Alexandra Maul, MPH and Stacey Chazin, MPH, CHESJune 23, 2015
Childhood obesity is a serious health concern leading to a greater likelihood of many chronic illnesses and an increased risk of adult obesity. While the issue has received increased focus at the national and local level in the last few years, there are few examples of collaboration between state Medicaid programs and public health agencies. This represents a significant missed opportunity, as children covered by Medicaid are nearly six times more likely to be treated for obesity than those who are privately insured.
Building Momentum for Addressing Childhood Obesity
Annual health care costs for childhood obesity and related conditions among Medicaid beneficiaries are about 80 percent greater than the costs for privately insured children. Children from racial and ethnic minority groups — more than half of all child Medicaid beneficiaries — are also at higher risk. Children who are obese are more likely to be obese as adults, leading to lifelong risks for heart disease, stroke, and several types of cancer.
Public health initiatives such as Healthy People 2020 and First Lady Michelle Obama’s Let’s Move campaign illustrate a growing national commitment to address the issue. State-level coalitions and non-profits such as Eat Smart Move More North Carolina and LiveWell Colorado are also focusing on childhood obesity. Medicaid agencies in Michigan, South Carolina, and elsewhere are targeting childhood obesity through the health care delivery system. Efforts include educating providers around billing and reimbursement for obesity-related services for children in Medicaid; requiring contracted managed care organizations (MCOs) to implement Performance Improvement Projects focused on childhood obesity; and reimbursing non-physicians (e.g., dietitians) for obesity-related services.
Supporting New Collaborative Approaches
Because state and local initiatives are usually spearheaded by either Medicaid agencies or public health organizations, collaborations between these two agencies offer new opportunities for reducing the epidemic. A few states — Arizona, New York, and Pennsylvania — are taking the lead, and early results of their collaborations show promise. For example, the Arizona Medicaid agency’s Chronic Care Model is engaging the public health sector to focus on modifiable factors that contribute to child and adolescent obesity. Pilot results suggest that a combination of physical health, physical activity, and nutrition counseling, as well as behavioral supports emphasizing “willingness to change,” can help stem childhood obesity and yield positive health changes for engaged parents.
By collaborating with the public health sector, Medicaid agencies leverage the strong health-promotion infrastructure, and can collaborate to design interventions that can best resonate with low-income populations. In turn, public health leaders receive insights into the needs of beneficiaries and can encourage alignment between Medicaid payment systems and their own objectives.
Looking Ahead: Innovations in Childhood Obesity
To further explore this untapped opportunity, CHCS is leading the Innovations in Childhood Obesity (ICO) initiative, with support from Kaiser Permanente Community Benefit. The ICO includes five Medicaid and state/county public health “pairs” working together to reduce obesity prevalence among low-income children. Participants and their likely focus areas include:
- Arizona – The Medicaid agency, contracted MCOs, county public health departments, and community health centers will expand on and test the efficacy of the state’s Childhood Obesity Chronic Care Model;
- Maryland – The Horizon Foundation, Medicaid-contracted MCOs, and the state, city, and local departments of health will partner to test a community health campaign that includes practice transformation and community environmental changes;
- Oklahoma – The Medicaid agency and department of public health will work to increase the use of nutritional counseling for children and youth and integrate childhood obesity prevention efforts into early childhood education settings;
- Oregon – The Medicaid agency and department of health will promote collaboration among county and tribal health departments, and Coordinated Care Organizations to implement community-wide policy, systems, and environmental change strategies; and
- Texas – The City of Laredo Health Department will partner with local primary care sites, schools, and Medicaid-contracted MCOs to develop new care models to reduce obesity among high-risk children.
Working together over 18 months, state Medicaid agency and public health organization pairs will design and pilot new strategies for curbing childhood obesity. As promising interventions are identified, CHCS will disseminate findings nationally to drive broader change. Because childhood obesity not only adversely affects individuals during childhood but is a strong indicator of future adult obesity and its related complications, addressing this epidemic is crucial to the future health and health care costs of the nation.