James Roosevelt Jr., CEO, Tufts Health Plan, said “34% of adults in America are overweight and an additional 32% are obese. Obesity and the number of severely obese individuals in our country cost the U.S. economy in excess of $100 billion annually and results in 400,000 deaths”. He made his remarks at the 5th Annual World Health Care Congress held in April in Washington D.C.
To address the obesity problem, Tufts Health Plan is providing a specialized modification program to help the members that are interested in their controversial bariatric surgery program. The health plan has identified evidenced-based criteria for the coverage of bariatric surgery, including BMI limits. For an individual to be considered for bariatric surgery, they have to complete a six month lifestyle modification program before the surgery will be done.
Roosevelt emphasized that this is very important since the patients selected have to be right for the program and the surgery has a very high complication rate. If surgeons do the surgery without the patient making changes in their behavior and lifestyle, then the surgery may be less safe.
The participants in the 6 month life style modification program have one-on-one calls with a dedicated health coach, access to web tools, communications with their primary care physician, and access to a variety of informed decision making tools. The participants must set two behavior goals that are meaningful for them, and they must complete informed decision-making modules regarding bariatric surgery options.
After the 6 month program is completed, members can opt to continue their lifestyle changes without further program intervention, or they can enroll in the program for up to an additional 12 months, or at this point, consider bariatric surgery options.
The program currently has 229 members enrolled and 119 members have graduated from the program with a combined weight loss of 997 pounds. Early results show that 17% of the people graduating from the modification program have deferred surgery and have modified their behavior. Overall there is a reduced surgical trend due to the acceptance and success of non-surgical strategies with an estimated annual cost savings resulting in more than $4 million.