Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Dr. Eric Berman, D.O., M.S., medical director, Horizon Blue Cross Blue Shield of New Jersey.

Question: What initiatives have been enacted by health plans to furnish reimbursement or financial incentives to providers for investing the extra time and resources needed to implement and coordinate effective health interventions in overweight children?

Response:(Dr. Eric Berman) That is an area where most health plans are woefully inadequate. Our health plans do not reimburse pediatricians for addressing obesity as a primary diagnosis, which is a big problem. One way to address this is to develop regional programs in weight management. Horizon has developed a Health and Wellness Education program for our HMO members that is a self-referred program for members aged 12 or older.

Members can call and have a frank discussion with a nurse who will either direct them to a registered dietician or exercise physiologist or hear out their concerns and develop a weight-loss program for them to start exercising and eating right.

In Atlantic County, New Jersey, we are developing an entire wellness program that includes children and adults. There are specialized classes for children on exercise and food selection.

We’re also looking into rewarding our members who are able to lose weight and keep the weight off. WellPoint and possibly Blue Shield of California have embarked on similar programs where they are starting to give people reductions in their premiums or cash bonuses. If they are able to lose 10 to 15 pounds, they receive a reduction of $200 to $500. If they keep the weight off for another six months, they get a second payment of equal amount. Many health plans are looking at this and over the course of the next few years, there will be more and more plans offering some kind of bonuses for people who are starting to adapt these more healthful behaviors.

For more details on weight management, please visit:
http://store.hin.com/product.asp?itemid=3023