The goal of the Alliance is to eliminate childhood obesity and to inspire young people to develop lifelong healthy habits.

Alliance Programs

Healthy Schools Program

Healthy Out-of-School Time

Industry Initiatives• Food and Beverage• Healthcare• School Meals

• at least four follow up appointments with a primary care provider

• at least four visits with a registered dietitian

Insurers and employers offer:

Alliance Healthier Generation BenefitPrevention, Assessment & Treatment

The Alliance for a Healthier Generation convened national medical associations, leading insurers and employers to offer comprehensive health benefits to children and families for the prevention and treatment of childhood obesity.

Building from the Evidence Base

Alliance Healthier Generation Benefit is the place where these new best practices have real-world application.

Healthier Generation Benefit: Supporting Organizations

Healthier Generation Benefit Signatories

Evaluation of Healthier Generation Benefit Progress

Kimberly J. Rask, MD, PhDJulie A. Gazmararian, PhD, MPHSusan Kohler, RN, MPHJonathan Hawley

Rollins School of Public HealthEmory UniversityApril 2013

Overview

• Third party evaluation of both implementation and outcomes

• Best practices and lessons learned from key informant interviews

• Monitoring use of the Benefit through claims data• Recommendations to increase use of obesity

prevention and treatment services

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Implementing a new health benefit

Administrative Barriers to Offering the Health Coverage: • Few barriers noted• For several this is expansion of an existing Benefit

Coverage Offered: • Most restrict the coverage to children with BMI greater than or equal to the

85th percentile for age• Co-pay requirements vary by group and/or plan and apply to each visit

Enrollment Process for Families: • Most signatories have no formal enrollment and/or pre-certification process

Marketing: • Focus of marketing efforts varies with insurers reaching out to providers and • Employers reaching out to employees

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Use of the BenefitChallenges to Identifying Obese Children from Administrative Claims

Data: • Use of BMI specific ICD-9 codes is rare• Use of CPT or HCPCS codes for nutrition counseling are rare• Increase in the number of obese children having at least one

preventive medicine visit and/or at least one dietitian visit

Remains difficult to identify paid claims processed specifically for obesity-related services

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Percentage of Covered Children with an Overweight or Obesity Diagnosis

Small but consistent increase in the number of covered children that are identified as overweight or obese.

Overall percentage increased from 1.5% to 1.9%.

This signatory allows providers to use the broadest range of available diagnosis codes.

Number of Overweight /Obese Children with at least One Preventive Visit

Most children diagnosed as overweight or obese have at least one preventive medicine visit with a PCP.

Overall percentage with a preventive medicine visit increased from 65% to 71% .

This signatory dropped co-pays for use of the benefit.

1 YearBefore HGB

1 YearAfter HGB

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sig1Sig2Sig3Sig4Sig5Sig6Sig7Sig8Sig9

Signatory reviewing data to better understand why so low.

Recommendations going forward

Build upon the current successes…1. Continue educational initiatives and outreach to encourage

accurate documentation of BMI status. Promote use of overweight and obese diagnosis and procedure codes

to allow better identification of eligible children and more reliable monitoring of preventive and treatment services.

2. Evaluate pilot strategies to increase use of obesity services and monitor utilization to identify best practices.

3. Continue collaborative efforts with professional organizations to offer and disseminate resources for health care providers and families. 15

AAP/ Academy/ Alliance Resources

Pediatric Weight Management Algorithms

Algorithms are available online: www.andevidencelibrary.com

• Pediatric Weight Management Nutrition Care Process

• Nutrition Assessment• Nutrition Diagnosis• Nutrition Intervention• Monitoring and Evaluation

Evidence Based Guidelines > Guideline List > Pediatric Weight Management > Algorithms

17

This Evidence Analysis Library® project is free to the public. To access, go to http://www.andevidencelibrary.com/topic.cfm?cat=2721

Accessing Pediatric Weight Management Recommendations

Other Academy of Nutrition and Dietetics Pediatric Resources

• Academy Evidence Analysis Library® Store• http://www.andevidencelibrary.com/store.cfm• Pediatric Weight Management Toolkit• Pediatric Weight Management PowerPoint

• Academy Eatright.org Store• Various Pediatric Publications

– http://www.eatright.org/Shop/Categories.aspx?id=255

• Academy Pediatric Nutrition Care Manual• http://peds.nutritioncaremanual.org/demo/peds.c

fm

• KIDS Eat Right - public website at kidseatright.org

www.eatright.org/alliance

Link to:• Academy

Guidelines• Academy Positions• Care Coordination

documents• HGB Benefit

Details

Primary Care Providers: How to Find a Registered Dietitian

For physicians who do not have an existing relationship with a local registered dietitian (RD), the following resources can be used to

locate an RD: • The Virginia Dietetic Association’s “Find an RD”:

http://www.eatrightvirginia.org/page/find-an-rd

Local Perspective: RDs

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• Coordinate with the Academy to:• Market initial provider webinar• Communicate benefit information to RDs• Encourage VDA members to partner with

PCPs to provide the HGB• Increase utilization of RD services via potential

benefit redesign

Obesity Related Resources

PREVENTION. TREATMENT. RESULTS.

Weight of the State, April 2013

Pediatric e-Practice: Optimizing Your Obesity Care

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 24

www.pep.aap.org

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 25

Sample Room: Exam Room

26

Sample of resources accessible via PeP

Healthy Active Living for Families

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 27

www.healthychildren.org/growinghealthy

HALF Implementation Guide

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 28

EvidenceParent FeedbackOpportunities for CareConversation StartersRelated Parent Resources

www.aap.org/HALFIG

HALF Implementation Guide

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 29

HALF APP

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 30

COMING SUMMER 2013!

Other sample resources:

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 31

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 32

www.aap.org/obesity

Opportunities for Involvement• Join the AAP Section on Obesity

email: mbedient@aap.org

• Connect with the Virginia AAP Chapterhttp://www.virginiapediatrics.orgVirginia Chapter AAP2201 W Broad Street Ste 205Richmond , VA 23220-2022

INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT 33

Weight of the State

Alliance for a Healthier Generation

Rhonda Keith, M.S.

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Anthem’s Role

The Alliance for a Healthier Generation convened national medical associations, leading insurers and employers to offer comprehensive health benefits to children and families for the prevention and treatment of childhood obesity.

Anthem covers benefit for…• at least four follow up

appointments with a primary care provider

• at least four visits with a registered dietitian

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

Program History

• Pilot officially launched May 15, 2010

• Rolled out in conjunction with the Virginia Weight of the State Conference

• No system changes were needed

• Focused on promotion and use of benefits

• Early interest by pediatric practices was high

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 36

Who is eligible?

550,000 eligible children in VA

• Children age 3-18 with BMI ≥ 85th percentile

• All Anthem lines of business

• No referral required• Appropriate

documentation per CPT and ICD-9 guidelines

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 37

How do we bill?

Diagnosis codes – for physician and registered dietitian services

• V85.53 – Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age

• V85.54 – Body Mass Index, pediatric, greater than or equal to 95th percentile for age  

All services are subject to member copayments and coinsurance per the member’s benefits – for physician and dietitian services

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 38

How do we bill?Physicians• Physician services billed

using regular Evaluation and Management Codes

• Use diagnosis codes provided

• Subject to the appropriate fee schedule for the line of business

Nutritional Counseling Services• Must be billed under the

supervising physician’s NPI• 97802 – Medical Nutrition

Therapy (MNT); initial assessment & intervention, individual, face-to-face with the patient, each 15 minutes

• 97803 - MNT; re-assessment & intervention, individual, face-to-face with the patient, each 15 minutes

• Covered up to 16 units – four unit per day restriction

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 39

Measures of Success

Use of Benefit• We had a 6% increase in

the number of preventive visits with a PCP in those children with an obesity diagnosis

• This compares one year prior to implementation to one year after

Participation• 38 Pediatric practices

utilizing benefit• Physician Champions!• Physician – Registered

Dietitian Relationship

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 40

Partnerships

• Alliance for a Healthier Generation– American Heart

Association– William J. Clinton

Foundation• Virginia Chapter of the

American Academy of Pediatrics

• The Virginia Department of Health

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 41

What’s Next?

Expansion of Program• CA Pilot - began April 2012• WI Pilot - start date TBD• VA Pilot – increase participating practices

EvaluationAnthem will begin research to…• Review three years of EMR data • Evaluate changes in BMI for participants

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 42

Contact

Rhonda D. KeithCommunity Collaboration ManagerPatient Centered Care ProgramsAnthem Blue Cross Blue ShieldTel: 804.212.6952Email: rhonda.keith@anthem.com 

COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY 43

Office Obesity Management

Carilion ExperienceJohn E. Moore, MD

Brooke Mercedes, RD, CSSDBotetourt Pediatrics

Carilion Clinic Children’s Hospital

Carilion Clinic Practice Demographics: Located in southwest Virginia Roanoke metro region: approx

300,000 Primarily suburban / rural Practice catchment area of 5 counties

• Some patients are driving hours to this location!

Carilion Clinic Practice Demographics:

Hospital-owned general outpatient pediatrics

2.5 FTE satellite office, • Main office 5.5 FTE with 1 NP

Approx 6000 patients 20% Medicaid / MCO 50% Anthem

How I Became Involved Step 1: Recognize a Problem

• More and more children in my practice were obese

Step 2: Find a Solution• I realized I was in over my head!!!• I looked for help

Where did I go? AAP national

Virginia Chapter• Great toolkit!

Carilion Clinic Practice:Nutrition service!

In 2011, Anthem rolled out nutrition counseling pilot

One of the first times commercial insurance, governmental agencies, hospitals, and private practice were on same page

Coverage for in-house nutritional service

Carilion Clinic Practice:Nutrition service!

Changes office needed to make prior to scheduling patients

Find a qualified nutritionist! Work out referral process Iron out coding, billing

• Anthem would not cover “obesity”• Had to code as “Elevated BMI”

Case discussion:11yo male (JF)

Presents with obesity and probable Type II diabetes.

Pt seen for education of carb counting and healthy eating

Potential barriers: understanding of carbs and how to count them, concern of commitment- appeared overwhelmed

NUTRITION EVALUATION Wt: 127.14 (>95 %ile) Ht: 59.5in (90 %ile) BMI: 25.4 (>95 %ile) Pt is a 10yo male being seen for BMI >95%ile as well as new

onset Diabetes which he is jointly followed by Peds Endo for. Reviewed knowledge of CHO counting with pt. His base knowledge was very minimal. Reviewed basics of CHO counting and provided family with handouts for guidance. Helped family to develop meal plan that fits pts current needs. Provided recommendation of 60g at meals and 20-30g at snacks.

Recs/Goals 1) CHO intake- meals: ~60g/ea and snacks: 20-30g/ea 2) fiber goal 15g/day 3) eat every 3-4hrs- counting CHOs and monitoring Glu levels

as prescribed 4) focus on adequate activity level 5) Prot goal is >15g/meal

Case discussion: Breaking barriers

Provided hands on examples Provided family with “cheat sheets”

and discussed each one. Developed a plan with the pt and

mom. On going communication with pt and

mom.

Case discussion: 1 month later

Previous Wt: 127.1 Current Wt: 124.0 (>95 %ile) Wt Change: down 3 lbs Pt is doing well with changes. He is

understanding what a carb is and where it is found. Discussed different ways to put meals together and what he could eat with freedom. Pt is able to verbalize some of the different carb amounts in food. Very pleased with progress and wt loss. Will send not to school to allow mid morning snack.

Carilion Clinic Practice:Barriers

Practice: coding, referrals. marketing Patient: education, stigma, behavior

changes Financial: copays, high deductible

• All Anthem is not the same• Out-of-state plans

Carilion Clinic Practice:Making It Work

Staff education Communication! Working with Anthem / Medicaid

guidelines to craft appropriate follow-up plans

Individualization of guidelines, recommendations

NCQA PCMH certification