Insurelane Insurance Blog

The Public Employee Insurance Agency of West Virginia developed a program for 60,000 of the heaviest government workers and school teachers to help them lose weight.

Eligible public employees and teachers enroll in the program for one year. Some of the requirements include exercising at least twice a week, monitoring eating habits, and tracking weight. Participants will responsible for up to $258 in copayments.

One elementary school teacher who completed the program in October lost 124 pounds. She recalls considering surgery before she learned about the program.

“I had a lot of physical problems with my knees, feet, joints and lower back,” the teacher said. “I was getting very disabled carrying around all that weight.”

West Virginia Medicaid beneficiaries will also have access to weight-loss programs. Medicaid recipients will be able to participate in Weight Watchers free for up to 16 weeks. People will be able to enroll if they are over a certain body mass index and have a primary care physician’s referral.

Healthcare officials are happy with the money these programs will save on weight-related health conditions, but they are more focused on the benefits people will have losing weight and becoming healthier.

“It’s not about immediate cost containment,” said Medicaid spokesperson Shannon Riley. “This is about slowing the growth of lifestyle-induced diseases and disabilities.”

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The Mayo Clinic has developed a new healthcare reimbursement system. President and CEO Denis Cortese M.D. and Chief Administrative Officer Robert Smoldt of the Mayo Clinic designed the new system to continue the improvement of healthcare while keeping costs low.

The current system — used by insurers and Medicare — is called Pay for Performance. This system rewards doctors, hospitals, clinics, and other healthcare providers with higher reimbursements for higher quality healthcare.

Cortese and Smoldt’s model is called Pay for Value. Like Pay for Performance, this system rewards higher quality care. But under the Pay for Value model, care facilities must also provide cost-efficient healthcare to get the maximum reimbursements.

“Pay for Value looks at both sides of the equation, quality and cost, and defines quality in a way that is meaningful to patients,” Smoldt said. “To have a health system that delivers the best care to every patient over a lifetime, America needs a more comprehensive approach to the problem.”

The ideal healthcare facility under the Pay for Value system would provide the highest patient satisfaction with the least amount of spending. But care facilities with low patient satisfaction or high spending would not get full reimbursements. The model’s supporters hope that the lower reimbursements will serve as an incentive to improve their quality and reduce the costs of care.

“We need to align the incentives in the system to patients’ interests,” said Dr. Cortese. “They want good outcomes in a system that treats them respectfully, at a reasonable cost. They don’t want expensive, invasive tests and procedures that aren’t going to improve their lives.”

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