Patients with chronic or ongoing illnesses or conditions need first dollar access to all three levels of prevention.

Definition of Prevention:

Primary Prevention: Services which prevent a condition from ever presenting.

Secondary Prevention: Services which detect a condition prior to clinical symptoms.

Tertiary Prevention: Services focusing on diagnosis, then management of chronic conditions including mental health, after presentation of clinical symptoms. Often referred to as disease management or care management, most are truly preventive in that they have the potential to halt progression, avoid co-morbidities and prevent costly events such as hospitalization or surgery.

Services which prevent a condition from ever presenting. These services often require a referral to a specialist, and include:

Examples of Primary Prevention:

Examples of Secondary Prevention: Diagnostic testing and screening, may include but not be limited to

Providers: Medical home, specialists for affirmative diagnosis and/or treatment initiation

Examples of applicable chronic conditions: Diabetes, Cardiovascular Diseases, Alzheimer’s or other dementia disorders (e.g., vascular dementia, Parkinson related) , Multiple Sclerosis, Asthma, Cancer, Fibromyalgia, Temporomandibular disorders


Providers: Medical Home, Physician or Specialist, Nurse Practitioner, Physician Assistant, Care Manager

The Cost-Effectiveness of Prevention

Providing affordable and patient-centered access over the course of the disease or condition – at all three levels of prevention – is cost effective due to the reduction or elimination of unnecessary hospitalizations, surgeries, physician visits, and nursing home placement. When prevention is not affordable, patients will forego necessary testing, prescriptions, or medical visits and their medical conditions will ultimately worsen.

Empowering & Motivating Patients Improved Health & Lowered Costs
Example: The Asheville Project – Diabetes


What are Co-morbidities?

Many Californians with an ongoing or chronic illness or condition have more than one chronic condition (co-morbidities). Co-morbidities not only create a greater risk of disability, but they complicate treatment and create a greater risk of hospitalization.

Concerns related to co-morbidities: