Obesity Initiatives Overview

The Integrated Healthcare Association has supported obesity prevention over the past several years through its Healthy Alternatives Vending Machine Program, Bariatric Surgery Study conducted by UCLA on behalf of IHA and the California HealthCare Foundation, and through exploration of metrics that may support obesity prevention within the California Pay for Performance (P4P) program.

Healthy Alternatives Vending Machine Program

IHA developed the Healthy Alternatives Vending Machine Program to combat obesity by urging employers to offer nutritious, low-fat and low-sugar alternatives in worksite vending machines. Healthy Alternatives creates workplace environments where making a healthy food choice is easy. IHA promoted the program via a statewide mailing to employers and materials posted on the IHA web site to facilitate employer policy implementation. In addition, with support from sanofi-aventis, an evaluation of the program was completed which identified important learnings from this initiative.

Since the Healthy Alternatives program was launched in 2005, at least 200,000 employees at 500 worksites in California, along with 6.5 million Kaiser Permanente members at Kaiser facilities across the state, now have access to healthier options in vending machines. IHA was recognized on the Governor's Honor Roll at his Summit on Health, Nutrition, and Obesity in September 2005.

Bariatric Surgery Outcomes Study

In April 2005, IHA worked with its bariatric advisory group to design a research study that would collect and publicly report surgical outcomes and examine the efficacy of bariatric surgery. This study was funded by the California HealthCare Foundation and conducted by the Center for Medical Technology Policy and the Center for Surgical Outcomes and Quality, University of California at Los Angeles (UCLA). For more information please refer to the Bariatric Surgery Outcomes Study Overview and Bariatric Surgery in California Report listed in the related resources section to the right.

California Pay for Performance - Obesity Prevention Metrics

A clinical measure of obesity was tested and adopted for P4P measurement year 2006 which used information collected in the Patient Assessment Survey (PAS) to calculate the percent of obese or overweight patients (based on self-reported BMI) who received counseling on nutrition and exercise.  However, before actual measurement and payment occurred, the measure was removed from the clinical measure set due to the lack of evidence supporting the efficacy of physician counseling to influence obesity.  Information on physician counseling on nutrition and exercise continues to be collected through PAS, and starting in Measurement Year 2008, was included as a payable patient experience measure.

There is still interest in finding an evidence-based clinical measure of obesity.   A multi-stakeholder P4P obesity work group was convened in 2007 and was informed by the work of National Committee for Quality Assurance (NCQA) expert Obesity Measurement Advisory Panels.  All of the potential NCQA measures require medical record review, and therefore are not feasible for P4P.   As adoption of electronic medical records and interoperable data exchange increase, it may become possible to calculate these measures electronically, at which time P4P could reconsider adoption.  

For more information on the Healthy Alternatives program or to request the Vending Machine Program communication materials, please contact Cindy Ernst at cernst@iha.org or 510-208-1743.