Pediatric Obesity Treatment and Reimbursement in Primary Care

Primary care providers have struggled to find a cost-effective clinically-based pathway to treat pediatric obesity and cardiovascular risk. Providers cite lack of reimbursement for obesity-related services as one reason that precludes their ability to effectively treat obesity. With the implementation of the Affordable Care Act (ACA) insurance companies and Medicaid should cover services provided for obesity treatment, including nutrition and exercise counseling. The purpose of this project was to determine the feasibility of implementing the Intensive Lifestyle Intervention Program (ILIP) in a primary care practice setting. The ILIP has been developed to treat obese and overweight patients 8 to18 years of age. Objectives of this project included:  Identification of potential participants through biometric risk screening measures and recruitment for participation in the pilot program.  Maintaining subjects' participation over the duration of the program.  Demonstrating cost-effective reimbursement for obesity management in primary care.  Evaluating the appropriateness of using the selected biometric measures as a benchmark for the program's success in reducing cardiovascular risk factors associated with obesity. This program would be feasible to implement in the primary care setting. This project shows an improvement in reimbursement of obesity treatment related services since the implementation of the ACA. The individual components of the ILIP program have been proven successful in other studies, however there was insufficient data in this retrospective study to determine statistical significance in the effectiveness of the ILIP program in improving biometric measures such as BMI, weight and HbA1c. The treatment of pediatric obesity is a challenging problem in the American health care system due to the lack of adequate reimbursement for provider services. This program provides pediatric primary care providers a cost-effective clinical pathway that is appropriately reimbursed by third-party payers.