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| Key processes | Findings |
|
| Claims processing | (i) Challenging to integrate BMI information with claims processing |
| (ii) Insurer-specific billing codes are challenging for providers who bill to multiple insurers |
|
| Benefit structure | (i) Most offered more generous coverage than required by the initiative |
| (ii) Most but not all allow direct billing by registered dietitians |
| (iii) Copayments varied and were often significant |
|
| Coordination with other wellness programs | Programs often not coordinated |
|
| Enrollment requirements | (i) Pre-certification and disease management enrollment requirements created barriers to utilization |
| (ii) Manual enrollment processes created barriers to provider participation |
|
| Marketing | (i) Insurers tend to focus outreach on providers |
| (ii) Employers tend to focus outreach on employees |
|
| Engaging providers | (i) Difficult to know if materials ever reach the provider |
| (ii) Direct interaction with providers is the most successful |
| (iii) Insufficient number of registered dietitians available in some networks |
| (iv) Providers have educational needs around motivational interviewing, billing codes, and effective care coordination between physician practices, dietitians, and health educators |
|
| Engaging families | (i) Most marketing efforts focused on open enrollment period |
| (ii) Need for coordination between employers and insurers to effectively identify and reach overweight children |
|
| Monitoring utilization of obesity-related health services | (i) Infrequent use of BMI-specific billing codes |
| (ii) Infrequent use of counseling-specific billing codes |
|
