DMAA Outlines Groundbreaking
Obesity Benefit Design Approach

WASHINGTON—DMAA: The Care Continuum Alliance today outlined new research to help guide employers, health plans and others in creating a package of benefits for the prevention and management of obesity, among the nation's top health issues.

The Value-Based Benefit Design for Obesity and Comorbidities combines the best available scientific evidence on effective obesity management strategies with pricing structures universally accepted by insurers to build a suggested approach to obesity benefit design.

"Employers and other health care purchasers recognize the severe burden obesity places on health and productivity. But often, they have only piecemeal solutions to the problem," DMAA President and CEO Tracey Moorhead said during a news conference with the Strategies to Overcome and Prevent (STOP) Obesity Alliance, of which DMAA is a member. "This groundbreaking research provides an evidence-based approach to obesity benefits development users can adopt to fit their specific needs, budget, and culture."

Moorhead described the research as an approach to benefit design, rather than a "plug and play" benefit. "It's not possible to produce one benefit that meets the needs of all populations," she said. "Our goal was to compress future benefit plan development time by laying a groundwork based on the best available scientific evidence and national practice guidelines."

The benefit is designed as a "rider"—a supplemental package of services offered at an additional premium, such as vision or dental care. It is structured in three tiers of services, based on program design needs, all supported by an underlying disease management program for obesity and related conditions. The first level of coverage would provide enhanced primary care physician services, professional nutritional counseling and obesity-specific drugs. A second tier would add specialized obesity care and the third level, surgical interventions.

Although the mix of specific services would vary by plan and service level, covered services could include primary care comprehensive evaluation, initial and follow-up visits with a registered dietitian, pharmaceuticals, clinical laboratory tests, initial and follow-up visits with exercise physiologists, bariatric surgery and post-surgical reconstructive surgery.

Eligibility for the benefit would be based on a plan member's body mass index (BMI), a measure of body fat calculated by height and weight. Also considered would be comorbid conditions, such as diabetes and metabolic syndrome. The benefit model assumes eligibility criteria include an overweight or obese BMI of 25 or higher.

To develop expected per-capita costs for the obesity benefit, DMAA, with the assistance of Milliman Inc., incorporated pricing structures universally recognized by the managed care and insurance industry to produce per member per month costs. The basic pricing elements are expected utilization per 1,000 members; unit price (based on 100 percent of the national average Medicare 2006 fee schedule); cost-sharing by plan participants; and a 75 percent loss ratio for administrative costs and profit and risk charges.

In addition to the document's monograph on the approach to benefit design, it also provides an obesity rider pricing template and a "fact book" that summarizes the high-quality research and other information on obesity and overweight that informed the approach.

To develop the Value-Based Benefit Design for Obesity and Comorbidities, DMAA and its contractor, Health and Technology Vector Inc., assembled a core team of experts in obesity management, actuarial sciences, benefits design and population health strategies. Development of the benefit also involved DMAA research committees, including its Obesity Workgroup and Obesity Steering Committee, and support from DMAA member sanofi-aventis.

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Note: Media requests for the obesity benefit documents should be directed to Carl Graziano, at cgraziano@dmaa.org. All other requests should be directed to Karen Moseley, at kmoseley@dmaa.org.

About DMAA: The Care Continuum Alliance
DMAA: The Care Continuum Alliance convenes all stakeholders providing services along the care continuum toward the goal of population health improvement. These care continuum services include strategies such as health and wellness promotion, disease management, and care coordination. DMAA: The Care Continuum Alliance promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for individuals with chronic conditions and those at risk for developing chronic conditions. DMAA's activities in support of these efforts include advocacy, research and the promotion of best practices in care management.

DMAA: The Care Continuum Alliance represents more than 200 corporate and individual stakeholders—including wellness, disease and care management organizations, pharmaceutical manufacturers and benefit managers, health information technology innovators, biotechnology innovators, employers, physicians, nurses and other health care professionals, and researchers and academicians. Visit DMAA on the Web at www.dmaa.org.