The federal government estimates that about 30 percent of its Medicare population is obese, and obesity contributes to chronic diseases like diabetes and heart disease that are widespread among the elderly -- driving up the government's healthcare bills. In an effort to get obesity under control, Medicare this week added obesity screening and up to a full year of weight-loss counseling to the list of preventive services it will cover in full, at no cost to members.
Obesity coverage is just the latest step in a movement by Medicare in the direction of preventive care, said Dennis J. McGowan, public awareness coordinator for the New Jersey Division of Aging and Community Services in the state Department of Health.
Starting in January, Medicare made a number of other preventive services available free to members, including an annual primary care wellness visit and an eight-session program to help members quit smoking. Medicare also reduced or eliminated the 20 percent member copay for a variety of medical screenings, like glaucoma and mammograms and for flu and pneumonia vaccines.
Dr. F. Dein Rice, attending physician, internal medicine, at Newark Beth Israel Medical Center, called the Medicare obesity benefit an "excellent" change from the agency's previous approach to managing chronic illness. He said dealing with obesity attacks the underlying cause of metabolic syndrome, which is marked by high blood pressure, diabetes, and high cholesterol. Rice said the majority of his patients are overweight or obese.
Rice stressed the significance of Medicare's decision to cover a year of weight loss counseling. "Losing weight and maintaining weight loss is a life decision. It is very difficult to achieve weight loss that does not include a change in lifestyle that has to be monitored and encouraged and nurtured. For Medicare to say that they will cover preventive treatment is really exciting. Now we can start to do some things without waiting for someone to come in sick." Instead of treating full-blown metabolic syndrome, "we can have patients come in and do what we can to avoid it. It changes the way we practice."
Brian McGuire, associate state director of AARP, said the group supports Medicare's emphasis on prevention. "Medicare to its credit has looked across the board at the services that people 65 and older need, and we find more and more people are, unfortunately, obese."
McGuire said "If we address obesity, the healthcare costs associated with diabetes and a whole slew of other ailments can also be addressed. The [obesity] benefit is appropriate and we think it aligns the needs of Medicare members with the services that are actually covered." He said private health insurers often follow Medicare and "we hope this is a preventive service that will be covered by private insurance."
Dr. Robert W. Brenner is chief medical officer of the Summit Medical Group, which he said will encourage elderly patients to take advantage of Medicare's obesity counseling and screening.
"Obesity continues to be a growing healthcare problem in the United States, even in the later years of life," Brenner said. "Weight gain can be more serious in the elderly as they are more likely to become disabled and to be admitted to a nursing home. Obesity is a major predictor for loss of independence and exacerbates age-related decline in physical functioning."
Medicare works with the state health department to promote public awareness of services available to the New Jersey's 1.3 million Medicare members. Since Oct. 1, 2010, the state has been doing Medicare outreach under a two-year, $719,190 grant from the U.S. Centers for Medicare and Medicaid Services and the U.S. Administration on Aging. Through competitive bidding, the state then awarded 10 grants to local partners that reach all 21 counties. These local partners include the Community Health Law Project in South Orange and the Salem County Office on Aging.
"We have been promoting [Medicare] services for close to a year now, and seniors seem very receptive when they hear about them," McGowan said. Nationally, 65.5 percent of Medicare members have taken advantage of one or more of the preventive services, but that figure is 69.9 percent for New Jersey "so we are above the national average," McGowan noted. The new obesity benefit will be another preventive service that his team will publicize statewide, he said.
Outreach to Medicare members, one on one, is also done by the state health department through its State Health Insurance Assistance Program, whose 400 volunteer counselors work with the elderly to help them navigate the paperwork of Medicare and private health insurance programs. Counseling is also provided by the staffs of county offices on aging.
Mary McGeary, acting supervisor of the program, said by making preventive services available for free, Medicare is "trying to not just treat diseases, but to address overall wellbeing and to promote healthy behavior."
Geraldine Mackenzie, the state health department's program manager for community resources, education, and wellness, oversees a program called "Take Control of Your Health," a national, six-week program that teaches individuals with chronic diseases to manage their own ailments.
This program is available statewide, and although it's open to all adults, the majority of participants are over 60, Mackenzie said. "The program is designed to help identify the ways that chronic conditions impact their lives and give them confidence and skills to make decisions about changes they want to make in their behavior." Participants can focus on a variety of health factors, "and many choose to focus on physical activity or dietary and nutrition goals that are related to obesity."
The new Medicare obesity benefit provides screening for obesity by a primary care physician, followed by one counseling session each week for a month, then one session every other week for another five months. If the Medicare member loses at least 6.6 pounds (3 kilograms) in the first six months, the member is eligible for another six months of once-a-month counseling.
Jane Maloney is director of senior services for Ocean County, which offers the "Take Control of Your Health" program. "In Ocean County, we have been heavily involved in chronic disease self-management," Maloney said. "People have to get off the subject of diet and get onto the subject of good nutrition. We need to change the focus from 'going on a diet' to making lifestyle changes." She said the more than 157,000 Ocean County resident over age 60 represent more than a quarter of the county's population.
Individuals who enroll in "Take Control of Your Health" attend six weeks of workshops, and they create a personal action plan: to eat fruit instead of cake for desert four nights a week, for example, or to walk four times a week. The program was developed at Stanford University and has had success in "helping individuals make some major lifestyle changes," she said.
Ocean County has offered the program for five years, and this year has offered the workshops more than 20 times. She said the program encourages good habits and the commitment to stick with those habits.