4.19.2023 Board Book

physical, for example). Non-traditional providers, such as health coaches and commu nity health workers, could also play a role in establishing effective and culturally com petent engagement with patients with obesity. This could be another opportunity for demonstration of alternative payment models for obesity treatment and care, particu larly payment models that support population health management. Obesity care payment policy should incorporate metrics and reimbursement for a systematic assessment and diagnosis of obesity and associated health risks, no matter how the process begins. While patients are weighed routinely during clinician encoun ters and Body Mass Index is calculated routinely, diagnosis of obesity is limited, particu larly as a primary diagnosis for follow-up treatment. xxii Formal diagnosis and documen tation of obesity for the purpose of follow-up treatment or weight management is very limited. A BMI calculation alone is not equivalent to an assessment of the health risks associated with a patient’s obesity, or a sufficient basis for a clinician to recommend appropriate follow-up that might not only center on weight loss and weight manage ment, but on treatment for associated risks such as type 2 diabetes and hypertension. (See discussion of the Edmonton Obesity Staging System, below.) Physician-patient engagement and formal diagnosis of the patient’s obesity and health risks can also play a key role in addressing obesity stigma, provided it is conducted sen sitively and appropriately. Reimbursement of routine assessment of obesity will send an important signal to both clinicians and patients that obesity will be regarded as a serious medical condition that merits medical attention and support. Key metrics of Stage I would include measures of diagnosis and documentation of obesity (for example, metrics of diagnoses completed and documented, as recently rec ommended by leaders of the American Medical Group Association Obesity Care Model Collaborative). xxiii Measures of patient engagement and patient activation might also be developed for potential inclusion for support under new obesity payment models. Suc cessful completion of diagnosis and its documentation are prerequisites to moving the patient to the next stage of the patient clinical journey, (Stage II, below). Recent analysis of clinicians’ use of diagnostic coding and documentation of obesity diagnosis suggests that documentation alone can catalyze follow-up action by clinicians, xxiv but that barri ers to documentation, billing and reimbursement of obesity diagnosis remain a signifi cant barrier to follow-up care. xxv

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Envisioning Value-based Provider Payment for Obesity Treatment and Support