Program helps members lose weight and stay fit

Goal to prevent and minimize chronic conditions

Based on the success of a weight management program targeted at already obese employees of a major Northwest corporation, Premera Blue Cross is offering a five-tier weight management program to eligible employer groups who want to help their employees lose weight or stay fit.

In 2004, the Mountlake Terrace, WA, health plan brought together an internal comprehensive obesity strategy team to address overweight and obesity issues in general and to develop strategies and implement programs for other employers.

The five-tier program the team developed ranges from basic tools and incentives to a comprehensive obesity benefit with nutritional, behavioral, medical, and surgical interventions.

The aim is to slow the trend of members into disease management programs by helping them avoid potential chronic conditions that are caused or exacerbated by obesity.

"Obesity can have a significant impact on the health of people with diabetes, congestive heart failure, coronary artery disease, and other conditions. We know that if people lose weight, they may be able to reduce medication they take for blood pressure, cholesterol management or diabetes," says Premera's director of quality, Shelly Smith, RN, MN, CPHQ.

The team started by identifying programs that already are part of the standards benefit package and are available at no additional cost to the employer.

"These benefits have been available, but they haven't been used much. We decided to promote them so that people who are already healthy would know that they could access information and benefits that will help them remain healthy," she says.

Programs included in Tier 1, the basic benefit, include a basic on-line health assessment tool; information about fitness, weight loss, and health issues through AHealthyAdvantage, an award-winning on-line health education resource; and discounts for weight loss programs and health club benefits.

"We started out by identifying programs that we weren't promoting but that could motivate people to lose weight. These programs are for people who want to take better care of themselves or who need to lose a few pounds," Smith says.

Tier 2 adds a health management benefit, which provides coverage for community wellness classes, such as smoking cessation and weight management.

Members eligible for Tiers 3 and 4 are identified through a comprehensive health risk assessment administered by Summex Health Management, an Indianapolis-based wellness management company.

The majority of employers choose the package that provides coaching for the 40% to 55% of employees who are identified as having the highest risk factors.

The program helps employers identify incentives that will help their employees reach their fitness and weight loss goals. Incentives may be cash, tuition credit or discounts on other benefit package components such as life insurance, disability insurance or medical coverage.

Members who are eligible for the program are mailed a letter offering them the services, as well as educational material on weight loss and fitness.

A health coach helps the members enrolled in the program identify what they are ready to change and what they want to work on first.

They call members at regular intervals, typically once a quarter, and are available to the member by telephone.

The health coach helps the members develop goals and choose steps and actions to take. For instance, the member may decide to walk three times a week or keep a journal and document everything he or she eats for a week, with the long-term goal of losing 10 pounds.

Tier 4 targets members with a body mass index more than 30 and provides a more intensive level of management. The program provides a specialized assessment tool, followed by education and coaching.

The health coach contacts these members between 12 and 20 times a year and focuses only on obesity management, providing personal feedback and guidance to support their specific goals.

"At this level, we ask the members to document their goals in writing and to sign them. It includes a lot of education about what the member is eating and why," Smith says.

For instance, a participant may report being hungry after work and stopping by McDonald's for a snack before dinner. The health coach would work with the participant to keep snack crackers in the car to stave off hunger instead of stopping for a fast-food snack.

"The health coaches are looking for very specific behaviors. There is more frequent contact, more intensive goal setting, and more coaching around lifestyle changes," she says.

The health plan encourages members and employers to focus on Tiers 3 and 4 first, Smith says.

Tier 5 is a medical and surgical obesity benefit that can be customized to fit the needs of an employer's population.

The program provides physician-directed obesity and weight management, including medical visits, nutritional counseling, behavioral counseling, and other medical interventions, along with bariatric surgery benefits.

It's too soon for any definitive outcomes information for the program that Premera offers to all its employer groups, but the weight loss and corresponding improvement in health of participants are likely to be significant, Smith says.

"With our aging population, the potential for making a difference in disease management services is tremendous. When people lose weight, it can make a huge difference in their life."