A major barrier to states exploring the use of current Medicaid authority to fund upstream prevention of obesity is the lack of financial evidence to demonstrate the return on investment—specifically what cost savings are likely to accrue over a patient’s lifetime to health care providers and Medicaid when a state or Managed Care Organization (MCO) invests in upstream obesity prevention, and what are the associated changes in health outcomes.
Nemours developed a Prevention Business Case Simulation Tool to simulate the financial costs and benefits of investing in obesity prevention through Medicaid, building upon work in the Roadmap of Medicaid Prevention Pathways. This beta tool allows states to prospectively simulate the cost savings and returns to Medicaid generated by different types of obesity prevention interventions. This will help State Medicaid Directors and MCOs make the financial argument for investing in preventing childhood obesity. Children who are overweight or obese are more likely to be overweight or obese in adulthood. The tool can support efforts to explore reimbursement for upstream obesity prevention initiatives.The tool was built using evidence from the research literature and validated with Maryland Medicaid data. The tool enables state Medicaid agency and MCO staff to customize results by state data to take into account differences in child obesity rates and costs of Medicaid services.
The tool is one step in the process of sparking discussion on how to move beyond a traditional view of obesity prevention through a health care lens to bring more payors and stakeholders to the table to explore how to improve the health of children as they grow up and move into adulthood.
We hope to continue to refine and improve the tool based on the feedback of users. If you have suggestions for how we can improve the tool, please fill out this survey: https://www.surveymonkey.com/r/8MNJCCB.