State-created weight-loss program in review

State health insurance plans for teachers and state employees have spent more than $5.6 million on weight loss surgeries since 2011, but officials don’t know yet whether the Legislature-created program will save money by reducing obesity-related medical expenses, lawmakers learned Tuesday.





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The State and Public School Life and Health Insurance Program Legislative Task Force is examining the program as it develops recommendations to shore up the teachers’ insurance plans, which are expected to face a funding shortfall next year.

According to a report by the Arkansas Center for Health Improvement, 266 people covered by the plans for public school employees had bariatric surgery in 2012 and last year, at a cost of $2.6 million.

During the same period, 273 people covered by the state-employee plans had the procedure at a cost of $2.9 million. Complications occurred in about 19 percent of the surgeries across both groups, generating an additional $287,587 in medical costs, the report found.

People who had the procedure, and for whom adequate claims information was available, had average monthly medical expenses of about $400, compared with $480 before the surgery, according to the report.

However, Bob Alexander, director of the state Department of Finance and Administration’s Employee Benefits Division, said tests and other preparations for the surgery accounted for some of the expenses.

Studies of other programs haven’t found long-term savings, he added.

“The main problem is, these people don’t change their lifestyle,” Alexander said. “The ones that go to surgery are no longer diabetic, but within X number of months, they’re all diabetic again.”

Under Act 855 of 2011, sponsored by then-Sen. Jimmy Jeffress, D-Crossett, gastric bypass surgery, adjustable gastric band surgery and other bariatric surgeries are covered by the plans under a pilot program that will end on Dec. 31, 2017.

Participants in the program must meet criteria based on their height and weight, participate in a physician-supervised weight-loss program for six months before the surgery, and agree to complete a post-surgery treatment plan lasting at least a year.

The patients also must pay for some of the procedure’s cost. For instance, the silver plan for teachers and state employees required members to make a $300 co-payment and pay 20 percent of the facility and surgery fees, according to the report.

The average surgery-related expenses were $10,921 for patients covered by the state employees’ plan and $9,902 for those covered by the teachers’ plan.

Mark Meadors, a consultant to the Employee Benefits Division, told lawmakers he didn’t know of any private insurance plan that covers bariatric surgery. Medicare, the federal insurance program for the elderly and disabled, covers the procedure for patients who meet certain criteria.

Sen. Linda Chesterfield, D-Little Rock, said she wanted to know what effect the surgery had on patients’ health conditions such as diabetes and high blood pressure.

Rosemary Summers, a research assistant with the Center for Health Improvement, said she didn’t yet have that information.

“Some people tend to think this is just glamour surgery, when many times you have the morbidly obese who are just eating up a whole bunch of money” in healthcare costs,” Chesterfield said.

The task force is expected to issue recommendations for changes to the public school employees plan that would take effect next year. Rates for the plan for next year are expected to be set by July 1.

Arkansas, Pages 18 on 03/12/2014

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