Tuesday, March 18, 2008

Obesity & Disease Management: Why the Industry is Happy to Fill a Vacuum

So just what is going on with obesity and disease management?

While persons with obesity have greater claims expense, insurers and the actuaries that advise them are unsure if programs aimed at reducing the severity and prevalence of obesity in a covered population truly result in savings. Accordingly, they fear that if they cover obesity treatment, medical costs will not only remain high, they’ll have to bear the cost of a richer benefit.

Health insurers' customers don’t want to hear that. CEOs and human resource leaders have looked at their insurance premiums and the body habitus of the employees in their cafeterias, assembly lines and cubicles and have concluded that there is a causal relationship between obesity and the rising cost of health care. They have decided that addressing the former will mitigate the latter. They also believe that preventive and conservative obesity treatment programs will reduce the looming and unaffordable cost of bariatric surgery.

They don’t find much comfort in the argument that expensive up-front coverage of bariatric surgery will ultimately result in cost savings in the long run. They would rather avoid having to choose between the up versus downstream costs of obesity. Many employers have also not given up on the belief that their human capital is worth the investment in high value, cost effective and preventive health insurance. One market judgment beats five evidence-based medicines. It also beats five actuaries.

Whether they like it or not, health insurers are under pressure to do something. For employers who are self insured, they’re also prepared to do something.

And how has the traditional health care system responded? Except for a few successes, the silence has been deafening. While physicians can use a wide range of diagnosis codes (making the DMCB doubt the contention that obesity treatment is not “paid for”), their training and the traditional one-on-one care approach to care has been ill-equipped to provide lifestyle counseling. It has also been simply out-numbered by the sheer volume of persons with obesity. Other resources, such as registered dieticians or nutritionists, are too few or hospital-based.

In the meantime, obesity has long been addressed as a co-morbidity by disease management programs; contrary to popular opinion, it’s been years since they confined their care protocols to single disease treatment. They have been including weight management as part of their approach to chronic illness for years. Given their pre-existing treatment protocols, infrastructure and willingness to sell population based approaches for any condition at the right price, they have been more than willing to fill the vacuum created by the growing prevalence of obesity, the demand for affordable treatment as well as the inertia of the traditional health care system. They have been more than happy to respond to the “do something” described above.

The disease management care blog is unaware of any studies that describe the number of persons in or the revenue from commercial disease management obesity programs, but it suspects the numbers are considerable. Surprised? Don’t be, because they have an understandable product at a reasonable price that promises an alternative to hidebound traditional medical care, high cost pharmaceuticals and even higher cost bariatric surgery.

Oh, and last but not least, it’s ironic that weight loss medications and bariatric surgery are most effective if they are paired with ongoing counseling and follow-up. Care to guess if the disease management industry is ready to get paid for this too?

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