BadgerCare Plus Initiatives to Reduce Childhood Obesity Rates Milda Aksamitauskas, MPP Policy Analyst Division of Health Care Access and Accountability Department of Health Services July 24, 2008

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C grade for Wisconsin Approximately 174,000 of 593,000 Wisconsin children ages 10-17 years (29.4%) are considered overweight or obese according to BMI-for-age standards. More than half (54.1%) of Wisconsin children in poor families are overweight or obese. This prevalence rate is almost three times higher than the rate among children in higher-income families. http://childhealthdata.org/content/ObesityReportCards.aspx http://www.nichq.org/

Expert Committee Recommendations Primary care providers should universally assess children for obesity risk to improve early identification of elevated BMI, medical risk, and unhealthy eating and physical activity habits. BMI should be calculated and plotted at least annually, and the classification should be integrated with other information such as growth pattern, familial obesity, and medical risks to assess the child’s obesity risk. Providers can provide obesity prevention messages for most children and suggest weight control interventions for those with excess weight. http://pediatrics.aappublications.org/cgi/content/full/102/3/e29

Childhood Obesity Measure BMI = [weight (pounds) / height (inches)2 ] x 703 BMI-for-age is calculated using percentiles of BMI that are appropriate for age and gender < 5%ile Underweight 5-84%ile Healthy Weight 85-94%ile Overweight >95%ile Obese

I. BadgerCare Plus Pay-for-Performance BadgerCare Plus is moving to use Healthcare Effectiveness Data and Information Set (HEDIS), which is a tool used by more than 90% of America's health plans to measure performance on important dimensions of care and service. children w/ BMI percentile assessment during the measurement year children who had an outpatient visit during the measurement year V85.51 Body mass index, less than 5th percentile for age (Underweight) V85.52 Body mass index, 5th percentile to less than 85th percentile for age (Normal weight) V85.53 Body mass index, 85th percentile to less than 95th percentile for age (Overweight) V85.54 Body mass index, greater than or equal to 95th percentile for age (Obese)

I. BadgerCare Plus Pay-for-Performance 1) Communications plan about childhood obesity P4P initiative Outreach to providers Update Wisconsin HealthCheck form Make resources available to providers Survey primary care providers 2) Data sharing between WIC and HMOs 3) Work with budget and rate setting staff to determine the fee-for-service rate increase for reporting V85 codes 4) Explore expansion of covered codes for treatment of obesity (i.e., nutrition counseling by dietitians)

II. BadgerCare Plus Individual Healthy Living Incentives Pilot projects testing if individual incentives are effective Request for Applications – Spring’08 3 out 6 awardees chose to focus on childhood obesity Evaluations will be done in 2010

III. DHS Budget Proposal Rewarding Nutrition in FoodShare Cost and convenience are major factors that influence food choice for low-income individuals Reward households that buy fruits and vegetables by increasing their FoodShare benefits The program would provide a strong incentive to spend more money on fruits and vegetables to get more money on the FoodShare card As food prices continue to increase, the rewards program would help many low-income households to purchase nutrition-rich food at more affordable price.