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Blue Cross and Blue Shield

Blues Plans Use Bariatric Surgery Centers for Obesity Disease Management

Blue Cross and Blue Shield plans increasingly are making bariatric centers of excellence a component of their disease management (DM) strategy for managing obesity. The centers typically educate patients thoroughly and often require them to diet before agreeing to the surgery in effect performing most or all the functions of a strong morbid obesity DM program, right down to data collection.

"When you go to a good bariatric program, they will on their own want to make sure you've attempted to control your weight," says Don Bradley, M.D., executive medical director for Blue Cross and Blue Shield of North Carolina, which instituted a bariatric surgery centers-of-excellence program in October 2004 as part of its overall weight-management DM strategy.

Here's a look at three Blues plans' obesity management programs:

(1) The North Carolina Blues plan: While the insurer doesn't force patients considering bariatric surgery to enroll first in its DM program, the patients who don't enroll almost always receive education about nutrition, activity and health risks comparable to that received by those in the DM program - and of course about the surgery - from the surgery practices themselves.

In October 2004, the North Carolina Blues plan launched its Centers of Excellence for Morbid Obesity Surgery program as part of its overall weight-management DM program. The insurer credentials seven bariatric surgery sites that include a total of 12 physicians, "nicely distributed across the state," says Bradley. These surgeons perform a minimum of 50 bariatric surgeries per year, he says. Members are not required to use those surgeons to be covered. The insurer doesn't require preauthorization from these physicians, and in fact pays them 30% to 50% more than what it paid before the program began.

Since the North Carolina Blues plan launched the centers-of-excellence program, plan-wide readmission rates for bariatric surgery have fallen from 17% to about 8%. Readmission rates for patients of surgeons in the program run about 4% to 4.5%, the plan says.

(2) Blue Cross and Blue Shield of Massachusetts is in the process of implementing a bariatric surgery facility privileging program, which it expects to have in place by Jan. 1, 2007. Massachusetts Blues spokesperson Susan Leahy says that 24 hospitals now perform bariatric surgery in the state, and there's no way to know yet how many will receive privileges. The insurer paid for 756 bariatric surgeries in 2002, 1,169 in 2003, 1,337 in 2004 and 1,325 in 2005, Leahy says.

Members will not be required to go through the Massachusetts Blues plan's weight-management DM program before becoming eligible for bariatric surgery, but the plan intends to provide support for surgery candidates that will include information about patient safety guidelines and about various hospitals' bariatric surgery programs, Leahy says.

(3) Horizon Blue Cross Blue Shield of New Jersey also is vetting facilities in preparation for a new bariatric surgery centers-of-excellence program designed to complement and connect to the plan's DM programs, says Sue Binder, director, health and wellness education program, quality management and clinical innovations. The program, slated to start later this year, will include three facilities.

"A lot of these people going for bariatric surgery approach the surgery with chronic conditions already," says Binder. "They have the surgery and really need to be connected to the DM program." Horizon a plan with around 1 million members now has enrolled 9,188 patients into the obesity program.

Reprinted from the March 2006 issue of The AIS Report on Blue Cross and Blue Shield Plans, a hard-hitting independent monthly newsletter on business strategies, products and markets, mergers and alliances, and financing of BC/BS plans.

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