essential h ealth benefits and obesity treatment coverage
DESCRIPTION
Essential H ealth Benefits and Obesity Treatment Coverage. Obesity. Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decades In contrast, obesity prevalence has nearly tripled in the last 50 years Over 2/3 of Americans are overweight and obese - PowerPoint PPT PresentationTRANSCRIPT
Essential Health Benefits and Obesity Treatment Coverage
Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decades
In contrast, obesity prevalence has nearly tripled in the last 50 years Over 2/3 of Americans are overweight and obese 35.7% of Americans are obese It is projected that 42% of the population will suffer from obesity by the year
2030
It is major cause of death attributable to heart disease, cancer, and diabetes according to the Centers for Disease Control and Prevention
Obesity
National Institutes of Health (NIH) recognized obesity as a disease in 1991
American Medical Association (AMA) in 2013 officially recognized obesity as a disease
Governmental agencies recognizing obesity as a disease US Internal Revenue Service (IRS) Centers for Medicare & Medicaid Services (CMS)
Other organizations supporting surgical treatment of obesity American Heart Association (AHA) American College of Cardiology (ACC) American Diabetes Association (ADA) International Diabetes Federation (IDF)
Obesity is a Disease
2000
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
2010
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Ambulatory patient services
Emergency services
Hospitalization
Maternity and newborn care
Mental health and substance abuse disorder services, including behavioral health treatment
Prescription drugs Rehabilitative and habilitative
services and devices
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care
Essential Health Benefits
Each State decides whether the disease of obesity is a covered benefit within the qualifying health plans participating in the State Health Insurance Exchange
27 states and Washington DC do not cover bariatric surgery
Medical treatment for obesity is a covered benefit in only 5 states
Obesity Is Not Covered Under the Essential Health Benefits
Essential Health Benefit Benchmark Plan Coverage of Weight-Related Services
CA
WY
MT
ID
NM
UT
AZ
OR
NV
WA
HI
WI
IA
MN
NE
SD
ND
CO
VT
ME
NHMAR
ICT
NY
PANJ
MD
DEWV VA
SCGA
FL
AL
NCTN
TX
OK AR
LA
MS
KS MO
ILOH
KY
IN
MI
AK
Current as of 12-10-2012; Coverage may have changed since this printing
Does not cover bariatric surgery nor weight loss programs
Covers weight loss programs but does not cover bariatric surgery
Covers bariatric surgery but does not cover weight loss programs
Covers bariatric surgery and weight loss programs
DC
Source: Center for Consumer Information and Insurance Oversight summary of EHB benchmark plans based on 2012 benefits – STOP Obesity Alliance, Weight and the States Policy Research Bulletin, December 2012.(States that have not selected an EHB benchmark plan defaulting to the largest small-group employer plan in the state.)
Excess weight is responsible for 2.8 million deaths worldwide annually
Obesity accounts for 21% of national health spending
Obesity discrimination plays an important role in lower income and production
9% lower income
Economics of Obesity
Obese individuals have 42% higher annual healthcare costs 77% higher prescription costs (as high as 105%) 37% higher primary care costs
Obesity raises annual medical costs per obese individual by $2,741 (in 2005 dollars)
Obesity increases lifetime medical costs by 50%
Economics of Obesity
Productivity Costs Obese individuals compared to healthy weight individuals have
been shown to have 3.73 additional days lost annually 1.23 times higher absenteeism rate 194% more likely to use paid time off Greater lost productive time while present at work
Bariatric surgery provides immediate benefit by decreasing lost work time and disability
Treatment costs associated with bariatric surgery were relatively small compared to economic losses of not treating obesity
Economics of Obesity
24 million Americans have Type 2 Diabetes
41% increase in the total costs of treating diabetes was noted from 2007 to 2012
$174 billion to $245 billion
Economics of Obesity and Type 2 Diabetes
Durable weight loss 106 pound mean weight loss after 16 years
Remission of Type-2 diabetes (83%)
Reduction in mortality from diabetes by 78%
Bariatric Surgery Outcomes
Resolution of Obesity-related Medical Problems
High blood pressure 63.3% Sleep apnea 68.9% High cholesterol 61.4% Asthma 66% Gastroesophageal reflux 87.6% Arthritis of weight-bearing joints 61.4%
Bariatric Surgery Outcomes
Lifetime costs to medically treat a patient with Type-2 diabetes is approximately $300,000 compared to approximately $25,000 for bariatric surgery
Total health care costs Increased 9.7% in the first year after surgery, but Decreased by 34.2% and 70.5% in years 2 and 3 after surgery
Life expectancy is improved in bariatric surgery patients when compared to medically managed patients
Several studies show increased short-term medical costs are increased, but at an acceptable level of cost effectiveness (given that the guideline for cost-effectiveness in the United States is less than $50,000/quality-adjusted life years)
$21,973/quality-adjusted life years (QALY) $7,000-$9,000/QALY for gastric bypass surgery $11,000-$13,000/QALY for gastric banding surgery
Bariatric Surgery for Type-2 Diabetes
Compared 3651 bariatric surgery patients and 3651 matched surgery-eligible control subjects
Assessed total healthcare costs 6 month prior to surgery and up to 5 years after surgery
Cost savings began accruing as early as 3 months after surgery
Total surgery costs were fully recovered after 49 months for open procedures after 25 months for laparoscopic procedures
Cost Effectiveness Analysis
Mortality rate is 4.5% per year without surgery compared to 1% per year after surgery
Only 1% of the eligible population is treated through bariatric surgery
About 25% of patients considering surgery are denied approval for surgery at least three times before obtaining approval
By then, 60% will report worsening health problems
Three of every 100 patients denied surgery will lose their lives in the next year due to deaths that could have otherwise have been prevented with surgery
Cost of Human Lives
In-Hospital mortality rate for bariatric surgery is now 0.1 %
Gallbladder surgery mortality 0.52 %
Hip replacement surgery mortality 0.93%
Bariatric Surgery is SAFE!
Not cost effective In the long-term, surgery is less costly
Patients in your state are being denied treatment that is widely available to approximately 45% of Americans
Consider that therapy for patients with other chronic diseases are not denied coverage treatments are far more expensive and less effective in
terms of remission of disease and decreasing disability and increasing productivity Cancer treatments (medical and surgical) Heart surgery
Denying Bariatric Surgery
Obesity treatment coverage should be equitable for all Americans, including citizens who are beneficiaries covered through your State’s Health Insurance Exchange