Routine policy exclusions for obesity care could costnsurance companies more than they bargained for, according to an article in the American Journal of Managed Care.
The root of the issue may be the stigma that prevents obesity patients from getting the care they need, the article says. This stigma often means obesity patients can't get their treatment--which includes medications--covered by their insurance provider. But this reluctance to treat obesity in the same way as diabetes or heart disease are treated costs more in the long run.
Investing in preventive care has proven an effective strategy to save on the cost of treating chronic conditions such as heart disease and Type 2 diabetes, both of which are linked to obesity.
During a recent panel at Patient-Centered Diabetes Care, industry experts said that the move to a value-based system will help promote coverage for obesity care because it will make sense to pay for services with proven outcomes. The challenge, they said, comes from having to convince major employers with self-funded plans that obesity care is worth it.
Ted Kyle, who founded obesity care advocacy organization ConscienHealth, said the consequences of not covering obesity treatment could be greater than the cost of care access. "Whether or not healthcare plans cover care for obesity, we are paying for obesity," Kyle said during the panel. "Our 'sick care' system does a great job of paying for the result."
Still, reimbursement is improving for obesity care. Medicare covers bariatric surgery, and the U.S. Preventive Services Task Force has said that health plans must cover intensive behavioral counseling for people with obesity and at least one other cardiovascular risk factor, according to the AJMC article. The Centers for Medicare & Medicaid Services also has announced that it plans to expand the Affordable Care Act-funded National Diabetes Prevention Program after a promising demonstration involving the YMCA.
To learn more:
- here is the AJMC article