Posted 2/4/2013

Headlines

  • Obesity Community Responds to Proposed Regulations on Multi-State Plans & Employer Wellness Programs
  • Obesity Community Submits Candidates for PCORI Advisory Panels

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Editor: Christopher Gallagher, Director of ASMBS Washington Office February, 2013


Obesity Community Comments on Multi-State Plan Regulations

On January 4, 2013, the leading groups from the obesity community (ASMBS, ASBP, AND, OAC and TOS) submitted a joint comment letter regarding the Office of Personnel Management’s (OPM) December 5, 2012 proposed regulations on “Establishment of Multi-State Plan Program for Affordable Insurance Exchanges.”

In the letter, the obesity community expressed support for issuers of multi-state plans to adopt one of the OPM’s designated benchmark plans (Blue Cross Blue Shield (BCBS) Standard Option, BCBS Basic Option, and Government Employees Health Association (GEHA) Standard Option), as individuals affected by obesity would have access to critical obesity treatment services, such as bariatric surgery and nutritional counseling – some of the critical treatment avenues along the obesity care continuum. The groups also cautioned that such a coverage approach would still leave major treatment gaps in the care continuum such as coverage for a robust schedule of intensive, multi-component behavioral interventions and FDA-approved obesity drugs.

Unfortunately, the proposed regulations would appear to also allow issuers to select the state’s current benchmark plan selection as the basis for the multistate health plan’s EHB package. The obesity community expressed strong concern to OPM that issuers, like many states, will choose the lowest common denominator in terms of the EHB package – thereby further isolating affected individuals from treatment.

 

Coalition of Patient/Healthcare Provider Groups Comment on HHS Proposed Regulations on Employer Wellness Incentive Programs.

On January 25, 2013, a coalition of patient and healthcare provider groups (The Rudd Center for Food Policy & Obesity, The Obesity Society, The Obesity Action Coalition, The American Society for Metabolic and Bariatric Surgery, The Academy of Nutrition and Dietetics, Mental Health America, and The American Institute for Cancer Research) submitted ajoint comment letter regarding proposed regulations governing nondiscriminatory wellness programs in group health coverage — designed to “reward” employees for meeting specific goals related to health indicators such as cholesterol, smoking cessation and weight (BMI).

The coalition urged the government to put in place clear legal protections against wellness plans penalizing employees in order to ensure that individuals affected by excess weight or obesity are not stigmatized or discriminated against because of their weight. Specifically, the groups recommended: Employer incentive programs should be structured to reward employees for engaging in healthy behaviors, such as taking steps to improve awareness of personal health indices, making measurable changes in health behaviors such as nutrition or exercise, or participating in an evidence-based weight management program.

  • Employers should avoid using BMI as a basis for financial penalties or incentives, and should not make determinations about employee health based on body size alone without consideration of additional health indices.
  • Health insurance plans should encourage wellness by covering responsible weight loss programs that use evidence-based interventions. Employers who choose to reward weight loss or penalize weight status are testifying to the fact that obesity is a significant medical condition but in so doing are acting in opposition to scientific evidence.
  • Employers should position their health initiatives as a goal to achieve overall wellness for all employees, regardless of their body weight and avoid singling out or penalizing overweight and obese employees.
  • Employers who offer incentive programs should ensure that they create a supportive workplace environment that provides opportunities for employees to be healthy and practice long-term healthy behaviors (e.g. healthy cafeteria and vending options, gym discounts, attractive stairwells).

 

Obesity Community Submits Candidates for PCORI Advisory Panels

On January 29, 2013, the Patient Centered Outcomes Research Institute (PCORI) began accepting applications for individuals who would like to serve on one of four PCORI Advisory Panels. These groups, made up of patients, caregivers, clinicians, researchers, other healthcare stakeholders and the general public, are being set up to help PCORI identify research priorities and refine their research project agenda.

At press time, the leading groups in the obesity community were developing a list of candidates to serve on each of the following PCORI Advisory Panels:

  • Advisory Panel on Addressing Disparities.
  • Advisory Panel on Assessment of Prevention, Diagnosis, and Treatment Options.
  • Advisory Panel on Improving Healthcare Systems (Draft: Pending Final Board Approval, Feb. 4, 2013).
  • Advisory Panel on Patient Engagement.

Below is the timeline for submitting an application which is march 4th.

Advisory Panel Timeline

Application Period Opens: January 29, 2013

Application Period Closes: March 4, 2013, 5pm ET

Board Approval of Advisory Panel Members: March 26, 2013

Applicants Notified of Status and Next Steps: March 27, 2013 to April 5, 2013

Advisory Panel Kickoff and Training in Washington, DC: April 19, 2013 to April 20, 2013