt to assess relative program effectiveness. Next, we discuss how the programs are similar, as well as how they differ. Comprehensive programs usually create a list of preventive services recommended for each patient and track a patient's status for each service.
Providers review each patient's status prior to an office visit.
Scientifically based screening guidelines are a central feature of these programs. These guidelines, which are routinely reviewed and updated, are used to structure programs and develop measures of program success. The guidelines vary by plan, reflecting controversy over the appropriate use of services the guidelines recommend, variations in local provider practices, and differences in the characteristics of plans' enrollees. The programs' target populations are driven by the screening guidelines. For example, if a plan recommends an annual mammogram for all women age 50 and over and one every other year for women ages 40 to 49, all women age 40 and over are the target population.