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8 Payment Considerations
Pages 57-64

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From page 57...
... • Moving beyond medical and pharmacy costs to a broader consideration of costs, including those of absenteeism and lost productivity, can help employers recognize the full costs of obesity to their companies. (Parry)
From page 58...
... Three speakers followed Bradley's introduction of the panel, addressing a number of these topics. THE EMPLOYER'S PERSPECTIVE Thomas Parry, president emeritus and co-founder of the Integrated Benefits Institute, began by observing that employers represent the single largest segment providing health care coverage (see Figure 8-1)
From page 59...
... "If we don't effectively deal with the question of cost of coverage," he argued, "then we will never get the employer's attention about this issue." Parry also has worked with Ronald Kessler of Harvard Medical School to analyze data from a research-validated self-reporting tool called the Work and Health Performance Questionnaire (HPQ) , which has generated data on about 100,000 employees.
From page 60...
... "Other sources of information have to be part of that view." Absenteeism and lost productivity are particularly germane to chief financial officers, CEOs, and other people who are running businesses, he asserted. He argued that using data to demonstrate that good care is going to lead to better outcomes that drive business performance, including costs, will produce "a conversation that the employers are willing to listen to." A PRIVATE PAYER'S PERSPECTIVE California traditionally carries a lower population health burden than many other states, noted Bryce Williams, vice president for well-being at BlueShield of California, with prevalence rates for obesity, smoking, and comorbidities all being lower than the national average.
From page 61...
... a good number of Californians figure it is easier to go to a private weight loss clinic and get a prescription for their medications that way. It is more convenient than dealing with the health plan." Williams added that the company also covers bariatric surgery with certain conditions, and it works with the Blue Distinction Centers network, which comprises centers of excellence.
From page 62...
... Medicaid is a federal–state partnership that allows states flexibility to design programs that address their needs and reflect their priorities, Stockmann explained, which results in considerable variation across states in what obesity-related services, including obesity treatments, are covered for children and adults, and reflects the variability in the statutory authorities and regulations under which those services are defined. She highlighted some of the most common ways states are choosing to cover obesity prevention and treatment services in their Medicaid and CHIP programs.
From page 63...
... She added that states can include obesity treatment services under a number of different benefit categories, required or optional, depending on how they have structured their Medicaid plan. Stockmann described a newer and important state plan option for providing obesity treatment to both children and adults -- the use of health homes, which can coordinate care for enrollees with chronic conditions, including overweight and obesity.
From page 64...
... As an example, she suggested that managed care organizations could conduct performance improvement projects as part of their Medicaid contracts, including obesity prevention and treatment as an important focus. She also observed that states could incorporate pay-for-performance arrangements that include metrics related to obesity care into their managed care contracts.


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