Insurance Trend Articles
I pulled these from an Insurance Industry Magazine that I am privy
to. It gives you an idea of what the insurers are looking at, there
are two articles.
Good luck
Gary Viscio
www.obesitylawyers.com
Trimming The Costs Of Obesity
By Ronald S. Leopold
Benefits advisors should be offering employers ideas about ways to
fight employee obesity.
According to the National Institutes of Health, one-third of all
Americans are considered obese, with a body mass index over 30, and
two-thirds are considered overweight, with BMIs over 25.
The National Business Group on Health, Washington, estimates that
obesity costs U.S. employers $13 billion a year. Obesity has links
to everything from an increased risk of developing diabetes, heart
disease and kidney cancer to an increased risk of complications
during surgery.
The expansion of the American waistline is having an obvious effect
on the short-term disability and long-term disability claims that
MetLife receives. At MetLife, the proportion of STD and LTD claims
involving weight control surgery and other conditions and procedures
directly related to obesity doubled between 2001 and 2003.
Employers with high proportions of middle-aged female workers were
most affected by the increase in obesity-related claims. MetLife
data indicates that females accounted for 85% of STD obesity claims
processed over the past 3 years and that 48% of those claims were
from women between the ages of 35 and 54. Most of these claims were
connected with gastric stapling operations, gastric bypass
operations and related “bariatric surgical” procedures.
The average absence for a worker who filed a direct obesity-related
STD claim was 45 days.
When employers look at all employees and all insurance claims, they
will see that the 10% of employees who file STD claims during a
given year account for about 50% of the employers’ health care costs.
The current gender discrepancy in obesity-related STD claims may be
due partly to the fact that women tend to have BMIs, but it also may
be due to the fact that women are more likely to seek medical
attention and to seek bariatric surgical procedures. Young men who
aren’t filing bariatric surgery claims today might be filing
diabetes-related claims a few years from now.
Of course, employees have to take responsibility for their own
weight, but employers can help.
The first step is for employers to assess the impact of obesity on
their own employees. Obesity rates vary considerably with factors
such as geographic location, industry type and employee income
levels.
Employers also should benchmark their STD claims patterns against
industry averages to determine what types of disabilities are most
affecting their workers and what types of solutions can have the
greatest returns on investment.
Here are some specific options that brokers and agents might
consider sharing with clients:
–Ask the people who run company cafeterias and vending machine
operations to offer healthier foods.
–Host healthy eating programs, weight reduction programs and
wellness programs at work.
–Sponsor or subsidize employee health club memberships.
–Work with group health vendors to help obese employees.
–Offer financial incentives and other incentives for employees who
lose weight.
Ronald S. Leopold, M.D., M.B.A., M.P.H., is vice president and
national medical director for MetLife Disability, a unit of MetLife,
New York. He can be reached at rleopold@….
Bariatric Surgery: Separating Fat From Fiction
By Kathleen Thiesen
At a time when government figures show 27% of Americans are obese,
it’s no surprise that the public’s and the insurance industry’s
awareness of “bariatric surgery,” or gastric bypass surgery, has
grown.
The treatment is potentially effective, sometimes dangerous and
definitely expensive.
For brokers and agents helping companies find the right match of
health care against a picture of rising health care costs, here is a
quick primer on the insurance issues surrounding this treatment.
For the industry, the most urgent need is to look for cost-effective
answers with good outcomes, because obesity has far-reaching
implications.
Questions about the cost and popularity of bariatric surgery for
morbid obesity gained steam in mid-2004 following an announcement by
Medicare officials that the program will consider covering obesity
itself as a disease, rather than covering only so-called “co-
morbidities.” Major “co-morbidities” include hypertension, heart
disease, type-2 diabetes, sleep apnea, stroke and a range of cancers.
The bariatric surgery issue has many facets:
Results of clinical trials measuring the short-term and long-term
outcomes of bariatric surgeries vary depending on the type of
surgery completed, the experience of the surgeon and hospital or
other facility, how “sick” the candidates are before surgery, the
impact and compliance of post-surgical behaviors, and the general
risk of surgery for morbidly obese patients. Good results with one
study have not always carried over to the next.
Mortality rates for these procedures are between 1% to 3%.
According to a study published in the Journal of the American
College of Surgeons, the risk of death within 30 days after gastric
bypass surgery was nearly 5 times greater if the surgeon had
performed fewer than 20 procedures. In addition, about 20% of all
bariatric surgery patients require follow-up procedures to treat
complications. Despite the risks, experts support the results of
evidence-based studies, reaffirm the need for informed consent and
acknowledge that the risks for these individuals may be worth it in
the long run.
Even though Medicare decisions on coverage usually have helped
lead the industry toward universal reimbursement, many third-party
payers are hesitating due to the extreme costs associated with
complications for this high-risk population. Some 140,000 bariatric
procedures will be performed in 2004, according to an article that
appeared in the Journal of the American Medical Association.
Multiply that number by an average cost of $25,000 (with no
complications), and these 140,000 procedures will cost a jaw-
dropping $3.5 billion.
While self-insured employers may choose to cover the procedures,
fully insured employers cannot choose, thereby creating an adverse
selection by obese employees to secure reimbursement for the
surgery. While the treatment likely will decrease long-term direct
health care costs, the cost burden can be amortized over 3.5 years,
according to a recent study in the journal, Obesity Surgery.
Unfortunately, many employees change jobs before companies can
realize these health and financial gains.
All surgeries are not created equal. The Roux-en-Y gastric bypass,
which costs about $25,000, has come to be known as the “gold
standard” for its longevity with appropriate candidates. Because
cost is a factor, new procedures are entering the arena, including
laparoscopic methods that reduce hospital length of stay, physician
time and the recovery period. The “mini gastric bypass,” costing
just $17,000, produces results with major weight loss, and requires
less operating and recovery time. Unfortunately, there is not yet
enough evidence to ensure this procedure’s safety or to confirm
favorable outcomes.
So, what does the future hold? The American Society of Bariatric
Surgeons has begun a process for identifying and
credentialing “Centers of Excellence” for bariatric surgery. Its
goal is to establish guidelines for a procedure never before
regulated; investigate, evaluate and examine candidates for
certification to provide these services; participate in education
and research in the field; and provide data management for outcomes.
This effort offers a great deal of promise. Additionally, more
research is needed and will continue now that information about long-
term outcomes is more accessible.
In the interim, health insurers are looking at their options:
Eliminate coverage, increase out-of-pocket costs or offer selective
reimbursement only for procedures consistent with good outcomes.
It is clear that health care providers need to do the research and
develop comprehensive programs of care for obesity patients before
they are in the operating room. The successful programs are out
there, as are the experienced physicians. Rarely before has the
phrase “buyer beware” had as much financial impact as it does here.
Kathleen Thiesen, R.N., is market research analyst for the group
life, accident & health reinsurance operation at ING Re,
Minneapolis. She can be reached at 1. Kathleen.thiesen@….
Reproduced from National Underwriter Edition, January 6, 2005.
Copyright © 2005 by The National Underwriter Company in the serial
publication. All rights reserved.Copyright in this article as an
independent work may be held by the author.