Healthcare Purchasers and the Standard of Obesity Care
It came at the end of a discussion about obesity care that opened the Annual Forum of the National Alliance of Healthcare Purchasers Coalitions. With sharp questions, Neil Goldfarb captured a core frustration about obesity care. “Why are we even having this conversation? Think about any other disease. Do we even hesitate to cover needed care?”
Goldfarb is President and CEO of the Greater Philadelphia Business Group on Health. And there’s no good answer to his question. We can only say that bad habits die hard. And many health plans are in the habit of denying coverage for obesity care. Instead, they pay a fortune for the complications of untreated obesity – diabetes, heart disease, liver disease, certain cancers, joint disease. The list goes on.
But the cost doesn’t stop with the cost of medical care. It hits businesses with reduced productivity. Obesity causes work absences and it interferes with productivity on the job. So one is left wondering how we got here.
Bias Rooted in a Misunderstanding of Obesity Itself
ConscienHealth’s Ted Kyle opened with a overview of bias about obesity and the people who live with it. Most people incorrectly understand obesity as a condition of choice. But in fact, researchers have known for four decades now that obesity is a highly heritable condition. Genes set the table for obesity in a individual. And then the environment serves it up. We have more obesity now than thirty years ago because we have many environmental factors triggering it in susceptible individuals.
Of course, just as with any other chronic condition, once facing it, a person has to decide how to cope. However, in the case of obesity, health systems make it harder.
Developing a Standard of Care
From the Stop Obesity Alliance, Cristy Gallagher and William Dietz described their systematic approach to documenting this problem and developing a solution. That solution is a standard of care that actually provides care for obesity.
First they mapped out the gaps in current systems of care and health plans. Then they identified core competencies for providers. Finally, their team is now working on a comprehensive benefit design for obesity care. One to fill the gaps and yield a healthier and more productive workforce.
Bringing Action
From HEB, Abby Ammerman presented an overview of a plan that’s working. Ammerman has been leading an effort to meet the challenge of obesity in the workforce of this Texas grocery chain. The company has a 45 percent prevalence of obesity in its workforce. Ignoring the issue is not an option.
So instead, Ammerman has developed a complete approach to promoting well-being. The company now covers all forms of evidence-based obesity care. What’s more, Ammerman is starting to see favorable trends in the health of the workforce. Risk factors are declining.
Goldfarb is right. We should not have to have this conversation about covering such a serious chronic disease. But that’s where healthcare purchasers find themselves. So they’re rolling up their sleeves. And they’re bringing change.
Click here for the sides from this panel yesterday.
Panel on Obesity Care, photograph © National Alliance / flickr
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November 12, 2019
November 12, 2019 at 1:36 pm, Mary-Jo said:
It’s baffling. I find it especially mind-boggling that we still don’t proactively treat children, especially young women who will bear children when we know that both these groups alone, when treated and evidence-based interventions are applied, can affect the propagation of further occurrence of obesity in the population. Unconscionable. I’m really looking forward to following progress being made as in these initiatives.
November 12, 2019 at 4:38 pm, michael said:
Hi Mary-Jo.
Until obesity is widely accepted as a disease, the alternate moralistic narrative prevails. So nobody wants to get all moralistic about mums and bubs. Hence not really baffling, just disappointing. This is a human rights issue.
Arya Sharma has an excellent talk on all this: https://www.youtube.com/watch?v=25Ut8q0gDSY&feature=emb_logo
November 18, 2019 at 7:26 pm, Walter Lindstrom said:
I’m 25 years post-RNY (back in the days when this was “voodoo medicine.” I’ve been fighting for patients against payers for over 23 years and things are better for certain but too many of the battlegrounds haven’t changed at all. Naturally lean people often look down at us with disdain and suggest we should “just push away from the table and walk around the block…” Were it only that easy!
Unlike the vast majority of other diseases, Obesity is visible – it’s in everyone’s line of sight – and the [very wrong] perception of “I shouldn’t have to pay more for MY insurance just to help HER!” completely ignores the entire concept insurance is based upon, i.e., spreading risk.
Mr. Goldfarb is right, of course. And obviously I hope he is a visionary whose point of view will lead the way for other business leaders to view our disease – I want him to become one of the first of a “new normal.”
But I fear he (and the Philly Business Group on Health) might be more of an outlier and viewed by his colleagues as an aberration – so I’m going to continue fighting for patients to get fair and just access to care from payers who refuse to see what we all know, simply because the general public allows them to get away with it. It must end and must end now!
End of rant.