1. Assessing Weight Through Documentation of Body Mass Index (BMI) in Health Plan Populations Sarah Sampsel, MPH Research Scientist June 2008

2. 2 Academy Health June 2008 NCQA: Committed to Measurement, Transparency, Accountability Quality measurement means: Use of objective measures based on evidence Results that are comparable across organizations Impartial third-party evaluation and audit Public Reporting NCQA’s quality programs include: Accreditation of health plans using performance data HEDIS clinical measures CAHPS consumer survey Measurement of quality in provider groups Physician Recognition

3. 3 Academy Health June 2008 Research Objective Explore the validity and feasibility of a performance measure assessing percentage of adult health plan members with documentation of BMI in a medical record over a 2-year period.

4. 4 Academy Health June 2008Importance Nearly two thirds of US adults are overweight (BMI  25), and over 30% are obese (BMI  30). Nearly 18% of American children are overweight or obese (BMI > 95 th percentile for age and gender). Increased deaths per year due to poor diet/inactivity.

5. 5 Academy Health June 2008 NIH Obesity Treatment Algorithm Performance measurement opportunities

6. 6 Academy Health June 2008 NIH Obesity Treatment Algorithm Performance measurement #1: BMI capture

7. 7 Academy Health June 2008 BMI Assessment Measure Description: –The percentage of members 18 – 74 years of age who had an outpatient office visit and who had their body mass index (BMI) documented in the measurement year or year prior. Commercial, Medicaid and Medicare product lines Constructed as a hybrid measure –ICD-9 codes exist for BMI Assessment, however, rarely used

8. 8 Academy Health June 2008 Field-Test Data Characteristics Number of Records Submitted by Plans Plan/ProductAdmin Records Medical Records Percent EMR A9,575150100% B196,63133018.5% C337,28712450.8% Commercial502,56334546.4% Medicaid3,43454100% Medicare37,49620529.7% Total543,493604-

9. 9 Academy Health June 2008 Member Demographics GenderAges

10. 10 Academy Health June 2008 Office Visit Characteristics Commercial Plans Medicaid Plans Medicare Plans 86% of health plan members had at least one outpatient visit in 2005 or 2006 (Commercial = 85.4%; Medicaid = 84.4%; Medicare = 94.5%

11. 11 Academy Health June 2008 Plan Performance Prevalence of BMI documentation –Ages 18-74 years –Outpatient visit in either 2005 or 2006 A*BCTotal BMI Documented (n)982410132 Office Visit in 2005 or 2006 (n) 10513393431 % with BMI documented93.310.310.830.6 CommercialMedicaid*Medicare BMI Documented (n)803418 Office Visit in 2005 or 2006 (n) 3083786 % with BMI documented25.991.920.9 *Plan A – submitted utilizing EMR, all Medicaid

12. 12 Academy Health June 2008 BMI vs. Height/Weight Documentation # Medical Records Eligible members with BMI doc. Eligible members with both height and weight Eligible members with either BMI or both height and weight BMI (n)% MRBoth% MREither% MR A15011274.711476.011476.0 B330329.713741.513942.1 C124129.75947.66048.4 Commercial3456518.811031.911132.2 Medicaid543972.24074.14074.1 Medicare205209.82311.22311.2 Total60512420.517328.617428.8

13. 13 Academy Health June 2008 Conclusions Significant potential for improvement in tracking and monitoring BMI in adults – Use of EMR impacts rates… Holding health plans accountable for working with clinicians to measure and document BMI is only the first stop in combating obesity

14. 14 Academy Health June 2008 When will there be national level data? Awaiting final NCQA BOD approval Publication in HEDIS Volume 2 – July 2008 Plan reporting (measurement year 2009) – July 2009 1 st year measure results (aggregate) – September 2009 Determination of public reporting status for HEDIS 2010 – September 2009

15. 15 Academy Health June 2008 Acknowledgements Special thanks to NCQA staff who participated on this project team: – Dana Rey, MPH – Greg Pawlson, MD – Sarah Hudson Scholle, MPH, DrPH – Rich Mierzejewski

16. 16 Academy Health June 2008 Adult Obesity MAP David Arterburn, MD, MPH Center for Health Studies, Group Health Cooperative Lawrence Blonde, MD, FACP, FACE Ochsner Clinic David Brumley, MD Blue Cross Blue Shield of Massachusetts Marc Cornier, MD University of Colorado Health Sciences Center Morgan Downey, JD The Obesity Society (NAASO) Len Fromer, MD, FAAFP UCLA School of Medicine LuAnn Heinen, MPP National Business Group on Health Trina Histon, PhD Kaiser Permanente, Weight Management Institute Michael Jenson, MD Mayo Clinic Richard Kahn, PhD American Diabetes Association Jaan Sidorov, MD, MHSA Independent Consultant Thomas Stellato, MD University Hospitals of Cleveland Thomas Wadden, PhD University of Pennsylvania School of Medicine, Center for Weight and Eating Disorders Peter Wald, MD, MPH USAA