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

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

3. Alliance Programs

4. 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.  

5. Building from the Evidence Base Alliance Healthier Generation Benefit is the place where these new best practices have real-world application.

6. Healthier Generation Benefit: Supporting Organizations

7. Healthier Generation Benefit Signatories

9. Evaluation of Healthier Generation Benefit Progress Kimberly J. Rask, MD, PhD Julie A. Gazmararian, PhD, MPH Susan Kohler, RN, MPH Jonathan Hawley Rollins School of Public Health Emory University April 2013

10. 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

11. 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

12. Use of the Benefit Challenges 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

13. Percentage of Covered Children with an Overweight or Obesity Diagnosis This signatory allows providers to use the broadest range of available diagnosis codes. • 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%.

14. Number of Overweight /Obese Children with at least One Preventive Visit This signatory dropped co-pays for use of the benefit. • 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% . Signatory reviewing data to better understand why so low.

15. Recommendations going forward Build upon the current successes… • 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. • Evaluate pilot strategies to increase use of obesity services and monitor utilization to identify best practices. • Continue collaborative efforts with professional organizations to offer and disseminate resources for health care providers and families.

16. AAP/ Academy/ Alliance Resources

17. 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

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

19. 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.cfm • KIDS Eat Right - public website at kidseatright.org

20. www.eatright.org/alliance • Link to: • Academy Guidelines • Academy Positions • Care Coordination documents • HGB Benefit Details

21. 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

22. Local Perspective: RDs • 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 22

23. Obesity Related Resources Weight of the State, April 2013 PREVENTION. TREATMENT. RESULTS.

24. Pediatric e-Practice: Optimizing Your Obesity Care www.pep.aap.org INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

25. Sample Room: Exam Room INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

26. Sample of resources accessible via PeP

27. Healthy Active Living for Families www.healthychildren.org/growinghealthy INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

28. HALF Implementation Guide Evidence Parent Feedback Opportunities for Care Conversation Starters Related Parent Resources www.aap.org/HALFIG INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

29. HALF Implementation Guide INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

30. HALF APP COMING SUMMER 2013! INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

31. Other sample resources: INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

32. www.aap.org/obesity INSTITUTE FOR HEALTHY CHILDHOOD WEIGHT

33. 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

34. Weight of the State Alliance for a Healthier Generation Rhonda Keith, M.S. COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. What’s Next? Expansion of Program • CA Pilot - began April 2012 • WI Pilot - start date TBD • VA Pilot – increase participating practices Evaluation Anthem 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

43. Contact • Rhonda D. Keith • Community Collaboration Manager • Patient Centered Care Programs • Anthem Blue Cross Blue Shield • Tel: 804.212.6952 • Email: rhonda.keith@anthem.com COMPANY CONFIDENTIAL | FOR INTERNAL USE ONLY | DO NOT COPY

44. Office Obesity ManagementCarilion Experience John E. Moore, MD Brooke Mercedes, RD, CSSD Botetourt Pediatrics Carilion Clinic Children’s Hospital

45. 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!

46. 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

47. 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

48. Where did I go? • AAP national • Virginia Chapter • Great toolkit!

49. 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

50. 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”