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Blues' Weight-Loss Program May Be Blueprint for MC Industry

MANAGED CARE November 2004. © MediMedia USA
News and Commentary

Blues' Weight-Loss Program May Be Blueprint for MC Industry

MANAGED CARE November 2004. ©MediMedia USA

A health plan can never do enough to assuage critics of the managed care industry. Case in point: Blue Cross and Blue Shield of North Carolina. Last month the 3-million-member insurer unveiled what's been called the most comprehensive obesity-fighting benefit in coverage history. But just as soon as the effort was announced, complaints were leveled that the money being used should go to premium reduction instead.

Last year, BCBSNC drew fire after the not-for-profit organization recorded $193.3 million in net income. Some suggest that the obesity program, called Healthy Lifestyle Choices, is a way the insurer can get rid of excess profit.

"I have to question — when they are doing these things when no one else, like a Cigna or United is — if they are doing them to hold down their level of profitability," David Garbrick, a benefits consultant, tells the News & Observer of Raleigh, N.C.

But the Oct. 12 article goes on to note that net income for BCBSNC has actually been falling compared to last year and that the company increased premium rates for its most popular product, Blue Advantage, by 7 percent this year. That's the lowest increase in the Blue Advantage's history and the News & Observer points out that "there is no evidence that Blue Cross members are paying higher prices than they'd pay elsewhere for the same coverage."

With 55 percent of its members obese or overweight and accounting for about $83.1 million in excess costs a year, even some of Blue Cross's sharpest critics agree that Blue Cross's programs are worthy.

Calling Healthy Lifestyle Choices worthy perhaps doesn't do it justice. The program includes:

  • Coverage for four physician office visits a year and related testing for the evaluation and treatment of obesity, to begin April 1, 2005.
  • Coverage of two FDA-approved prescription weight-loss medications — Meridia and Xenical — when medically necessary, to begin Oct. 1, 2005.
  • Credentialing and contracting with licensed registered dieticians starting in the second quarter of 2005 to include their services in obesity treatment, starting Oct. 1, 2005.
  • Identification of 12 physicians in seven practices in North Carolina who have shown excellence in performing bariatric surgery. The health plan will continue to pay for the stomach surgery for members it deems to be eligible.

"Our doctors have told us they want to have conversations with their patients about how excess weight can lead to serious health problems, but they need our support — and to be paid for their time," says Bob Greczyn, president and CEO of BCBSNC. "We're making significant changes in how we do business. We're going to pay for some preventive care that historically hasn't been covered by insurance. We want to walk the walk on our obesity epidemic."

Perhaps the skeptical review of Healthy Lifestyle Choices in the News & Observer had to do with a "home-town" newspaper taking a parochial view of a story. The Washington Post reported on the efforts by BCBSNC the next day with nary a word about just what the health plan might "really" be up to.

However, the Post did mention what other insurers might have to soon be up to — namely, playing catch-up with BCBSNC.

The newspaper noted that the North Carolina plan's program is the first significant expansion of obesity coverage since Medicare annnounced last summer that it would now accept obesity as an illness.