Penn State Hershey Medical Center Site Team

A Patient-Centered PaTH to Address Diabetes: Impact of obesity counseling

Background

Overweight and obesity are America’s number one health concern. The prevalence of obesity in the US is greater than 36%, which is far above the Healthy People 2020 objective of less than 30.5%. Perhaps most concerning is the rate that obesity has increased, having doubled since 1970.3 As the second most preventable cause of death, obesity is a risk factor for diabetes, cardiovascular disease, stroke, and cancer, all major causes of death in the US.5 Addressing obesity through lifestyle interventions decreases the risk of developing type 2 diabetes, a disease which affects over 29 million people (9.3% of the US population). Diabetes is associated with serious complications, including cardiovascular disease, blindness, renal failure and lower extremity amputation. Although complications are preventable with proper medical and lifestyle management, including weight loss, nearly half of patients with diabetes do not have adequate glycemic control.

Primary care clinics may be an ideal setting for weight control interventions. Greater than 80% of Americans see a PCP regularly and access to primary care is expected to increase with health care reform. Further, as PCPs identify and treat the multitude of conditions affected by being overweight, including diabetes, they are ideally positioned to best engage their patients in weight management. The Centers for Medicare and Medicaid Services (CMS) implemented a healthcare procedure coding system code for intensive behavioral therapy (IBT) for obesity within primary care settings in 2012 to facilitate payment for addressing obesity, which was followed by universal coverage by insurers for IBT for adults of all ages in 2013. However, the impact of this coverage on patient-centered outcomes is largely unknown.

Project Overview

The overarching goal of this proposal is to understand the comparative effectiveness of obesity counseling as covered by CMS in improving weight loss for adults either with or at high risk of type 2 diabetes. CMS and most insurers now include obesity screening and counseling benefits, with no cost sharing to patients. Since overweight patients are at highest risk for diabetes, improved weight management services could prevent diabetes and its negative health outcomes. Beneficiaries with obesity are eligible for up to 20 face-to-face visits for weight counseling in the primary care setting. We propose comparing weight and diabetes outcomes in three states using EHR and claims data before and after this policy was implemented by leveraging the novel infrastructure of the Patient-Centered Outcomes Research Institute-funded PaTH Clinical Data Research Network.

Principal Investigators

JENK

Jennifer Kraschnewski, MD, MPH

Associate Professor of Medicine,
Pediatrics and Public Health Sciences

Penn State University

Co-Investigators

Jessica Yeh.jpg

Jessica Yeh, PhD

Associate Professor of Medicine and Epidemiology
Johns Hopkins University

Lan Kong.jpg

Lan Kong, PhD

Associate Professor of Public Health Sciences
Penn State University

Cindy Bryce.jpg

Cindy Bryce, PhD

Associate Professor,
Health and Policy Management

University of Pittsburgh

Anuradha Paranjape

Anuradha Paranjape, MD, MPH

Professor and Section Chief,
General Internal Medicine

Temple University

Rachel Hess

Rachel Hess, MD, MS

Chief, Division of Health System Innovation and Research
University of Utah

Sharon Larson

Sharon Larson, PhD

Director of Behavioral Research
Geisinger Health System

Project Staff

Erica Francis
Erica Francis, MS
Project Manager
Jennifer Poger
Jennifer Poger, M.Ed.
Project Manager
Hoglen,Brianna
Brianna Hoglen, MPH
Research Coordinator

Technical Staff

bolton
Matt Bolton
BI Analyst
Lehman.jpg
Erik Lehman, MS
Biostatistics and Bioinformatics Research Support
Bari Dzomba
Bari Dzomba, MS, PhD
Assistant Professor of Public Health Sciences

Patient Co-Investigators

Treva Alston.jpg
Treva Alston
MULLY CHEA
Mully Chea
Cynthia Bradley
Cynthia Bradley
JULIA TICE
Julia Tice
angela
Angela Evans

Stakeholders

MD, MSc
Christy Boiling Turer, MD, MSc
The Obesity Society
Jennifer Carroll
Jennifer Carrol, MD, MPH
American Academy of Family Physicians
Linda Dunbar
Linda Dunbar, MD
Johns Hopkins HealthCare LLC
hughes
Lauren Hughes, MD, MPH, MSc, FAAFP
Pennsylvania Department of Health
A. Everette James
A. Everette James, III, JD, MBA
University of Pittsburgh
Kristi Pier
Kristi Pier, MHS, MCHES
Maryland Department of Health and Mental Hygiene
Stephanie Rovito
Stephanie Rovito, MPH, CHES
Pennsylvania Department of Health
Linda Siminerio
Linda Siminerio, PhD
University of Pittsburgh
GASTON
Serina Gaston

Primary Care Providers

Tiffany-Gonzalo
Tiffany Gonzalo, CRNP
Provider female default
Regina Jacob, MD
Temple University
Provider female default
Rebecca Mancoll, MD
University of Pittsburgh
Provider male default
Tom Pozefsky, MD
Johns Hopkins