Transcript No Slide Title

Solving the Overweight/Obesity
Management Puzzle
10/22/04
Rosemary Burke, RN, MS
Robin F. Foust, BS, PAHM
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BACKGROUND
• MediCorp Health System
– 28 facility healthcare system headquartered in Virginia
• Mary Washington Hospital
– Benefits Department
– Associate Wellness Program
• Data/Experience
– MedPar: 22 cases in 2001 to 147 cases in 2002 for 3
hospitals reviewed in MediCorp’s region
– MediCorp: 16 cases many with poor outcomes
• Process for Change.
– Zoe Consulting, Inc.
– Associate/Member Wellness Program
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BACKGROUND
MediCorp is not alone but a pioneer in
Solving the Puzzle/Problem
One of the chief medical officers for the Division of Health Care
Financing in the Department of Health and Family Services in
Wisconsin also approached Zoe Consulting for help…
“We revamped our guidelines in 1999 using the recommendations of
the Am Bariatric Soc. , NIH National Heart, Lung, and Blood Institute
clinical guidelines and the Clinical guidelines on the Identification,
Evaluation and Treatment of Overweight and Obesity in Adults (Arch.
Int. Med/Vol 158 Sept 28, 1998).
“We went from 77 approvals in 1997 to more than 300 in 2004, which
will likely rise. We need to find the middle ground to support weight
loss through conventional means and provide surgery when
appropriate; i.e., the patient can cooperate, is psychiatrically able to
participate in pre and post surgery programs, and has acceptable
surgical risks”…
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BACKGROUND
OVERWEIGHT AND OBESE MEMBERS
Based on National statistics and MediCorp Associates’/Members’
research, MediCorp determined the need for work site nutrition and
weight management programs in order to educate Associates on
health risks and costs associated with obesity. There is a connection
with:
•
•
•
•
•
•
•
•
CVD: Heart disease, Hypertension, Diabetes
Certain Cancers; Breast, Endometrial, Prostate
Infertility, complex pregnancies, gestational diabetes, toxemia
Fibroid tumors
Sleep apnea or Pickwickian syndrome
Pulmonary embolus
Distress, anxiety, & depression
Arthritis
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BACKGROUND
OVERWEIGHT AND OBESITY
• Leading causes of morbidity and mortality
–
–
–
–
Sedentary Lifestyles
Unhealthy Weights (diets/overweight)
Tobacco Use
Risky drinking (alcohol)
• Consistent evidence that that behavioral risk factors
cluster in individuals and populations
• More than ½ of U.S. adults report two or more of the
four primary behavioral risk factors
• Progress in effective interventions for modifying these
primary risks
Source: Michael Goldstein, MD, and Susan Curry; Addressing Multiple
Behavioral Risk Factors in Primary© Care; American Journal of Preventive
Medicine; August, 2004
BACKGROUND
Surgeon General Satcher, MD states:
“Overweight and obesity may soon cause as
much preventable disease and death as cigarette
smoking. People tend to think of overweight
and obesity is strictly a personal matter, but
there is much that communities and employers
can and should do to address these problems.”
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BACKGROUND
PROGRAM TYPES
(choices)
Weight Management,
Obesity with request for Gastric Bypass Surgery
Overweight & Obesity Related Disease Treatment
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YEARLY COST PER PERSON BY
PROGRAM TYPE
$45,000
$40,000
$40,000
Weight Management
Program $662
$35,000
$30,000
Over weight & Obesity
Related Diseases
$5,000
Gastric Bypass
Surgery $40,000
$25,000
$20,000
$15,000
$10,000
$5,000
$5,000
$662
$0
Annual
Cost
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BACKGROUND
OBSTACLES FOR ASSOCIATES
A survey of 235 Associates determined what obstacles they
face in maintaining a healthy lifestyle.
Hectic Work Schedule
n=47
77
35%
Lack Time to Excerise
n=77
30%
25%
Wt Loss Center Not
Convenient n=26
47
42
20%
15%
10%
5%
26
14
Food Choices n=14
19
10
Healthy Eating Expensive
n=10
Lack of Education
Classes n=42
Lack of Support Groups
n=19
0%
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POLICY REVISION
PREMISE
Carrier’s policy was not effective,
Something had to change
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POLICY REVISION
OBJECTIVES
• Help achieve optimal outcomes for patients who have
gastric bypass surgery
– Improve Associate Satisfaction
– Improve Human Performance (Productivity)
– Improve Health Status Outcomes
• Reduce the number of inappropriate surgeries by applying
prudent criteria for coverage as indicated in the scientific
literature
• Ensure optimal quality of care is afforded gastric bypass
surgery candidates
• Achieve optimal health status, health care, and financial
outcomes
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POLICY REVISION
• Total document is over 50 – 500 pages (with or w/o guidelines)
• Actual Policy is 2 pages front & back
• Twenty (20) criteria for approving coverage
– Procedures
– CPT, ICD-9, DRG,
– BMI
– Other
• Unique criteria not in standard policies
– Mandatory 6 month participation in Associate Wellness Weight
Management Program pre and post surgically – if approved
and/or proceed with surgery
– Psychological assessment
– Sleep Apnea lab
• Backed by research & published guidelines (20 referenced sources)
• Periodically review and update
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COVERAGE
• Coverage differential for use of Center of Excellence
• Coverage for abdominoplasty or panniculectomy
• 100% covered for AW Weight Management and
other policy required services
• If proceed with surgery; coverage follows benefit
plan based on 3 levels
• If Associate/Patient does not comply with
requirements then all costs will be payroll deducted
and associate is responsible for all charges – Weight
Loss Program and/or Surgery
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THE POLICY
IN SUMMARY:
• Patient must file for approval through the
Benefits/Associate Wellness Program (AWP)
• Patient must meet clinical guidelines for approval
• Patient must comply with all procedures outlined by
the policy and the Associate Wellness’ Weight
Management program before approved for surgery
• Once the appropriate forms are filed and coverage
approved, the AW – Weight Management program
will work with the patient’s physician to refer the
patient to a designated COE
• AWP continues working with the patient for at least 6
months post surgery both by phone and in person
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Options for Program Delivery to
Support Employer Policy Revision
-- and -Policy and Program Implementation
– Internal monitoring and program delivery
like the MediCorp program design through
AW -- which is presented next -- or,
– External contracting through various
program providers, or
– Combination, and/or custom program design
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MEDICORP’S PROGRAM
• PROGRAM DESIGN:
– Basic:
• Weight Loss
– Monitoring and Support through Associate Wellness (AW)
– Weight Watchers for group support ongoing & in addition to AW
counselor meetings
– Counselors apply behavioral change communication techniques
to support lasting change
• Obesity Management – Gastric Bypass Surgery
– Compliance with Policy
– Monitoring and Support through Associate Wellness (AW)
– Weight Watchers for group support ongoing & outside AW
– Approval For Coverage
» Yes: Surgery with 6 months post surgical program
» No: Coverage for surgery denied
– Goal:
• To educate participants to manage their weight through:
– Improved nutrition and increased activity,
– Develop positive lifestyle behaviors, and
– Meet their individual weight loss goals.
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MHS PLAN
• Implement Weight Loss Program for Associates with 100 pounds
excess weight or have a BMI of 35 or more with co-morbidities
• Implement Weight Watchers at Work Program for
Associates with moderate excess weight
• Implement an alternative weight loss program for Associates
seeking Gastric Bypass Surgery
• Developed and implemented Program and Data Base System
– Monitor patient/associate’s progress – Initial Assessment,
Reassess every three months
– Monitor compliance to policy approval criteria
– Programs consist of:
• Lifestyle changes,
• Proper nutrition, and
• Physical Activity (exercise)
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ACHIEVE HEALTHY WEIGHT
PROGRAM ENTRY
SURGICAL
CANDIDATES
WEIGHT
MANAGEMENT
COMPLIANT
6 Month PreSurgical Plan
YES
NO
ELECTS
SURGERY
SURGERY
APPROVED
Y
Surgery
Denied
ASSESSMENT
EDUCATION:
Carekits/other
materials mailed
RISK
&
LEVEL OF CARE
GOAL SETTING
SHORT TERM
LONG TERM
N
GOAL ACHIEVED
6 Month Post
Surgical &
Weight
Management
PROGRAM
REPORTING & EVALUATION
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GRADUATION
COMPLIANCE
PROGRAMS &
ELEMENTS
GROUP
SUPPORT
SESSIONS
i. E , Weight
Watchers, or
other
Screen Shots
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Screen Shots
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Screen Shots
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PROGRESS REPORT
• Associates confirming improved overall health
– More energy and stamina
– Decreased medications
– Decreased shortness of breath with physical activity
– Decreased joint pain
– Increase in confidence and “Total Quality of Life”
– Decrease in time off from work and health claims
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ASSOCIATE PROGRESS REPORT
•
•
•
•
45 presently in Weight Management
52 enrolled in Weight Watchers at Work
235 have completed the program since 2000
MediCorp has lost a total of 5730 pounds since
9/2000
• Documented 9 surgeries avoided since program
began; or $360,000 saved. (average cost of
$40,000/case with no complications)
• 3 current candidates requesting Gastric Bypass
surgery:
– Wt loss from 45-73 pounds per person in <1yr
• 1 had a gastric bypass (Self-pay) after 31# loss in 8
weeks in program. Now a spokesperson to stay in
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AW program -- not surgery
92 Associates Who Have Lost As Little As 15% of
Their Total Body Weight Experienced Improvement
in Overall Health.
Overall Improved Health
n=43
Lost Time
n=92
Energy Level
n=30
n=38
Cholesterol
Blood Pressure
n=79
Improved Breathing
n=21
Medications
n=84
Self Esteem
0%
20%
40%
60%
80%
100%
120%
Percentage of Associates with Improved Health
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Where Are We Now?
MAINTAINED WEIGHT LOSS (6 Mo. To 3+ Yrs)
No Weight Loss or
Gained Weight
11%
Quit Program
18%
n=24
n=14
n=36
n=59
Lost 15% and over
of Body Weight
44%
Lost 5-14% of
Body Weight
27%
Lost 15% and over of Body Weight
Lost 5-14% of Body Weight
Quit Program
No Weight Loss or Gained Weight
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N=135 total
NEXT STEPS
• Increase promotion of programs:
• Campaign for membership – membership drives, hospital
orientation, Great American Weigh-In, Wellness Fair
• Advertise – ICP mail, posters, Quick Takes
• Offer non-food incentives for joining the program
• Increase number of mentors
• Continued support upon completion of program (re-assess
every 6 mo.)
• Implement a Weight Management Team consisting of Weight
Management Staff, F&N, Dietician, Assist, PM&R,
Orthopedic, Endocrinologist
• Increase number of Weight Watcher Meetings to 4 each week
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SUCCESS STORIES
60 yr old male lost 170 # over 15 months
“Made me more productive at work and home. Improved my
relationships with family.”
40 yr old female lost 40 # in 6 months
“I can walk without being winded. I can ride amusement rides,
not sit on the bench.”
30 yr old female lost 100 # in 11 months
“I never missed a meeting. This has changed my life forever. I
am no longer out of control.”
50 yr old female lost 75# in 12 months
“I am down from 7 to 2 pills a day.”
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CONCLUSION
Overweight/Obesity negatively impacts:
 Health
 Life at home and at work
 92% of on the job injuries at MHS
 Cost and Use of health insurance
 Our management survey revealed -- & weight
management Associates confirmed -- that obesity
decreases productivity
WORK PLACES CAN MAKE A DIFFERENCE
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The Surgeon General is right
“… there is much that communities
and employers can and should do to
address these problems.”
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THANK YOU
Rosemary Burke
[email protected]
Robin F. Foust
803-324-8626
[email protected]
www.zoeconsulting.com
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References:
1.
Obesity Statistics, National Institute of Diabetes & Digestive & Kidney
Diseases and WebMD.com
2.
O’Brien PE, Dixon JB, The Extent of the Problem of Obesity, AMJ
Surg. 2002 Dec; 184(6B):4S-8S
3.
US Department of Health and Human Services; Centers for Disease
Control and Prevention, 2002
4.
Finkelstein EA, Fiebelkorn IC, Wang G, State Level Estimate of Annual
Medical Expenditures Attributed to Obesity Jan 2004; 18-24
5.
Centers for Disease Control and Prevention, Prevalence of Overweight and
Obesity Among Adults; US 2004
6.
Monahan, b, AVP, Workforce Strategies, Fighting Obesity is the Key to Health
and Productivity Management Study, AON 2004
7.
Palmer and Cay Consulting Group “Policy Criteria and Procedures for
Gastric Bypass Surgery Approval” Aug. 2003
8.
US Surgeon General, Prevent and Decease Overweight and Obesity 2001
9.
US Depart. Of Health and Human Services NI Pub. No. 01-4006 Dec 2001
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