HMO offers Weight Watchers to West Virginia Medicaid enrollees

The effort dovetails with the state's Medicaid redesign pilot, which asks beneficiaries to make healthy choices or get fewer benefits.

By Doug Trapp — Posted Feb. 19, 2007

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West Virginia physicians can recommend a new tool to help their overweight Medicaid patients battle against the bulge. UniCare, one of the state's two Medicaid HMOs, recently began offering free 16-week Weight Watchers courses to the heaviest of its 76,000 members.

In a state where 64% of adults are obese or overweight -- the third-highest rate in the nation --the program is hoped to prevent diabetes, heart disease, stroke and other weight-related illnesses, according to Shannon Riley, spokeswoman for the West Virginia Bureau of Medical Services.

"We have a huge degree of obesity-related illness," she said.

The state's Medicaid program serves more than 300,000 people and is not facing additional costs for the Weight Watchers offer. UniCare began and is managing the initiative, but it meshes with the goals of West Virginia's redesigned Medicaid program, Riley said.

Adult UniCare members are eligible for the classes if they have a body mass index of 25 or greater. Children ages 10 to 17 are also eligible if they have a BMI in the 85th percentile or above. Potential participants need a physician referral.

It isn't clear how many of its West Virginia members qualify for the program because UniCare doesn't keep statistics on enrollees' weight, said John Monahan, president for state-sponsored business for WellPoint Inc., UniCare's parent company. WellPoint serves more than 1.8 million enrollees in Medicaid or other state-subsidized programs in 14 states.

"If we're successful here, we'll be looking at rolling out either Weight Watchers or a similar program in the states where we do business for Medicaid," he said.

Healthy choices

Weight Watchers members attend weekly meetings of less than an hour. Sessions include a confidential weigh-in. Participants choose to use a program assigning points to foods or another which focuses only on eating wholesome, nutritious foods.

"The majority benefit for our company is the fact that we get the opportunity to help people who normally would not be served by Weight Watchers," said Millie Snyder, CEO of Weight Watchers in West Virginia.

American Medical Association policy recognizes obesity in children and adults as a major health problem, supports physicians using available community resources to help overweight patients, and encourages physicians to use BMI in routine physical exams.

Obesity is a difficult issue for physicians, said Tom Bowden, DO, an internist with Charleston Internal Medicine. Counseling is very useful, but it's difficult for physicians to find the time to do it.

Weight Watchers has been found to have some effectiveness fighting obesity, according to studies, he said.

He cautioned, however, that offering it for free might lead people to value the program less than if there were a co-payment.

West Virginia isn't the first state to try such a program. TennCare began offering low-cost Weight Watchers classes to its Medicaid enrollees on Jan. 1, 2006. More than 1,400 took advantage of the opportunity in its first six months and lost a total of more than 8,000 pounds, said TennCare spokeswoman Marilyn Wilson.

The UniCare/Weight Watchers partnership fits in with the state's redesign of its Medicaid program into Mountain Health Choices, Riley said.

West Virginia is one of the first states to begin to revamp its Medicaid program under flexibility granted by the federal government in the Deficit Reduction Act of 2005. Mountain Health Choices will begin in three pilot counties on April 1. The state will learn from those counties how the new program is best managed before expanding it, Riley said.

It's no coincidence that "choices" is part of the program's name. It offers enhanced benefits to those who pick a medical home within 30 days of enrolling, follow physician directions, and visit a primary care doctor at least once a year. Physicians could, after collaborating with patients on a treatment plan, refer them to classes to manage weight or stop smoking.

Enrollees could be moved into a basic benefits package if they consistently fail to follow their treatment plan. Contrary to common misperceptions, physicians will not have to report their patients' behavior, Riley said. The state will track them.

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External links

West Virginia's Medicaid program, "Mountain Health Choices" (link)

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