Essential H ealth Benefits and Obesity Treatment Coverage - PowerPoint Presentation

1. Essential Health Benefits and Obesity Treatment Coverage

2. Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decadesIn contrast, obesity prevalence has nearly tripled in the last 50 yearsOver 2/3 of Americans are overweight and obese35.7% of Americans are obeseIt is projected that 42% of the population will suffer from obesity by the year 2030It is major cause of death attributable to heart disease, cancer, and diabetes according to the Centers for Disease Control and PreventionObesity

3. National Institutes of Health (NIH) recognized obesity as a disease in 1991American Medical Association (AMA) in 2013 officially recognized obesity as a diseaseGovernmental agencies recognizing obesity as a diseaseUS Internal Revenue Service (IRS)Centers for Medicare & Medicaid Services (CMS)Other organizations supporting surgical treatment of obesityAmerican Heart Association (AHA)American College of Cardiology (ACC)American Diabetes Association (ADA)International Diabetes Federation (IDF)Obesity is a Disease

4. 2000Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010(*BMI 30, or about 30 lbs. overweight for 5’4” person)20101990No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

5. Ambulatory patient servicesEmergency servicesHospitalizationMaternity and newborn careMental health and substance abuse disorder services, including behavioral health treatmentPrescription drugsRehabilitative and habilitative services and devicesLaboratory servicesPreventive and wellness services and chronic disease managementPediatric services, including oral and vision careEssential Health Benefits

6. Each State decides whether the disease of obesity is a covered benefit within the qualifying health plans participating in the State Health Insurance Exchange27 states and Washington DC do not cover bariatric surgeryMedical treatment for obesity is a covered benefit in only 5 statesObesity Is Not Covered Under the Essential Health Benefits

7. Essential Health Benefit Benchmark Plan Coverage of Weight-Related Services CAWYMTIDNMUTAZORNVWAHIWIIAMNNESDNDCOVTMENHMARICTNYPANJMDDEWVVASCGAFLALNCTNTXOKARLAMSKSMOILOHKYINMIAK Current as of 12-10-2012; Coverage may have changed since this printing Does not cover bariatric surgery nor weight loss programsCovers weight loss programs but does not cover bariatric surgeryCovers bariatric surgery but does not cover weight loss programsCovers bariatric surgery and weight loss programsDCSource: 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.)

8. Excess weight is responsible for 2.8 million deaths worldwide annually Obesity accounts for 21% of national health spendingObesity discrimination plays an important role in lower income and production9% lower income Economics of Obesity

9. Obese individuals have 42% higher annual healthcare costs 77% higher prescription costs (as high as 105%)37% higher primary care costsObesity raises annual medical costs per obese individual by $2,741 (in 2005 dollars)Obesity increases lifetime medical costs by 50%Economics of Obesity

10. Productivity CostsObese individuals compared to healthy weight individuals have been shown to have3.73 additional days lost annually1.23 times higher absenteeism rate194% more likely to use paid time offGreater lost productive time while present at workBariatric surgery provides immediate benefit by decreasing lost work time and disabilityTreatment costs associated with bariatric surgery were relatively small compared to economic losses of not treating obesityEconomics of Obesity

11. 24 million Americans have Type 2 Diabetes41% increase in the total costs of treating diabetes was noted from 2007 to 2012$174 billion to $245 billionEconomics of Obesity and Type 2 Diabetes

12. Durable weight loss106 pound mean weight loss after 16 yearsRemission of Type-2 diabetes (83%)Reduction in mortality from diabetes by 78%Bariatric Surgery Outcomes

13. Resolution of Obesity-related Medical ProblemsHigh 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

14. Lifetime costs to medically treat a patient with Type-2 diabetes is approximately $300,000compared to approximately $25,000 for bariatric surgeryTotal health care costs Increased 9.7% in the first year after surgery, butDecreased by 34.2% and 70.5% in years 2 and 3 after surgeryLife expectancy is improved in bariatric surgery patients when compared to medically managed patientsSeveral 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 surgeryBariatric Surgery for Type-2 Diabetes

15. 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 surgeryCost savings began accruing as early as 3 months after surgeryTotal surgery costs were fully recovered after 49 months for open procedures after 25 months for laparoscopic proceduresCost Effectiveness Analysis

16. Mortality rate is 4.5% per year without surgery compared to 1% per year after surgeryOnly 1% of the eligible population is treated through bariatric surgeryAbout 25% of patients considering surgery are denied approval for surgery at least three times before obtaining approvalBy then, 60% will report worsening health problemsThree 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 surgeryCost of Human Lives

17. 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!

18. Not cost effectiveIn the long-term, surgery is less costlyPatients in your state are being denied treatment that is widely available to approximately 45% of AmericansConsider 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 productivityCancer treatments (medical and surgical)Heart surgeryDenying Bariatric Surgery

19. Obesity treatment coverage should be equitable for all Americans, including citizens who are beneficiaries covered through your State’s Health Insurance Exchange