Managed Care - October 2008 - (Page 26) ical director “I work like a dog to find a nickel’s worth of per-member Numbers to chew on per-month savings if it’s medically lue Cross & Blue Shield of North Carolina wanted to see based and acceptable to our members,” how well its healthy lifestyle choices program was doing. The says Bradley. insurer tracked the progress of 1,171 participants in 2005 and The program covers physician treat2006, the first two years of the program. ments for obesity, up to six visits a year It found that with a nutritionist, and FDA-approved • Medical expenses for the group were about a third less than drugs for the long-term treatment of what the plan would have expected, given medical cost and obesity. In addition, the program is a utilization trends for commercial membership as a whole. gateway to what Bradley calls the in• The combined medical cost saving of the group was surer’s “centers of excellence for $437,729 over the two years. bariatric surgery” and “all of the difThe plan surveyed 258 participants at six months and then ferent ancillary and support pieces we again at 30 months. It found that put around it in terms of education • Of those who wanted to lose weight, 49 percent dropped an material, screening, and support. What average of 11.6 pounds. (One caveat: Of the people with a we call toolkits for physicians.” weight loss goal, average weight of the group as a whole Along the way, the plan is constantly did not change, but the behavior changes were significant.) measuring the reaction of doctors — • The numbers of days a week participants exercised inincluding Bradley’s wife, who is a famcreased from 2.9 to 3.4. ily physician. • Consumption of fruits and vegetables increased, going from “Primary care docs appreciate the 51 percent eating fruits and vegetables two or more times a fact that doing some of this work, parday to 60 percent. ticularly around obesity, takes time • Average waist circumference went from 37.1 to 36.6 inches. and effort on their part. So, actually providing coverage for some of these visits is very exciting stuff,” says Bradley. “Finanabetes, hypertension, and osteoarthritis. “We’ve got cially, we’re not seeing huge numbers of claims an epidemic going on here,” says Bradley. “Would coming in just for obesity, but as a recognition of you not treat an epidemic of avian flu? Have we got the type of effort that needs to be put into creating the specific answers to it? Not necessarily, but to let and facilitating healthy lifestyles, it’s a big incentive. it go unfettered we’d see some pretty dire conseThere’s nothing more frustrating to a primary care quences.” doctor than knowing what the patient needs, wantNot having specific answers led to BCBSNC’s ing him to do it, but finding out that there’s not decision to track the healthy lifestyle choices progoing to be coverage for it. The patient is just not gram since its launch. “The data about what works going to do it because it costs too much money.” and what doesn’t aren’t quite there,” says Bradley. “We’re investing money. We happen to be not-forprofit, but we’re not a charity. If something doesn’t Epidemic? work over three to five years, then we need to stop Bradley is one of those health professionals who doing it and move on to something else. Any wise label obesity an epidemic, though others would investor would track the resources he puts into it.” not use that word. It is, however, a recognized conOf course, being a wise investor means not only dition — with its own ICD-9 number (one of the tracking the money but making sure the money is 278 series) and progressive tendencies. “You gain a well-spent. Bradley knows that he is not alone in pound a year starting at about 35 until about 65,” thinking that fighting obesity is a wise investment. says Bradley. “That’s the natural history.” “As I look out in the marketplace, I think Aetna, Forget weight loss. Bradley feels that just stopping Cigna, UnitedHealthcare and others are all workthe progression would yield real health benefits. ing on this same kind of thing. I think we just do it Weight maintenance is nearly as important as better.” MC weight loss and can delay or prevent the onset of di- B 26 MANAGED CARE / OCTOBER 2008
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