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Key processes | Findings |
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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 |
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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 |
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Coordination with other wellness programs | Programs often not coordinated |
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Enrollment requirements | (i) Pre-certification and disease management enrollment requirements created barriers to utilization |
(ii) Manual enrollment processes created barriers to provider participation |
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Marketing | (i) Insurers tend to focus outreach on providers |
(ii) Employers tend to focus outreach on employees |
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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 |
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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 |
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Monitoring utilization of obesity-related health services | (i) Infrequent use of BMI-specific billing codes |
(ii) Infrequent use of counseling-specific billing codes |
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