PEDIATRICS Vol. 123 Supplement June 2009, pp. S301-S307 (doi:10.1542/peds.2008-2780I)
SUPPLEMENT ARTICLE |
Paying for Obesity: A Changing Landscape
a Child Policy Research Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
b National Initiative for Children's Healthcare Quality, Cambridge, Massachusetts
c Department of Pediatrics, University of Washington, Seattle, Washington
BACKGROUND. Coverage for obesity related services is highly variable. Despite this, health plans, purchasers, and states have mounted numerous recent initiatives.
OBJECTIVE. To identify the range of approaches being used to address coverage and reimbursement for childhood obesity services.
METHODS. Key informant interviews were conducted using a semi-structured protocol to identify the types of activities they or their organization were engaged in to address childhood obesity, to learn about private payer policies and procedures, to identify best practices, potential resources and/or other key informants. Domains addressed in the protocol included scope of the respondent's organization's activities, the rationale for supporting obesity activities, the degree to which obesity services were a covered benefit and what if any barriers or challenges were encountered in implementation, the policy climate within which the organization operates (e.g. state legislation, initiatives or task forces), and any assessment of the impact and/or cost of implementing their initiatives. The individuals interviewed represented respondents from each of the following categories: employer, health plan, and state insurance programs and conducted by phone between November 2007 and March 2008. In addition to the information gathered by the key informant interviews we conducted a search of the relevant peer review and grey literature between 2005 and 2008 and input from a national expert advisory group.
RESULTS. Significant variation, as well as recent changes, were identified in both the private and public sector. Approaches included new benefits and incentives for parents and providers. Only anecdotal evidence of impact of the recent changes was available.
CONCLUSIONS. There is important forward movement in how public and private players are addressing paying for obesity related services. Medicaid and SCHIP programs have an opportunity to provide additional leadership. Substantial investments in evaluation and research are needed to learn which approaches are most effective.
Key Words: obesity • overweight • coverage • reimbursement • payment • costs • trends • insurance • incentives
Abbreviations: BCBSMA—BlueCross BlueShield of Massachusetts • EPSDT—Early and Periodic Screening Diagnostic and Treatment • CMS—Centers for Medicare and Medicaid Services • SCHIP—State Children's Health Insurance Program • CED—coverage with evidence development • QI—quality improvement
Accepted Feb 18, 2009.
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