Designing Insurance to Promote Use of Childhood Obesity Prevention Services

Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage. 1. Background The secular rise in obesity among American youth has been well documented. Among children and adolescents aged 2 to 19 years, 16.9% have a body mass index (BMI) for age at or above the 95th percentile and 31.7% have a BMI percentile at or above the 85th percentile [1, 2]. An estimated 60% of overweight 5- to 10-year-olds already have a cardiovascular disease risk factor or hyperinsulinemia and more than 20% have two or more risk factors [3, 4]. The impetus to address rising obesity rates is driven also by the trajectory of health care costs [5–7]. By recent estimates, the annual burden of obesity has risen to almost 10% of health care spending, amounting to $147 billion in 2008 [8]. With frequent access and opportunities to engage families, a 2005 Institute of Medicine (IOM) report concluded that physicians, nurses, dietitians, and other clinicians are in a key position to influence children and their parents to adopt healthy lifestyles [9–12]. Despite these recommendations, a national population-based survey found that obesity was diagnosed at only 18% of well-child visits for children with known obesity, and diet and activity counseling was documented for only 51% of known obese children [13]. One barrier is that few health insurance plans have covered the costs of obesity prevention or treatment, leaving providers with a disincentive to offer the services and families facing