The Affordable Care Act is coming soon and a tidal wave of 40 million new people will enter the healthcare system. Many of them will be overweight. This could represent a shot in the arm that the weight loss market needs. However, not all parts of a given program will be covered by insurance.
Obesity screening and counseling will be covered with no patient co-payments, under the preventive services benefit. Plans vary widely. Some insurers will offer telephone counseling, while others cover visits to a health coach, and some cover group sessions that provide lifestyle advice. Some even refer people to Weight Watchers, with insurers picking up the tab for memberships or offering discounts. The task force does not address what insurance companies should specifically offer.
Insurers usually follow the lead of the CMS (Centers for Medicare & Medicaid Services). That means that for weight loss counseling to be reimbursed, it has to be by a primary care MD, a nurse practitioner, or a physician's assistant. A "health coach" or "diet consultant" or MLM distributor will not qualify. One thing is sure -- diet company food and supplements are definitely NOT covered.
Lots of questions remain. For example, if a person pays for a subscription to WeightWatchers.com or other weight loss website, and obtains email support, will that qualify as counseling? Will insurers be flexible on the qualifications of coaches or counselors?
In any case, the advantage seems to be shifting to medical weight loss programs, since they are more likely to have an MD, nurse practitioner or physician's assistant on staff. For the commercial diet companies, a prudent strategy would be to start hiring some NPs and PAs for their centers, or setting up a call center staffed by them, so that part of the cost of their program can be paid by insurers, thus reducing the total cost to the customer.
Since the service part of a weight loss program will be covered but not food, commercial companies may now have to assign a separate cost to that counseling portion. This will be a challenge. How does Jenny Craig separate out the counseling part of the program from the cost of the food? Ditto for NutriSystem, which now provides the counseling free of charge. It will be much easier for Weight Watchers, since customers already pay a service fee for the monthly pass, or a subscription to their online plan.
Advantage Weight Watchers. It is a SERVICE company, not a FOOD company.
These strategies will be an important factor in a weight loss company's plans for 2014, with ramifications on logistics, billing, and marketing. Bottom line - be ready for Obamacare, and take advantage of it, by providing a variety of advice delivery options.