Highmark’s Obesity Benefits and Provider Outreach

1. Highmark’sObesity Benefits and Provider Outreach A comprehensive approach to a national epidemic. Mary Goessler, MD Medical Director Janice Raffa, RN Clinical Outcomes Consultant

2. Introduction • Leading health experts tell us that we are in danger of raising the first generation of American children who will live sicker and die younger than the generation before them. • Health habits children develop at a young age will continue with them through adulthood. • In Pennsylvania, 39% of children are obese.

3. First Steps • Highmark takes the lead to bring together the Childhood Obesity Regional Strategy Committee (CORC) • Members of CORC include: pediatricians, Children’s Hospital of Pittsburgh, Allegheny County Health Department, Highmark medical directors, Pennsylvania Advocates for Nutrition and Activity (PANA) and the Highmark Foundation. • CORC identifies need for professional and community education/awareness programs.

4. Professional Development Summit 2006: • Attended by 350 physicians, teachers, nutritionists to identify issues, opportunities and solutions. • Recognition that it would take a broad based team to implement effective strategies and there would be no quick fix. BOUNCE 2006: • Held at same site as Professional Summit, attended by 7000 families. • Sponsored by 60 community organizations in addition to Highmark. • Goal: to raise awareness and engage families to believe that in working together they could impact the problem.

5. Issues Identified thru “Summit and Bounce Programs” • Poor understanding by physicians and families of how to effectively identify “at risk” children. • Sensitivity of raising the issue of weight issues. • Lack of awareness of the scope of the problem. • Lack of effective means for sustainable lifestyle change(s) to impact the problem. • Sedentary American lifestyle issues “screen time.” • Lack of activity opportunities • Difficulty of creating healthy meals and family time

6. ACTIONS Nutritional group counseling services 10 free sessions provided to members at no charge; mostly at YMCA sites. Highmark’s Obesity Toolkit • BMI wheel • BMI charts for children (male and female) • Information on: scope/magnitude of the problem, strategies for engaging the parents and children, nutritional guidelines, activity recommendations and suggested follow up/treatment • Posters to highlight misperceptions of normal build children as truly being overweight • American Academy of Pediatrics (AAP) policy statements on managing obesity. • Web based as well as community resources.

7. Obesity Benefit Added to Pediatric Preventive Health Benefits • Effective January 2006 • Goal to encourage early identification and intervention for childhood weight problems. • Recognition that effective counseling and engagement of members requires additional provider time. • Obese children may have additional issues which could be identified by screening lab tests for diabetes, lipid problems etc..

8. Body Mass Index (BMI) greater than 85% but less than 95%: • Two additional preventive health visits specifically for obesity management and blood pressure measurement. • Two annual individual nutritional counseling visits specifically for obesity. Body Mass Index (BMI) greater than 95%: • Two additional preventive health visits specifically for obesity management and blood pressure measurement. • Two annual individual nutritional counseling visits specifically for obesity. • One set of the recommended laboratory studies: lipid profile, aspartate aminotransferase (AST), alanine aminotransferase (ALT), hemoglobin A1C, and fasting glucose.

9. Highmark Foundation Actions to Create Community Initiatives • Kidshape program developed at four pilot locations in Pittsburgh 2003. • PANA (Pennsylvania Advocates for Nutrition and Activity) grant awarded. • Healthy High Five • A five year, $100 million children’s health promotion initiative. • Targeting children 6 to 18 to promote lifelong, healthy behaviors to help them grow physically, mentally and emotionally. • Healthy High 5 Components: Activity, Nutrition, Self Esteem, Bullying and Grieving

10. Results/Learning's • Providers overwhelmingly supportive of toolkit. • BMI wheels and charts filled a critical gap in identifying high risk patients. • Resource gaps were identified. • Nutrition counseling identified as hard to locate service. • Increasing child/family activity levels difficult. • Achieving member engagement presented an additional challenges. • There are no “quick fixes.” • This project will require time, patience and a team approach.

11. Results continued • 3000 toolkits distributed • Provider response overwhelmingly positive; valuable feedback provided. • Demand for group nutrition counseling increased significantly resulting in additional sites being added. • Baseline BMI data gathered 2007 for SCHIP population (an especially vulnerable group for a variety of reasons). • Plan is to track SCHIP BMI data annually.

12. Next Steps Toolkit Revision: • Needed because of updated treatment guidelines. • Readiness for change tools identified as important drivers for treatment success • Hypertension is an often unrecognized complication of obesity; normal blood pressure varies by age and sex. • Recognition of team approach/ support success. • Coding education key to track use of benefit.

13. Toolkit Revision Continued • 5210 pneumonic (AAP) 5 Eat 5 fruits and vegetable per day 2 Limit screen time to 2 hrs per day 1 Get one or more hours of moderate physical activity every day and vigorous activity 20 min per day 3 times per week 0 Drink no sugared drinks; instead drink water or low fat milk • 15 minute obesity prevention protocol

14. Measure Effectiveness Continued • American Academy of Pediatrics publishes Guideline for lipid disorder treatment • Enrollment increases as does demand for Kidshape programs resulting in program expansion • Multiple initiatives developed to increment physician and member awareness of significance of problem and available resources and benefits • Healthy High Five initiatives to increase activity in schools very well received

15. Obesity is a societal problem in the US due to a lifestyle that reduces the opportunities for vigorous physical activity at all ages. Sedentary jobs, increased computer and television screen time and fewer family meals with healthy choices are just some of the issues. Impacting a child’s lifestyle will impact the family lifestyle creating benefits across generations.