Essential Health Benefits and Obesity Treatment Coverage

Slides:



Advertisements
Similar presentations
DC Responses Received WA OR ID MT WY CA NV UT CO AZ NM AK HI TX ND SD NE KS OK MN IA MO AR LA WI IL MI IN OH KY TN MS AL GA FL SC NC VA WV PA NY VT NH.
Advertisements

Essential Health Benefits and Obesity Treatment Coverage.
THE COMMONWEALTH FUND Millions of uninsured Source: Income, Poverty, and Health Insurance Coverage in the United States: United States Census Bureau,
Figure 1 K A I S E R C O M M I S S I O N O N Medicaid and the Uninsured Dual Eligibles: The Basics Barbara Lyons, Ph.D. Director, Kaiser Commission on.
NICS Index State Participation As of 12/31/2007 DC NE NY WI IN NH MD CA NV IL OR TN PA CT ID MT WY ND SD NM KS TX AR OK MN OH WV MSAL KY SC MO ME MA DE.
Definitions: Definitions: Obesity: Body Mass Index (BMI) of 30 or higher. Obesity: Body Mass Index (BMI) of 30 or higher. Body Mass Index (BMI): A measure.
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
Essential Health Benefits Benchmark Plan Selection, as of October 2012
Medicaid Eligibility for Working Parents by Income, January 2013
House Price
WA OR ID MT ND WY NV 23% CA UT AZ NM 28% KS NE MN MO WI TX 31% IA IL
Who does Medicaid cover? How are Medicaid funds spent?
House price index for AK
Exhibit 1. The Number of Uninsured Declined to 40
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
Children's Eligibility for Medicaid/CHIP by Income, January 2013
Medicaid Income Eligibility Levels for Other Adults, January 2017
NJ WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NH NV
The State of the States Cindy Mann Center for Children and Families
Comprehensive Medicaid Managed Care Models in the States, 2014
Expansion states with Republican governors outnumber expansion states with Democratic governors, May 2018 WY WI WV◊ WA VA^ VT UT TX TN SD SC RI PA OR OK.
Expansion states with Republican governors outnumber expansion states with Democratic governors, January WY WI WV◊ WA VA VT UT TX TN SD SC RI PA.
Share of Births Covered by Medicaid, 2006
Non-Citizen Population, by State, 2011
Status of State Medicaid Expansion Decisions
Share of Women Ages 18 – 64 Who Are Uninsured, by State,
Coverage of Low-Income Adults by Scope of Coverage, January 2013
Who does Medicaid cover? How are Medicaid funds spent?
WY WI WV WA VA* VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WY WI WV WA VA VT UT TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Current Status of the Medicaid Expansion Decision, as of May 30, 2013
IAH CONVERSION: ELIGIBLE BENEFICIARIES BY STATE
WAHBE Brokers / QHPs across the country as of
State Health Insurance Marketplace Types, 2015
State Health Insurance Marketplace Types, 2018
HHGM CASE WEIGHTS Early/Late Mix (Weighted Average)
Status of State Medicaid Expansion Decisions
Status of State Participation in Medicaid Expansion, as of March 2014
Status of State Medicaid Expansion Decisions
Current Status of State Medicaid Expansion Decisions
Medicaid Income Eligibility Levels for Parents, January 2017
Current Status of State Medicaid Expansion Decisions
State Health Insurance Marketplace Types, 2017
S Co-Sponsors by State – May 23, 2014
The US is facing an unprecedented opioid epidemic, which has resulted in increases health care services utilization and a surge in overdose deaths. Medicaid.
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Seventeen States Had Higher Uninsured Rates Than the National Average in 2013; Of Those, 11 Have Yet to Expand Eligibility for Medicaid AK NH WA VT ME.
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Cathy Schoen Senior Vice President The Commonwealth Fund
Average annual growth rate
Market Share of Two Largest Health Plans, by State, 2006
Percent of Children Ages 0–17 Uninsured by State
Current Status of State Medicaid Expansion Decisions
Current Status of State Medicaid Expansion Decisions
How State Policies Limiting Abortion Coverage Changed Over Time
Premiums for Family Coverage, by State, 2011
Status of State Medicaid Expansion Decisions
Employer Premiums as Percentage of Median Household Income for Under-65 Population, 2003 and percent of under-65 population live where premiums.
Percent of Adults Ages 18–64 Uninsured by State
Status of State Medicaid Expansion Decisions
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
WY WI WV WA VA VT UT* TX TN SD SC RI PA OR* OK OH ND NC NY NM* NJ NH
Current Status of State Individual Marketplace and Medicaid Expansion Decisions, as of September 30, 2013 WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK.
Status of State Medicaid Expansion Decisions
Income Eligibility Levels for Children in Medicaid/CHIP, January 2017
WY WI WV WA VA VT UT TX TN SD SC RI PA OR OK OH ND NC NY NM NJ NH NV
Presentation transcript:

Essential Health Benefits and Obesity Treatment Coverage

Obesity Life expectancy, smoking prevalence and use of drugs and alcohol have improved over the last three decades In contrast, obesity prevalence has nearly tripled in the last 50 years Over 2/3 of Americans are overweight and obese 35.7% of Americans are obese It is projected that 42% of the population will suffer from obesity by the year 2030 It is major cause of death attributable to heart disease, cancer, and diabetes according to the Centers for Disease Control and Prevention

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

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

Essential Health Benefits Ambulatory patient services Prescription drugs Rehabilitative and habilitative services and devices Emergency services Hospitalization Laboratory services Maternity and newborn care Preventive and wellness services and chronic disease management Mental health and substance abuse disorder services, including behavioral health treatment Pediatric services, including oral and vision care

Obesity Is Not Covered Under the Essential Health Benefits Each State decides whether the disease of obesity is a covered benefit within the qualifying health plans participating in the State Health Insurance Exchange 27 states and Washington DC do not cover bariatric surgery Medical treatment for obesity is a covered benefit in only 5 states

Essential Health Benefit Benchmark Plan Coverage of Weight-Related Services AK WA MT ME ND MN OR NH ID WI NY VT SD MI MA WY RI PA CT IA NE OH NJ NV IN IL UT WV DE CO VA KS MO KY MD CA NC TN DC OK AR SC AZ NM AL GA MS TX LA HI FL Does not cover bariatric surgery nor weight loss programs Covers weight loss programs but does not cover bariatric surgery Covers bariatric surgery but does not cover weight loss programs Source: 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.) Covers bariatric surgery and weight loss programs Current as of 12-10-2012; Coverage may have changed since this printing

Economics of Obesity Excess weight is responsible for 2.8 million deaths worldwide annually Obesity accounts for 21% of national health spending Obesity discrimination plays an important role in lower income and production 9% lower income

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

Economics of Obesity Productivity Costs Obese individuals compared to healthy weight individuals have been shown to have 3.73 additional days lost annually 1.23 times higher absenteeism rate 194% more likely to use paid time off Greater lost productive time while present at work Bariatric surgery provides immediate benefit by decreasing lost work time and disability Treatment costs associated with bariatric surgery were relatively small compared to economic losses of not treating obesity

Economics of Obesity and Type 2 Diabetes 24 million Americans have Type 2 Diabetes 41% increase in the total costs of treating diabetes was noted from 2007 to 2012 $174 billion to $245 billion

Bariatric Surgery Outcomes Durable weight loss 106 pound mean weight loss after 16 years Remission of Type-2 diabetes (83%) Reduction in mortality from diabetes by 78%

Bariatric Surgery Outcomes Resolution of Obesity-related Medical Problems High 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 for Type-2 Diabetes Lifetime costs to medically treat a patient with Type-2 diabetes is approximately $300,000 compared to approximately $25,000 for bariatric surgery Total health care costs Increased 9.7% in the first year after surgery, but Decreased by 34.2% and 70.5% in years 2 and 3 after surgery Life expectancy is improved in bariatric surgery patients when compared to medically managed patients Several 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 surgery

Cost Effectiveness Analysis 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 surgery Cost savings began accruing as early as 3 months after surgery Total surgery costs were fully recovered after 49 months for open procedures after 25 months for laparoscopic procedures

Cost of Human Lives Mortality rate is 4.5% per year without surgery compared to 1% per year after surgery Only 1% of the eligible population is treated through bariatric surgery About 25% of patients considering surgery are denied approval for surgery at least three times before obtaining approval By then, 60% will report worsening health problems Three 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 surgery

Bariatric Surgery is SAFE! In-Hospital mortality rate for bariatric surgery is now 0.1 % Gallbladder surgery mortality 0.52 % Hip replacement surgery mortality 0.93%

Denying Bariatric Surgery Not cost effective In the long-term, surgery is less costly Patients in your state are being denied treatment that is widely available to approximately 45% of Americans Consider 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 productivity Cancer treatments (medical and surgical) Heart surgery

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