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