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Medicaid Managed Care and Childhood Obesity Prevention: A Multi-Level Intervention Model

Nancy Wongvipat, MPHAnita Keneipp, MS

Bruce Chernof, MD, FACPPeggy Haines, RN

Health Net of CaliforniaState Health Programs

Presentation to:American Public Health Association 131st Annual Meeting, San Francisco

November 19, 2003

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Overview

Health NetOverview of Childhood ObesityWeight Management-Be In Charge!

sm Program for Children and Adolescents

Teen Body Image Pilot InterventionCommunity Partnerships

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Background (HNT)

Health Net, Inc. (HNT) is one of the nation’s largest publicly traded managed health care companies. Its mission is to help people be healthy, secure and comfortable.

5.3 million members in 15 states through group, individual, Medicare, Medicaid and TRICARE programs.

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Background (HN-CA)

Health Net of California (HN-CA), a subsidiary of Health Net, Inc., is one of the largest network-model health plans in California, serving more than 2 million members statewide.

Contracts with approximately 44,000 physicians, 400 hospitals and 4,300 pharmacies.

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HN-CA’s State Health Programs

CA Department of Health Services (DHS) and the Managed Risk Medical Insurance Board (MRMIB) for Medi-Cal (MC) and Healthy Families Program (HFP) services.

MC and HFP operations in seven (7) California counties and (44) service areas. 600,000 MC/100,000 HFP members.

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SHP’s Health Education Dept

Provides appropriate health education programs, materials, and services to its MC and HFP members based on community health, cultural, and linguistic needs.

Works closely with medical management, community relations, quality improvement and cultural and linguistics services teams.

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Prevalence of Overweight Among U.S. Children and Adolescents (Ages 6-19 Years)

45

4

67

5

11 11

15 15

0

2

4

6

8

10

12

14

16

Per

cen

t

1963-70 1971-74 1976-80 1988-94 1999-00

6-11 Years 12-19 Years

3 FoldIncrease

CDC/NCHS, NHES and NHANES

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Obesity-Associated Annual Hospital Costs (Aged 6 to 17 Years)

Wang, G, Dietz W, Economic burden of obesity in youths aged 6 to 17 years:1979-1999. Pediatrics, 109:5; May 2002.

35

127

0

20

40

60

80

100

120

140M

illi

on D

olla

rs

1979-81 1997-99

3 FoldIncrease

Pediatrics, 109:5; May 2002

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Weight Management-Be In Charge!sm

G reen Leve l: ------------------------> G enera l ch ild popu la tion (<85 th% )O range Leve l: -----------------------> C h ild a t risk o f ove rw e igh t (85 -94 th% ) +

based on spec ified risk fac to rsR ed Leve l: --------------------------> O verw e igh t (> 95 th% )N IL : --------------------------> N u trition In fo rm a tion L ineS truc tu red P rog ram s: -------------> W e igh t W atchers

Weight Management- Be In Charge!sm

Childhood Overw eight (C/O) Program Model

Risk Level:GREEN

(800) HealthEducation Line

Mem ber or P rovidercalls Health Net'sHealth Education

Line for Target Child

Interventions-Newsletter artic les

(-Hom e-based self-learning packet)-O ther health education m ateria ls

-N IL inbound calls-W eb-based

Risk Level:ORANGE

Risk Level:RED

InterventionsSam e as Green Level +

the fo llow ing:-N IL outbound calls

InterventionsSam e as Green + Orange Levels

+the fo llow ing:-S tructured program s (see flow

chart below)-M edical treatm ent as

needed

Age 10-20

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Weight Management-Be In Charge!sm

W eight W atchers (# of sites)

Los Angeles: 53San Diego: 22Sacram ento: 25Fresno/Tulare: 38San Bern/Riverside: 30

W eight W atchers(Mandatory parental

partic ipation--Child and Parent)

Ages 15-20Ages 10-14

W eight W atchers(Optional parental

partic ipation--Child alone -or-

Child and parent)

Ages 10-14Requires signed

Parental Consent and

Doctor's Note withgoal weight or

range every 6-9m onths

Ages 15-17Requires signed

Parental Consentand

Doctor's Note withgoal weight or

range every 6-9m onths

Ages 18-20No Parental

Consent or Doctor'sNote needed

Weight Management- Be In Charge!sm

Childhood Overw eight (C/O) Program Model

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Teen Body Image Pilot-Overview

“What’s Up With Body Image” magazine

1000 teen members ages 12-17 in LA10-item evaluation survey BRC with

$10 Tower Records incentive to first 20

52 evaluation survey respondents

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Teen Body Image Pilot-Evaluation Highlights

Profile: age 15, 5’3”, 128lbs, 75% female, 22.5 BMI 33%His/31%Af/19%As/17%Cau

62%green/15%orange/17%red/6%underwt

29% reported having tried ways to lose or gain wt.

Self-ranking of satisfaction with body image after reading the magazine significantly increased (paired-samples test).

Eating habits are decided by “what my parents serve me” (67%) and “if I feel hungry” (69%).

I get most of my health info from my doctor (56%).

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Teen Body Image Pilot-Evaluation Highlights (cont.)

Minority teens tended to be more overweight than Caucasian teens (23%-29% As/Af/Hisp in red vs. 0% Caucasian), while males tended to be more overweight than females (38% males in red vs. 19% females)

85% found info in magazine very or somewhat useful.

35% reported making changes to own body image in last six months, with change as exercise or healthier eating.

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Community Partnerships

FITWIC Task Force & Nutrition Subcommittee LA Region Project LEAN 5 -A- Day POWERPLAY Los Angeles Collaboration for Healthy Active

Children Sacramento childhood obesity Prevention Task

Force Coalition on Children and Weight-San Diego County Fresno/Madera Medical Society Alliance Health fairs and health education classes

(Headstart, other CBOs)