Generous support for this program provided by

1

MBGH Learning Network
The Benefits of Minimally Invasive Procedures
Best Practices in Obesity/Weight Management
and Bariatric Surgery

• Generous support for this program provided by

2
For Those Present

• Please silence your
• Pagers
• Cell phones
• Blackberries
• IPODS
• X-Boxes/ Game Boys
• Other noise making devices or colleagues

3
For Those On The Phone

• Be aware your telephone is an open microphone and
  we want to allow all to hear the program, not
  office music, so
• Please place your phone or speakerphone on MUTE,
  not HOLD, during the program
• Let us know if you cant hear the speakers
• Questions will be taken at end of the formal
  talks and we will ask you for any comments
• When asking a question, please identify yourself
• During the roundtable portion, please stay on the
  phone and participate

4
Program Objectives

• Learn how advances in laparoscopic surgery have
  reduced employer costs, decreased absenteeism,
  reduced hospital stays enabled quicker
  return-to-work for employees
• Learn why employers need to be concerned about
  obesity
• Learn how to mine your health data to identify
  opportunities for saving surgical dollars
• Learn how to drive employee accountability,
  senior management support and employee buy-in on
  weight management programs

5
Agenda

• Employer Practices in Managing Surgeries and
  Obesity - Larry Boress, President, MBGH
• Right Patient, Right Surgery, Right Time  Know
  the Options
• Pamela Martin, MD, Director of Medical
  Education, Ethicon Endo-Surgery
•  Finding Potential Cost Savings in Your
  Population
• Gaye Fortner, RN, Vice President, HealthCare 21
  Business Coalition
• Break
• Obesity Management Continuum of Care Wellness
  to Bariatric Surgery
• Christopher Still, DO, Director, Geisinger
  Health System Center for Nutrition Weight
  Management
• Contracting with Centers of Excellence
• Kevin McCabe, MD, Medical Director, SC Johnson
• Roundtable
• Adjournment

5
6
Results of MBGH Benchmarking Survey on Management
of Surgery Obesity

• Employer familiarity with laparoscopic surgical
  procedures
• 10 very familiar
• 67 somewhat familiar
• 24 no familiar
• Where employees obtain information for surgical
  decisions
• Health plan
• Physician
• Internet
• DM/employer
• Reasons employers cover minimally invasive
  procedures
• Shorter recovery and quicker return to work
• Fewer complications
• Less pain/lower costs

7

Wellness and Weight Programs Offered by Employers

• Wellness programs offered to workers
• 95 offer educational programs
• 76 offer disease management/health coaching
• 66 offer health fairs
• 61 offer Weight Watchers
• 52 offer onsite fitness facility
• 47 offer bariatric surgery
• 28 offer weight loss medications
• 23 offer health club membership/medical weight
  management

8
How Employers Are Managing Obesity

• Tracking BMI
• 71 No
• 19 Yes
• If tracked, what of workers are clinically
  obese?
• 6-28
• Main entities that drive education/compliance
  with weight management programs
• Employee self motivation
• Physician direction
• Peers
• Incentives
• Spouse

9
Bariatric Surgery Coverage

• How does your health plan address bariatric
  surgery?
• 71 covered under plan
• 23 not covered
• 9 covered, if employee uses bariatric center of
  excellence
• Why bariatric surgery is not covered
• Little demand
• Cost of potential complications
• Perceived safety of procedures
• Barriers to use of coverage
• None
• Employees condition doesnt meet plan criteria
• Approval process is challenging even for those
  who meet criteria
• Have you re-assessed coverage in past 1-2 years?
• 57 No
• 43 Yes

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Why Employers Should be Concerned About Obesity
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Why Employers Should be Concerned About Obesity

• In the workplace, obesity can
• Increase a persons medical costs by 36 and
  increase drug costs by 77
• Cause longer hospitals stays and more frequent
  doctor visits
• Result in billions of dollars in low
  productivity, lost work days, sick pay, medical
  costs and higher insurance premiums
• Cause workers to be absent 14 or more times a
  year, and tend to under-perform

12
Employer Actions

• Almost half of large employers provide some form
  of obesity management programs or services
• Weight Watchers
• Screenings
• Website support
• Nutritional counseling
• Drug benefits
• Surgical options
• Some employers are building incentives for weight
  loss and participation in obesity DM programs
• Many are focusing on fitness to try help people
  from gaining more weight, rather than losing
  weight

13
Bariatric Surgery

• Gastric bypass is covered more often than
  stapling
• At 25-40,000 per procedure, an employer needs a
  structured approach to avoid having to pay for
  inappropriate procedures
• Cingular Wireless stopped its program after 400
  people received the surgery in the first six
  months
• Medicare pays for the surgery for obese patients
  who are suffering from other health problems
  related to their weight
• The procedure is covered only at centers that
  have been certified as qualified by the American
  College of Surgeons or the American Society of
  Bariatric Surgery
• The coverage is limited to three of the most
  commonly performed procedures Roux-en-Y gastric
  bypass, gastric banding and biliopancreatic
  diversion with a duodenal switch
• Although some insurers do not cover it, the
  number of people undergoing the surgical
  procedures for obesity jumped from about 16,000
  operations in 1992 to an estimated 170,000 in 2005

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Low Cost Ways to Address Obesity

• Require or incentivize employees to complete
  health risk appraisals to obtain baseline data
• Require vendors to include healthy food choices
  in cafeterias and vending machines
• Charge LESS for fruits, vegetables, salads and
  fish than sandwiches and other fast food meals
• Offer nutritional counseling for cafeteria
  selections
• Create competitions among departments, locations,
  sales teams for TOTAL weight loss using peer
  pressure as primary tool

15
Low Cost Weight Management Approaches

• Offer onsite Weight-Watchers or other education
  programs related to nutrition and exercise
• Create safe walking paths, encourage the use of
  stairs
• Slow down elevators
• Distribute health education materials
• Offer free nutritional lunch for attending lunch
  learn programs
• Offer discounts or incentives for joining fitness
  centers
• Support and disseminate information on community
  programs that focus on nutrition and fitness

16

MBGH Learning Network
The Benefits of Minimally Invasive Procedures
Best Practices in Obesity Management and
Bariatric Surgery

• Generous support for this program provided by