Did IOM Overlook Literacy and Prevention With Their EHB Recommendations?

“The ACA requires that certain insurance plans—including those participating in the state purchasing exchanges—cover a package of diagnostic, preventive, and therapeutic services and products that have been defined as “essential” by the Department of Health and Human Services (HHS).

This package—commonly referred to as a set of essential health benefits (EHB)—constitutes a minimum set of benefits that the plans must cover, but insurers may offer additional benefits. The EHB are intended to cover health care needs, to promote services that are medically effective, and to be affordable to purchasers.”

The Institute of Medicine (IOM) put out a report recently about Essential Health Benefits (EHBs). While I haven’t fully digested the report and its implications, I noticed two things:

1. There was no one from the pharmacy community on the committee.
2. They seem to overlook the value of health literacy.

While I know observation #2 is an opinion that could be heavily debated, let me share my logic here.

If you look at the criteria for EHB selection (see below), they call out that it must “be a medical service, not serving primarily a social or educational function.” I would argue that it is risky to ignore education and its correlation with health. There are many educational functions around prevention which are important. Additionally, there is a lot of research these days around the social value of different networks and tools and their relevance to overall health.

This is Health Literacy Month so you can go visit several sites to see more about this topic. You could also look at research on social aspects of health from Pew. Or, I might even draw upon research around pets and their value in healthcare.

I’m sure the panel didn’t mean it to be interpreted this way, but we know how our government works. These comments become “law” and hard to overcome. I would think some clarification to say something more like the following would be better.

“Be a medical service or a program whose educational or preventative objectives have been demonstrated to improve health outcomes.”

Other articles on the report include:

• The New York Times article
  
• The Washington Post article
  
• Bloomberg article
  
• Reuters article
  
• The Hill article