Week 5 – October 27
Liz Walker – HSMP 660
Topic: Obesity Policy, Implementation, Upstream/Midstream/Downstream differentiation, Scope
Research Question for HSMP 660: What are the barriers and facilitators of integrating obesity treatment services into state health plans?
Obesity is a disease state with multiple pathophysiological aspects requiring a range of interventions.
A quick look at how the ACA has affected persons with obesity (as of January 1, 2014):
-57.8 million adults with obesity will be protected from losing coverage (citing obesity as pre-existing condition)
-No annual or lifetime caps
-External and independent review of claim appeals/denied claims
-Intensive behavioral counseling for obesity
One of the tenets of the ACA is establishing 10 Essential Health Benefits (EHB) to each state Medicaid program. Namely, “Preventive and wellness services and chronic disease management”includes obesity and obesity-related comorbid conditions. Under the Supreme Court Decision of National Federation of Business v Sebillius, the expansion has to be a voluntary decision by each state.
Medicaid is a joint federal-state health program serving low-income families with dependent children and persons with disabilities. Presently, all Medicaid programs cover at least one sort of obesity treatment modality (e.g. screening, drug therapy, counseling , etc) and 8 states cover all three recommended treatments: nutrition counseling, pharmacotherapy, bariatric surgery. Given the poor coverage of obesity treatments under current Medicaid programs, expanding the number of states which provide comprehensive obesity treatment alternatives and which adjust their reimbursement rates to make the provision of services realistic is necessary next step to assure access to safe and effective treatments of obesity and to reduce racial and socioeconomic disparities.
The question then becomes, which kinds of obesity policies and interventions are worthwhile to implement? Thus, I enter into the “Framework” aspect in my quest to produce a meaningful prospectus for this course…
Questions:
- What are the Pros and Cons to the Leeman et al. Evaluation Framework? How does it help shape the research territory? Given its “prevention” stance, can such a framework aid in policy initiatives aimed at mitigating obesity?
- Pros and Cons of the Obesity Policy Action framework? I really enjoy this framework as it provides a tiered approach when confronting obesity: upstream, midstream and downstream policies (spoiler alert: this might be the one!).
- Pros and Cons of the RE-AIM framework? This is not an obesity-specific framework, and that might potentially be a strength? Could approaching obesity through a “chronic illness management” lens be helpful in mainstreaming its treatment pathways/policy initiatives?