Blue Cross and Blue Shield of North Carolina Prevention and Health Education December 2004

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1 Health Plans and Obesity: Blue Cross and Blue Shield of North Carolina s Approach Blue Cross and Blue Shield of North Carolina Prevention and Health Education December 2004

2 Health Plan Challenges Treatment is unclear Prevention is unclear Lack of data and impact unknown Unable to identify at risk population Expectations of health plan unclear Return On Investment (ROI) difficult to determine Physicians barriers Time Reimbursement Lack of treatment modalities Opportunity for fraud and abuse

3 Recent Changes Medicare now calling obesity a condition USPSTF added recommendations Recognition of implications by Health Plans

4 Why did BCBSNC Address Obesity and Overweight?

5 Obesity Trends Among U.S. Adults BRFSS, 2003 No Data <10% 10% 14% 15% 19% 20%-24% 25% Source: Behavioral Risk Factor Surveillance System, CDC

6 Prevalence of obesity and overweight among BCBSNC, NC and US adults Percent of Population 70% 60% 50% 40% 30% 20% 10% 21% 23% 22% 34% 36% 37% 59% 59% 55% BCBSNC NC US 0% Obese (BMI >30) Overweight (BMI 25 to <30) Total Overweight or Obese Sources: BCBSNC Member Survey, November 2003 and NC Department of Health and Human Services, August 2003

7 BCBSNC Member Perceptions About Their Weight 90% 80% 70% 71% 78% 77% 68% 60% 50% 40% 30% 27% 51% 32% 53% Normal Weight Overweight Obese 20% 10% 5% 0% Trying to lose weight Believe weight is "just right" Stongly agree weight affects health Source: BCBSNC Member Survey, November 2003

8 Economic Impact of Obesity Among BCBSNC Adult Membership Medical and Rx PMPM by BMI Normal Weight $26 $130 Overweight $35 $149 Drug PMPM Medical PMPM Obese $36 $168 $0 $50 $100 $150 $200 $250 PMPM Obese members cost 32% more than normal weight members, overweight members cost 18% more. Overweight and obesity accounted for $83 million in excess costs to BCBSNC in 2003.

9 Rates of Overweight and Obesity Among BCBSNC Members Enrolled in Health Management Programs Percent of Enrolled Members 80% 60% 40% 20% 55% 76% 73% % Obese (BMI 30+) % Overwt (BMI 25-29) 0% Asthma CHF Diabetes 2003 Data

10 Economic Impact for BCBSNC Members with Asthma Rates per 1, Obese Overwt Healthy wt 0 Asthma admits Asthma ER Total Admits Total ER Source: Your Asthma Care program analysis

11 Economic Impact of Obesity - Diabetes Relative Risk of Developing Type II Diabetes BMI < > 30 Men Women Source: Am J Health Promotion 1998 In 2002, costs were 3.8 times higher for BCBSNC diabetics Lifestyle change reduces the incidence of type II diabetes by 58% Over $1,500 saved for each year diabetes onset delayed

12 Consequences of Childhood and Adolescent Obesity Common Growth Psychosocial Hyperlipidemia Hepatic steatosis Abnormal glucose metabolism Persistence into adulthood Uncommon Hypertension Sleep apnea Pseudotumor PCOD Cholelithiasis Orthopedic

13 Impact of Childhood Overweight (BMI > 95th percentile) on Adult Obesity (BMI > 30) 25% obese adults were overweight children 4.9 BMI unit difference in severity Onset < 8y more severely obese as adults ( BMI = 41.7 vs 34.0) CVD risk factors reflect adult BMI Freedman et al, Pediatrics 2001; 108: 712

14 Healthy Lifestyle Choices Program Weight Control, Nutrition, Physical Activity, Stress Management, Safe and Effective Treatment Provider Component Office tools and patient education materials to support office practices. Member Component Risk stratified program. Level of benefit based on member enrollment, risk and motivation. Centers of Excellence for Morbid Obesity Surgery

15 Healthy Lifestyle Choices Key Components Four physician office visits and related testing (Adult and Child) Self-management program (Adult and Family) FDA approved weight loss medications (generally not used with children) Credentialing and contracting with registered dieticians (Adult and children) Centers of Excellence for bariatric surgery

16 Physician Office Visits Support physicians in assessment of overweight and obesity Support physicians in monitoring Provider toolkits (Adult and Children) Coverage effective 4/1/05 at group renewal

17 Self- Management Component Piloted in August ,000 members with weight related risk factors invited Ten percent response rate to date Self referral option and incentives to be added in 2005

18 FDA Approved Weight Loss Drugs Weight loss medications approved for long term use Prior authorization criteria: BMI >30 OR BMI > 27 with cardiovascular risk factors Patient is actively participating in an established weight management program Coverage effective 10/01/05 at group renewal

19 Credentialing Dieticians Over 700 clinical and private practice RD s in NC Cover nutritional counseling for weight management and other chronic illnesses Patient s will be required to be participating in a BCBSNC program Effective 10/01/05 at group renewal

20 Centers of Excellence Why? To improve the quality, cost and appropriateness of bariatric procedures being performed. Difficulty obtaining adequate PA information Complication and re-operation rates Escalating costs Media attention (positive and negative outcomes) Withdrawal of coverage by several insurers

21 % Readmit Rates COE vs. All MDs % 8.9% % COE selected RFI threshold AVG all MDs Not invited 4 14% 12% 10% 8% 6% 4% 2% 0% #procedures readmit rate

22 Opportunities Best Practice models Provider training and support Preventive screening recommendation changes Proceed with caution

23 Questions

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