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Tackling Obesity via Benefit Design

Les Masterson, for HealthLeaders Media, May 28, 2008

Nearly 90% of people with type 2 diabetes are overweight, obesity is responsible for many cases of hypertension, and being overweight or obese is linked to increased risks for certain types of cancer.

Despite those sobering facts, many still view obesity as a lack of will power and fail to focus on the health quandary that is leading to comorbidities, higher healthcare costs, and premature illness and death.

But there are those trying to turn the tide. The Strategies to Overcome and Prevent (STOP) Obesity Alliance—comprised of consumers, providers, government officials, labor organizations, health insurers, and numerous other stakeholders—has taken the lead to promote the obesity problem and how it impacts the nation.

DMAA: The Care Continuum Alliance has also taken an active role in exploring the issue and its impact on employers and the healthcare system. Last week, DMAA raised the bar by presenting a new flexible obesity benefit design approach, which it developed with Health & Technology Vector Inc.

DMAA offered the Value-Based Benefit Design for Obesity and Comorbidities at a Washington, DC, press conference with members of the STOP Obesity Alliance and Service Employees International Union on hand.

DMAA's design benefit takes a unique approach to the problem of obesity. It combines scientific evidence on effective obesity management strategies with pricing structures that allow health plans, employers, and organizations representing businesses, providers, academia, and other stakeholders, to create a benefit design to reach those who may be on the road to obesity or are already there.

DMAA describes the approach as a supplemental package of services offered at an additional premium, such as vision or dental care. No person would be required to enroll or participate in the obesity benefit and employers could choose to offer it at no additional charge.

Eligibility in the benefit program would be based on the person's body mass index (with those listed 25 or higher considered overweight or obese) and comorbid conditions, such as diabetes.

The benefits program would be broken into three levels that would use health management programs. The actual programs and cost structures would depend on an employer's budget, culture, and values.

DMAA's prototype suggests the following services in each level:

  • Level 1—Initial comprehensive evaluation by and follow-up visits with primary care physicians; behavior modification services, including initial and follow-up visits with a registered dietitian; and obesity-related pharmaceuticals.
  • Level 2—Visits with a registered dietitian, as well as e-mail and telephonic support; an EKG; physician visits; initial and follow-up visits with exercise physiologist; clinical laboratory panels; and obesity-related pharmaceuticals.
  • Level 3—Bariatric surgery; psychological evaluation; and adjuvant services, including post-surgical reconstructive surgery and travel/lodging allowance.

The first question a health plan and employer will surely ask about this program is: How much will this cost my company and our members? The program design makes that question difficult to answer because there are so many variables, such as population size and benefits provided. DMAA's proposal is not a "plug and play" program, but leaves the specifics up to the employer, health plan, or other plan sponsor. This will allow a health plan or company to develop a design that best benefits them.

That critical cost question may soon become clearer. DMAA is working with the SEIU to pilot programs to test and refine the benefit design.

There are still plenty of questions left with this benefit design, but it is an important first step. Whether this idea gains momentum, improves health, and reduces costs is in question, but this is the chance for the employer community to step forward to take part in a pilot that could ultimately reverse obesity trends and provide long-term savings.


Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
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