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The U.S. is experiencing a crisis in obesity. More than two-thirds of adults in the United States are overweight or obese according to the U.S. Department of Health and Human Services National Institutes of Health (NIH). Obesity contributes to, and worsens, fatty liver disease, diabetes, hypertension, high cholesterol, osteoarthritis and more. Excessive weight also increases the risk of early mortality. Bariatric surgery is a means to address this issue – but it is not a magic bullet, and it is not an easy path.

Elements of a Successful Bariatric Management Program

Bariatric Management Programs have proven to help minimize risk associated with the procedure and co-morbidities and to promote long-term success for health plan participants in their journey to attain and maintain an appropriate weight.

In order for Plans and Plan Sponsors to experience optimized near- and long-term benefits from bariatric surgery for weight loss, there is a need to provide comprehensive pre- and post-surgery support to those undergoing the procedure.

Behavior change to address obesity requires dedicated and coordinated efforts by a bariatric team to assist participants in setting new lifestyle habits, addressing critical medical, economic and behavioral issues and providing the tools essential to the success of individual participants. To accomplish this, the following objectives must be met by a Bariatric Management Program:

  • Utilize the bariatric surgery program to improve the financial and clinical outcomes in individuals with morbid obesity, or obesity with serious chronic health conditions.

  • Optimize weight loss, lifestyle changes, compliance with the provider’s treatment plan and compliance with new healthy habits that will enhance lifetime success for participants after bariatric surgery.

  • Implement a program that requires bariatric surgery candidates to become fully engaged in utilizing the multidisciplinary support and case management needed both pre- and post-surgery to ensure success. Support is recommended for at least six months pre-surgery and continuing for one year post-surgery.

For years, Advanced Plan for Health clients have utilized Poindexter’s advanced and predictive analytics as an integral part of their Bariatric Management Programs to analyze member needs (through the comprehensive longitudinal member view), progress and outcomes. They are also able to gauge individual and aggregate clinical and financial results over time.

Another critical piece to the puzzle of successful Bariatric Management Program are Nurse Case Managers who are able to optimize member preparation, care coordination, support and education both pre- and post-surgery. For our clients, these nurses’ actions are powered by Poindexter’s analytics insight.

Example of a Bariatric Management Program Construct

Clients utilize Poindexter, APH’s data analytics risk engine custom built for population health management, to assess their health costs and risks and to identify opportunities for individuals who would benefit from bariatric surgery. From there, their Bariatric Management Nurse Case Managers review the full health picture of each participant through analytics and map individualized goals that address medical and psychosocial needs to prepare for surgery and be successful in making health improvements both pre- and post-surgery.

Bariatric Nurse Case Managers must work effectively and collaboratively with other Bariatric Professionals including the surgeon, dietician, psychologist, primary care provider and the Health Plan to coordinate medically necessary healthcare and provide the essential support and education for success.

An Outline of a Bariatric Program Journey

An example best practice program journey is as follows:

  • A bariatric surgery program may offer a bariatric educational session to learn about the process.

  • If interested in moving forward, Plan members should explore whether this benefit is covered, learn about any conditions that must be met, and then meet with the bariatric surgeon to discuss whether the surgery could benefit them and determine their best course of action.

  • If accepted into the program, the participant will meet with the dietician to receive details on optimal health practices, habits needed for those undergoing bariatric surgery and nutritional suggestions, followed by multiple appointments with their primary care physician to set and monitor goals.

  • During this process, the participant will also have psychological consults, additional visits as needed with the dietician, and coordination of care with other providers in accord with their health and medical needs.

  • In many successful programs, in order for the Health Plan to pay for the surgery, participants are required to work with a Bariatric Nurse Case Manager after each physician visit. This happens at least monthly, and could occur more often when there are other serious medical or psychosocial conditions that need to be addressed during the pre- and post-surgery periods.

  • Their Bariatric Nurse Case Manager will perform a thorough assessment and work to address compliance with care gaps (preventive medical office visits, cervical cancer screening, mammograms, or colorectal cancer screening). They will also promote required primary care physician, nutrition, and psychological testing visits.

  • Their Case Manager will also focus on identifying lifestyle issues related to activity, mobility, nutrition, adequate rest and sleep, work, support systems and stress management, and then encouraging participants to take small steps in making essential changes needed to ensure long-term success.

  • Analytics (like Poindexter) should be used to track and monitor success in reaching and sustaining desired outcomes and to identify medical, behavioral and pharmacologic issues that need to be managed for each individual.

  • Motivational interviewing techniques, practical tips to reinforce the care plan, care coordination, encouragement and bolstering self-confidence are all part of the Case Management process, particularly where other complex medical or psychosocial issues are present.

  • Then there is the very important follow-up in the immediate post-operative period by the Nurse Case Manager and Team, as well as periodic quarterly contacts for one year to ensure success and early intervention for untoward issues, lack of progress and individualized support and care coordination.

Practical tips that the participant can use in everyday life are incorporated into case management encounters. During the span of pre- and post-surgery case management, the case manager provides an important point of accountability and support for the participant and works to help the participant set small, realistic goals that are cumulative over time. The goal is to have a healthier lifestyle in place for a lifetime, and for the participant to receive essential and timely help to overcome any obstacles faced.

Areas of Bariatric Program Results

Advanced Plan for Health clients have been tracking results of client Bariatric Management Programs over the course of several years. Our analytics are able to provide critical visibility into trending of health plan medical costs after surgery, as well as reduction in costs in subsequent years when compared to medical costs prior to surgery.

The pain and debility from hip, knee and ankle issues are a big motivator for bariatric surgery. An interesting finding in the data shows that once the weight is lost and the individual has stabilized, lower extremity joint surgery is prevalent in about the fourth year after bariatric surgery. That is because surgeons frequently refuse to operate when there is so much weight stress on joints, because of the increased opportunity for failure and complications. Once the weight is reduced and stabilized, joint surgeries are more successful.

To learn more about how Advanced Plan for Health clients utilize our Poindexter analytics and consultative and clinical services to support Bariatric Management as well as other high risk, high cost areas, please contact us today.


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