A healthy alliance
By Pam Auchmutey
Kimberly Rask is evaluating the pros and cons of an insurance benefit to help reduce childhood obesity.
A few years ago, community leaders asked Kimberly Rask to serve on a coalition to address children’s health in their rural county in Southeast Georgia.
Their request was prompted by a hard lesson. When a new prison opened, two-thirds of the employees came from outside the county. Many of the in-county residents who applied for jobs were too overweight to meet the physical requirements for prison work.
"They wanted a healthier workforce to provide more jobs," says Rask, associate professor of health policy and management.
Georgians have reason to be concerned about overweight and obesity. According to the nonprofit Alliance for a Healthier Generation, Georgia is the 20th most obese state for adults and the 10th most obese state for children.
In 2009, the Alliance launched the Healthier Generation Benefit to expand insurance coverage for childhood obesity. To date, 22 insurance companies and self-insured employers are working with 56,000 providers to extend the benefit to more than 2.7 million children. The benefit includes four follow-up visits with a primary care provider and four visits with a registered dietician for children with a body mass index (BMI) in the 85th percentile or higher for their age.
When the benefit was launched, the Alliance asked Rask and her research team to evaluate its effectiveness. They found, for example, that copayments of $20 to $75 often discouraged return visits to providers. Some provider networks lacked a sufficient number of dieticians to serve patients. Infrequent use of billing codes for BMI-specific diagnosis and counseling made it difficult for insurance claim administrators to monitor use of these services by eligible children.
The dearth of billing data for obesity treatment and counseling also made it difficult for researchers to measure quality of care in their evaluation of the benefit.
Given such barriers, is the benefit destined for greater use and effectiveness? Rask believes that a relatively new health care quality indicator called HEDIS (Healthcare Effectiveness and Data Information Set) will help long term. To be accredited by the National Committee for Quality Assurance (NCQA), insurance companies must use HEDIS measures to gauge quality of health services under the benefits they offer. Three of those measures pertain to childhood obesity—documentation of BMI, counseling about healthy nutrition, and counseling about healthy exercise.
"Many health plans accredited by NCQA have to report that data," says Rask. "That’s an incentive to put programs in place to promote these measures. Starting this year, we’re switching from using claims data to HEDIS measures to monitor how well health insurance plans cover childhood obesity."
Rask’s team is now following a practice in California where children visit physicians and nutritionists five times a year to achieve a healthier weight. BMI measurements for some children have plateaued or dropped.
"We think this type of care is going to be a more effective strategy," says Rask. "The key is to integrate it into routine care."—Pam Auchmutey
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