State plans' study finds higher cost for obesity

A graph showing the cost of obesity
A graph showing the cost of obesity

The health plans covering public school and state employees in 2015 spent an average of about 31 percent more on obese employees or their obese spouses than they did on others, a report found.

According to the report by the Arkansas Center for Health Improvement, the plans spent an average of $4,302 in 2015 on health expenses for employees and spouses whose reported height and weight indicated they were obese, compared with an average of $3,270 on slimmer employees and spouses.

The average health costs were even higher for employees and spouses who said they exercised fewer than 20 minutes per week -- $6,043, compared with about $3,445 for those who exercised more.

The study analyzed the results of a survey employees and spouses were required to fill out in 2015 to avoid having an extra $75 per month added to their premiums the next year.

The report was prepared for the State and Public School Life and Health Insurance Board, which governs the health plans.

Chris Howlett, director of the Department of Finance and Administration's Employee Benefits Division, said he expects the board to begin considering options soon for encouraging healthy behavior among employees.

For instance, he said, the plans could discount premiums for employees who maintain a healthy lifestyle or meet goals such as quitting smoking or losing weight.

"I know there's definitely an interest in individuals wanting to put, instead of cost increases across the board, cost increases to the population that becomes noncompliant" with health-related requirements, Howlett said.

The plans cover about 45,000 public school employees and about 26,000 state employees, in addition to retirees and the spouses and dependents of retirees and employees.

This year, the plans' premiums rose an average of just 2 percent for public school employees and 3 percent for state employees.

But the board's actuarial consultant has warned that larger increases will be needed in future years unless medical and drug costs rise more slowly or state and school district funding increases.

"I think we've about cut on the program everywhere else that we can cut on it," said Jeff Altemus, deputy superintendent of the Marion School District and chairman of the health plan board's benefits subcommittee.

"I think we're going to have to start looking at the health of the members in order to control costs."

Michael Motley, assistant policy director at the Center for Health Improvement, said 69,063 employees or their spouses completed the 2015 health-risk assessment survey, administered by CompPsych of Chicago.

The center linked data from the survey to the plans' claims information to examine the health plan expenses associated with each respondent. The data excluded information identifying individual employees and spouses.

The center found that 43 percent of the respondents reported a height and weight indicating they are obese.

By comparison, a survey administered by the Arkansas Department of Health in 2015, on behalf of the Centers for Disease Control and Prevention, indicated that 34.5 percent of all adults in Arkansas that year were obese, giving Arkansas the sixth-highest adult obesity rate out of the 50 states and the District of Columbia.

In both the Health Department and CompPsych surveys, a respondent's reported height and weight was used to calculate a "body mass index" that determines whether the person is considered obese.

For instance, a 5-foot-tall adult is considered obese if the person weighs 154 pounds or more. The cutoff for a 6-foot-tall adult is about 221 pounds.

Among public school and state employees and spouses who were obese, the Center for Health Improvement study found that medical and drug expenses increased along with the severity of obesity.

For example, employees and spouses whose obesity was classified at the lowest level of severity among three categories, the covered expenses averaged $4,031, compared with $4,261 for those in the second-highest level and $4,921 with the most severe obesity.

According to the National Institutes of Health's National Institute of Diabetes and Digestive and Kidney Diseases, obesity has been linked with a higher risk of diabetes, heart disease, stroke, arthritis and some cancers.

"Obesity is a really big deal" for public school and state employees, Arlo Kahn, senior policy adviser for the Center for Health Improvement, told the health plan board's quality of care subcommittee last week.

Similarly the study found that employees' health expenses tended to fall along with the frequency with which employees reported that they exercise.

For instance, the costs averaged $4,243 for the 13 percent of respondents who said they performed "moderate" exercise for at least 20 minutes once a week and $3,776 for the 19 percent of respondents who performed such exercise twice a week.

The health costs for the 22 percent of respondents who reported engaging in moderate exercise three times a week or "vigorous exercise" once a week averaged $3,345.

Reducing the cost for the higher-cost survey respondents to that level would have saved the plans more than $31 million, the report found.

Moderate exercise was defined as the equivalent of a brisk walk -- enough to break a light sweat. Vigorous exercise included running, or enough to break a heavy sweat.

The study also examined smoking rates, finding that less than 10 percent of the respondents reported being smokers. The true rate likely is higher, the researchers concluded, noting that the Health Department survey found almost 25 percent of Arkansas adults are smokers.

The health plans' expenses for respondents who reported being smokers averaged $3,703. Motley said the center hasn't yet calculated the average cost for nonsmokers.

He said the center will analyze how the survey responses and costs differ between state and school employees, who are covered by different plans and pay different rates.

Altemus said he also wants to see information collected during uniform wellness exams that the health plan board is considering requiring school and state employees to undergo.

Although employees must visit a doctor during the year to avoid the $75 penalty, the board has not yet set criteria for what the visit must entail or what information should be gathered from the visits.

"We've got to know what we're dealing with," Altemus said.

SundayMonday on 02/19/2017

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