Q&A with Marilyn Elam, 

communications manager for the state's bureau of TennCare

TennCare's trying something new -- nipping health problems in the bud (or in this case, maybe, the butt). Last week, the state's health-insurance program for low-income residents announced a partnership with Weight Watchers.

TennCare will cover the cost of weekly meetings for its obese enrollees, a step that could save TennCare money in the long run. Obesity contributes to a number of chronic health problems, such as diabetes and cardiovascular disease.

According to Marilyn Elam, communications manager for the TennCare bureau, sustained, moderate weight loss can reduce the cost of a person's lifetime medical care by over $5,000. Beginning January 1st, enrollees with a body mass index (BMI) of over 30 can begin attending Weight Watchers' weekly meetings.

-- by Bianca Phillips

Flyer: Why Weight Watchers?

Elam: Because Weight Watchers is the only commercial weight-loss program that has a proven track record of results. By results, I mean sustained moderate weight loss that can actually reduce the risk of further medical expenses. We've seen it documented in two medical journals, the Journal of the American Medical Association and Annals of Internal Medicine.

How much does it cost TennCare?

Weight Watchers is giving TennCare a discounted rate. The program will cost the state $120 per enrollee. It's a per-meeting charge. Normally, it's about $15 per visit and it's a 12-week program. They have discounted the rate for TennCare to $10 per visit. Enrollees will have to pay $1 a week as a co-payment. They have to meet their minimum weight-loss targets, and they have to go to at least 10 of those 12 meetings. If they don't, they will not qualify for another 12 weeks.

How large is the obesity problem in the state?

We've seen the rate of obesity double in the last 10 years. Tennessee ranks fifth in the nation for the rate of adult obesity.

Does TennCare have other preventative programs like this?

This is a pretty innovative program. We've not done anything like this before on TennCare.

How do you justify paying for Weight Watchers after having dropped more than 190,000 enrollees, some on life-saving medications, from TennCare?

It's been a tough year for the program, especially for our enrollees. We were faced with the unprecedented budget challenge of needing $650 million just to sustain the program as it was. Reform balanced our budget.

The idea that you should not improve the quality of care for [current] enrollees because you were facing a fiscal crisis that required a change in eligibility isn't taking into account the fact that we're serving 1.2 million people today. Now that we have turned that fiscal crisis, we're in a much better position to actually have a stronger program in terms of quality of care for our enrollees. It's one of the things that TennCare has not done well. You have not seen a decrease in medical expenses for our enrollees. The health of TennCare enrollees has not improved in the 10 years we've had TennCare. It's certainly something we need to be doing a better job of -- with or without the changes in reform.

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