Wellness Policy

America’s HealthShare Wellness Policy Version 1.0

    1. Adults (18 years and older)
      1. Wellness Visit (once per year)
        1. Up to 1-hour office visit with Primary Care Provider
      2. Labs (once per year):
        1. CBC with differential and platelets
        2. Comprehensive Metabolic Panel
        3. Lipid Profile with Lipoprotein Particle Assessment
        4. Hemoglobin a1c
        5. Vitamin D-25 OH
        6. C-Reactive Protein
        7. Fecal Occult Blood
        8. Prostate Specific Antigen (PSA) for males age 40 and older
        9. Other Labs:
          1. Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.
          2. Hepatitis C screening for adults at increased risk, and one time for everyone born 1945–1965
          3. HIV screening for everyone ages 15 to 65, and other ages at increased risk
          4. Tuberculosis screening for certain adults without symptoms at high risk
            1. Risks include:
              1. Born in or have lived in a country where TB is common
              2. Live or have lived in a large group setting – for example, a homeless shelter or a prison
      3. Female Specific
        1. Well Woman visit including physical exam, once per year
        2. Pap Smear with or without HPV testing every 3 years for women 65 and younger
        3. Breast Cancer Screening
          1. Mammogram or Thermography (one or the other) every year for women 40 to 49 years old.
          2. Mammograms or Thermography (one or the other) every 2 years for women aged 50 to 75 years old.

            3. *3D Mammograms may be shared due to dense tissue.

      1. Cardiovascular Screening
        1. Abdominal aortic aneurysm one-time screening ultrasound age 65 or older
      2. Osteoporosis Screening
        1. DEXA Scan every 2 years age 60 and older
      3. Hereditary Cancer Screening
        1. Hereditary Cancer Screen once in a lifetime for those with a 1st degree relative with cancer or a family member with a diagnosed cancer gene.
      4. Colorectal Cancer Screening
        1. Colonoscopy every 10 years from age 45 to 75.
        2. If member refuses a colonoscopy then other alternatives are shareable
          1. FIT Fecal DNA (ie: cologuard) once every 3 years

            2. -or-

          2. CT Colonography every 5 years
      2. Exceptions for High Risk
        1. Lynch Syndrome
          1. Colonoscopy every year beginning at age 20 years old or 5 years younger than youngest age at diagnosis of colorectal cancer in the family if diagnosed before age 25 years old.
          2. Colonoscopies start at age 30 years old with MSH6 gene
          3. Colonoscopies start at age 35 years old with PMS2 gene
          4. Annual colonoscopy in MMR mutation gene
        2. Family Colon Cancer Syndrome X
          1. Colonoscopy every 3 years beginning 10 years before the age at diagnosis of the youngest affected relative
        3. Colorectal cancer or an advanced adenoma in a single first-degree relative
          1. Colonoscopy every 5 years beginning 10 years before the age at diagnosis of the youngest affected individual or age 40, whichever is earlier
    2. Lung Cancer Screening
      1. Yearly low dose computed tomography (CT)
        1. Only adults 55-80 years old with high risk
        2. High risk
          1. Heavy smokers with at least a 30-pack year who have quit within the last 15 years.
          2. Yearly screening is discontinued once the member has not smoked for 15 years.
  2. Pediatrics (Birth through 17 years old)
    1. Well Child visits
      1. First 12 months: total 7 office visits
      2. 12 to 23 months: total 3 office visits
      3. 24 to 35 months: 2 office visits
      4. Yearly at 36 months
    2. Screening Labs/Imaging under the guidance of the American Academy of Pediatrics are eligible for sharing