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Plans can use tech to meet new ACA counseling requirements


An expansion of the ACA requires health plans to cover a new preventive service: Regular nutritional counseling for millions of overweight Americans with other health risks.

Despite food tracking and diet books, walking programs and gym memberships, incentives and biometric screenings, adult obesity in the United States is still on the rise-especially among middle and lower income families.

LangheierIn fact, according to data gathered by the National Institutes of Health, obesity has more than doubled from the 1960s to the present. In an article published in the journal Lancet in November, 2011, experts predict that if current trends continue unchanged, by 2030 more than half of the U.S. adult population will be obese.

Unfortunately, we can expect skyrocketing obesity to be accompanied by an increase in diabetes and its related comorbidities. America’s weight gain can only lead to poorer health for the population and higher costs for the healthcare industry.

It comes as no surprise, therefore, that the federal government is taking steps to nip obesity in the bud. An expansion of the Affordable Care Act (ACA) in 2016 requires health plans to cover a new preventive service: Regular nutritional counseling for millions of overweight Americans with other health risks. Specifically, the ACA mandates that private health insurers provide no-cost coverage of nutrition counseling for specific populations by January 2016.

In other words, a large percentage of the U.S. population will need to see a dietitian, and self-insured employers will have to fund these visits.

New model required                                                                                  

The current model for nutrition services is to offer health plan members who are eligible for nutrition counseling a referral to a registered dietitian or otherwise qualified health professional. Every employee or member who qualifies is directed to a live provider, and every employee receives in-person treatment.

That kind of nutritional counseling isn’t cheap. An initial consultation with a registered dietitian costs about $100 to $200, and follow-up visits range from $50 to $150.

With the ACA expansion, this model may be unsustainable, as health plans and employers may be required to cover the cost of nutrition counseling for millions of individuals. And it remains to be seen whether that legally required investment will even help organizations lower chronic disease rates-along with overall healthcare costs-among their employees.

Next: Technology’s role



Technology's role

As a result, some health plans may want to consider a step-therapy strategy.

The first step would be to deploy a first-line therapy-digital nutrition counseling, for example-at a cost of less than $50 dollars per employee per year for unlimited visits. Designed to help employees get and stay healthy, digital nutrition solutions change the paradigm for nutrition services to provide more value for self-insured employers and better outcomes for patients.

Of course, automated, digital-only counseling doesn’t always work as a standalone for everyone in a population. The next step, therefore, would be digital group counseling led by a dietician to deliver additional support and motivation to group members.

If a group approach is daunting for some individuals, they can get one-on-one attention through telemedicine dietitian visits (which might cost about $50 per session instead of $75).

Such visits aren’t allowed in all states and may still not be personal enough for some. To address these situations, the final step would be in-person care with a dietician.

By creating a model for nutrition intervention that incorporates the four steps mentioned above (digital-only care, digital group care, telemedicine and in-person care) organizations can meet ACA regulations and empower their employees to achieve sustainable health outcomes-without breaking the bank.

Jason Langheier, MD, MPH, is CEO and founder of Zipongo, a San Francisco-based digital health company.

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